Acities and Edema

Good morning Dr.
I go to see my Gastro doctor ever three months. 523 days ago I was diagnosed with end stage alcoholic cirrhosis. Here are a list of my symptoms:

End stage cirrhosis
Gall stones
Splenomegaly
Portal hypertension
Varices grade 3
Spider nevi
Hepatic encephalopathy
Hiatal hernia
Umbilical hernia
During my last visit to the doctor he told me that “he guarantees that in about 5 years I will be needing a liver transplant, 10 years on the outside.” I imagine he is basing this on the severity of my portal hypertension. My platelet 67, ammonia 61, bilirubin 2.4, GGT 127. 6 months ago meld score 8. At the time of diagnosis 17. So I feel recovery has been going amazingly well for me. The rest of my numbers are all within normal ranges. l limits and I drink probably 10-12 16oz bottles of water a day.
Medications: I take vitamin C, B-complex, milk thistle. Other daily meds include xifaxan, lactalose, lexapro and metoprolol. Blood pressure diuretic Lisinopril,Hydrochlorthiazide 20mg/12.5mg. BP is 100/58. Diagnosed at age 38 currently 39 male.

1) Finally on to my question, is it really strange that I don’t have or never have had Ascites or Edema? Is this a problem you see in my future?
2) I’ve tried to provide as much information as possible so I could ask you if you agree with my doctors assessment of transplantation.
3) I currently have great medical insurance through my wife’s work. If we relocate and she loses the insurance I would be eligible for Medicare. Would having different insurance effect the procedure or my ability to have the procedure in any way? Should I consider not relocating?
4) Is there a large risk of a liver not being available at the time of my needing one?
5)             Do you have any suggestions for me? I would really apreciate the advice.

[Thomas D Schiano, MD]

first off, congratulations on your long-standing sobriety.  alcoholic liver damage can sometimes be totally reversible with abstinence and many people have avoided transplantation all together.  if the patient has cirrhosis then the risk for tthe development of HCC persists so appropriate screening is necessary.  keep doing what you're doing--abstinence is the key for you for a healthy liver.

[rpooo]

Thank you very much Dr. Schiano. Maintaining my sobriety has been the easy part of all of this. I was very surprised and relieved to read your reply. I have often wonder about my diagnosis since I was never biopsied. I have had a Ct Scan and ultra sounds used as a diagnosis tool. I have always been very determined to make a good recovery with diet, exercise and abstinence. It would seem that its the portal hypertension getting the best of me now and I don't believe the TIPS or shunting would be practical with the HE problems I already have.

1)Do you know of any other methods to reduce the portal hypertension?
2)A year and a half has gone by since diagnosis, is it still possible for my liver to regenerate to relieve the hypertension?

[Thomas D Schiano, MD]

TIPS is the only way to mdecrease portal hypertension appreciably.  There is still some hope that there can be some interval improvment but more likely not.  keep doing what you're doing