End-Stage Cirrhosis

[zoolal]

Dear Dr. Schiano,

If you can recall, my mother had an acute liver failure 3 months ago induced by Lipitor.  Her liver enzymes went up to 4000 at one point but were down in 240 levels with Prednisone until 3 weeks ago.  Since then, her numbers keep going up again.  Her first biopsy 3 months ago showed no scarring.  We got the results from her biopsy done last week.  She has end-stage cirrhosis.  Her doctors are shocked at how fast the scarring advanced.  She is stable and her MELD is 11.  I guess her only option at this point is living donation.

We are at complete shock with the news!

Is end-stage cirrhosis ever reversible? Have you seen a case where end-stage is reached so quickly?

Thanks for all your help in this forum and with my questions.
Zola

[Thomas D Schiano, MD]

i do not think any additional testing is necessary.  Using steroids for a short time should definitely be considered

[zoolal]

Dr. Schiano,

Today, mom's doctor confirmed that she has AIH most likely induced by Lipitor.  Her ANA tests keep coming back negative but the biopsy confirmed it.  They are waiting for her total bilirubin to go down below 3 (hers is 3 now) to put her on Imuran.  

Shouldn't Prednisone lower her AST/ALT drastically if she had AIH?  Her enzyme levels are very slowly dropping.  It's been 3 months.  Are there other tests other than ANA and biopsy to confirm AIH and if in case she does not have AIH, will Imuran hurt her?

Thanks,
Zola

[zoolal]

This is great.  I will ask USC to forward her records to you soon. Please email me information about payment, etc... (***@****).

We have been seeing a hepatologist here, but we are switching to Dr. Donovan.  Any additional recommendation from you will be much appreciated.

zillion thanks,
Zola

[Thomas D Schiano, MD]

you can definitely forward rrecords which i could review.  i can also recommend some docs in LA if you want.

[zoolal]

We live in Los Angeles.  Mom is being seen at USC.

[Thomas D Schiano, MD]

where do you live?

[zoolal]

Dr. Schiano,

Thank you so much again for your response.  Is there a way we could have a consultation with you remotely after we send you mom's records?

Thanks,
Zola

[Thomas D Schiano, MD]

cirrhosis can be reversible if the inciting agent is removed.  it will take time for reghression to occur but i have seen many times.  Things sometimes can progress in the opposite direction quite quickly. This could've been an autoimmune hpeatitis triggered by the medication and as such could be reversible.