Timing of Transplants

Posted by Debbie on June 14, 1999 at 03:41:23
My husband was diagnosed with HepC in late 1998.  In January of 1999 he was seen by a well-known medical center where he received extensive testing and diagnosed at that time with advanced liver disease.  Tests determined to be abnormal were:
Hypersplenism ( 18 centimeters in thickness and length)
Prothrombin time of 11.9, platelet count 41,000, INR 1.19
Albumin 3.5, bilirubin 1.5, AST 101, ALT 102, Alk Phos. 271
IgA(S) 758, Anti-Smooth Muscl AB  positive, Alpha-Feto 8.5
Portal Hypertension, minimal irregularity of left hepatic lobe, two grade one esophageal varices and one grade 2 varix.  
His hepatologist told him that he should receive blood tests every three months and ultrasound and discussed the need for transplant sometime in the future depending on the rate of progression. This medical center is a long distance from our home and with our internist's help a referral was made to a medical center closer to home for a transplant evaluation 3 months ago.  This week we were contacted by an R.N. who schedules the evals and he told my husband that his numbers don't look that bad and perhaps he should wait on the evaluation.  I asked if bloodtests could be taken before we made that decision.  His tests this week were as follows:
Glucose 110 ?, Bilirubin 2.0, AST 90, ALT 87, GGT normal, AlkPhos.normal, WBC 2.9, Platelets 33, INR 1.3, Protime 14.0, Albumin 3.6 Bilirubin direct .68 and AFP 6.4  .
My question is this.  Based on your experience with transplant recipients and the waiting period involved, can you determine if he is a candidate at this time?  He works and plays as usual.  He has not consumed alcohol for six months which would account for some of his better results but other tests are worse. He doesn't want to wait too long, yet he doesn't want to have the transplant sooner than needed. Also, would he be a candidate for living donor transplantation I've read about?  
Thanks for all your helpful info on this site.  It has been more useful than all the other websites put together.

Posted by Debbie on June 14, 1999 at 04:05:44
As a follow-up to my original question, should ammonia level be tested?  I know encephalopathy is criteria for transplants and he has never had this test. However, his mental function seems normal. He also has never received any treatment for the varices, which have not bled to my knowledge.I had read that there is preventive treatment.  He is taking Celebrex for arthritis as needed for the past couple of months, prescribed by his internist. Is this safe and can it affect his blood tests?
Thanks Again

Posted by HFHSM.D.-D.M. on June 27, 1999 at 16:33:55

Dear Debbie:
I appreciate your questions and I appreciate the opportunity to talk about the timing of liver transplants.  At Henry Ford, we have an active liver transplant program and I spend much of my time focusing on issues of transplant waiting lists.  
First and foremost, transplant waiting lists vary from one part of the country to another.  Some parts of the country can have lists as short as six months (or less) whereas other parts of the country can have lists as long as two years.  Therefore, transplant physicians base much of their decisions on when to place patients on the transplant list on the waiting periods of their respective regions. If you feel someone will need a transplant in about two years and your waiting list is six months, you probably can wait awhile.  The second thing we focus on is the individual patient, how ill she/he looks and the rate at which they appear to be deteriorating.  This really takes a hands on exposure to a patient.
Once we have all this information, we sit down with the patient and the family and explain how we feel a patient is doing, how long we expect them to remain stable and when we feel might be an appropriate time to put some one on the list provided they are an appropriate candidate.  These can be very complex decisions and we share the same concerns as you.  We certainly don