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High liver enzymes after transplant
I had a liver transplant last April due to Hepatitis C, and the doctors said I don't need to start treating the virus yet, but lately my liver enzymes are getting high, what could be going wrong? Is my body rejecting it?
MEDICAL PROFESSIONAL
if you have not had a recent liver biopsy it might need to be performed. Most likely it is HCV but one can never be totally sure.
Once again I apologize for posting here. I thought I was on the liver disorders page. I would never knowingly post on an expert forum because I am not an expert or even in the medical field. I will definitely be more careful in the future.
I'm an idiot sometimes.
Mike
I'm an idiot sometimes.
Mike
I would guess that you are experiencing recurrence of hepatitis c.
Many, if not most, transplant centers are reluctant to treat HCV post transplant until there is evidence of histological change - early fibrosis.
Have you checked your temperature? A fever often accompanies organ rejection so, if you have a fever, I would get to your center and get seen. I believe that with organ rejection you wouldn't see a gradual increase in your enzymes - it would be rapid and significant elevation. I could be wrong about this but that was my experience.
Distinguishing HCV recurrence on biopsy is difficult and the rule of thumb used to be - if the histological change is within 6 months of transplant then suspect acute organ rejection and if it is outside of 6 months suspect then suspect HCV recurrence. This is not a hard and fast rule but it was somewhat of a guideline at my center.
I have no idea of your overall situation but, if you have no damage or minimal damage there is hope that 2 Protease Inhibitors (Telaprevir and Boceprevir) will be available by next year - at least Telaprevir should be. These drugs significantly increase the efficacy of treatment in Genotype 1 patients - the hardest genotype to eradicate. I have not seen any trials of either of these drugs where liver transplant recipients were treated so perhaps the general population might get access to these drugs before they are used in transplant recipients. That seems wrong to me but perhaps there are circumstances and risks that I am not aware of.
I assume that your transplant center is aware of your enzyme elevation and has an opinion as to the cause. You might call and speak with your coordinator and possibly get some peace of mind. I always push for answers and usually get them.
Good luck,
Mike
Many, if not most, transplant centers are reluctant to treat HCV post transplant until there is evidence of histological change - early fibrosis.
Have you checked your temperature? A fever often accompanies organ rejection so, if you have a fever, I would get to your center and get seen. I believe that with organ rejection you wouldn't see a gradual increase in your enzymes - it would be rapid and significant elevation. I could be wrong about this but that was my experience.
Distinguishing HCV recurrence on biopsy is difficult and the rule of thumb used to be - if the histological change is within 6 months of transplant then suspect acute organ rejection and if it is outside of 6 months suspect then suspect HCV recurrence. This is not a hard and fast rule but it was somewhat of a guideline at my center.
I have no idea of your overall situation but, if you have no damage or minimal damage there is hope that 2 Protease Inhibitors (Telaprevir and Boceprevir) will be available by next year - at least Telaprevir should be. These drugs significantly increase the efficacy of treatment in Genotype 1 patients - the hardest genotype to eradicate. I have not seen any trials of either of these drugs where liver transplant recipients were treated so perhaps the general population might get access to these drugs before they are used in transplant recipients. That seems wrong to me but perhaps there are circumstances and risks that I am not aware of.
I assume that your transplant center is aware of your enzyme elevation and has an opinion as to the cause. You might call and speak with your coordinator and possibly get some peace of mind. I always push for answers and usually get them.
Good luck,
Mike
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