HCV Post-Transplant

Dr, Schiano,

My husband had a liver transplant on August 5, 2008.  Reason for transplant was suspicious lesion on his liver as a result of 30+ years of chronic HCV.  Other than a bout of rejection in late Jan. 2009 brought on, the hepatologist thinks, by the Pegasys treatment that he began and had to discontinue, he has done exceedingly well in terms of resuming a normal life.  His AST and ALT are now starting to edge upward.  Yesterday's labs showed that his ALT had increased from 246 to 379, a large increase.  His Total Bilirubin was .7 and Indirect Bilirubin was .1.  Creatinine was 1.0.  So all of those tests look good.  He has to do labs in another week and maybe another biopsy--he's already had 5 or 6. Since the diabetes caused by the meds is improving, he recently switched from injectable insulin (lantus and novolog) to Glimiperide (1/2 mg daily).  Could this be causing the elevation in LFTs or do you think it's definitely the HCV?
Thank you for your advice.

[Thomas D Schiano, MD]

i think its probably the HCV but if the liver tests increased like this, a biopsy is warranted to exclude the possibility of rejection.

[Sky_King]

In my previous post I said Indirect Bilirubin when I should have said Direct Bilirubin.