Liver Transplant

Indira Tekwani
F/55
• HISTORY
• HCV / Cirrhotic Liver Disease   - 2 ½ years        9-10
• Hepatic Encephalopathy  ,Ascites +
• HRS+
• ? Diabetic Nephropathy one year
• Obesity
• Recurrent Hospitalisations
• Hypertension ,Diabetes  - 8 yrs
• Hypothyroid - 22 years
• H/O off & on malena required blood transfusion last Jan 2009
• Did not tolerate antiviral in past [2006-07]
• Bl Group O+ve
• Operated for Umbilical hernia and hysterectomy 20 yrs back
• Obese / Grade I encephalopathy, mild pallor , mild pedal oedema

• INVESTIGATIONS
• HCV +ve [Genotype 3a] HCV RNA 1,14,350 viral  copies/ml [08-09-2007] / was 19,37,000 0n [08-02-2007
• Hb 9.4
• TC 7100
• PC 118000
• S.Bilirubin : 0.59
• S Alk POase 186
• SGPT 14.38
• Albumin 2.7
• PT 1.19
• Na 134
• K 4.2
• Urea 40.02
• Creatinie 1.25

• USG Abdomen : Chronic Liver Parenchymal Disease
• Gall Bladder Calculi -  Chronic Renal ParenchymalDisease
• ? Right colon colitis
• Mild ascites
• Left pleural effusion
• HBsAg : Negative
• Liver Biopsy : Chronic hepatitis [grade II] with moderate fatty change and cirrhosis [stage IV] 08/02/2007

16/06/2009
• Ammonia 20.0
• S Potassium 5.4
• S Sodium 139.0
• R Blood Sugar 122
• Alpha Fetoprotien 4.90
• S Creatinine 1.9 [11/06/2009]
• PT 15.2 – Control 11.5 INR 1.32 [11/06/2009]    

• QUERY
• She had side effects with interferon and was withdrawn afte 9 doses in 2007?
• Ammonia increase 2-3 times in a month and is hospitalized with hepatic encephalopathy repeatedly ?
• Is there any  medical treatment ?
• Should She Go For Liver Transplant ?
• Her daughter aged 35 years with two children and hemodynamically stable is the donor ?
• When should she go for the transplant ?
• What is the long term prognosis as she is HCV positive ? After Tranplant
• Would risk factors like Obesity ,Hypertension ,Hypothyroid ,Diabetes Mellitus and Impaired renal function affect the prognosis ?
• What will be the course of disease if no transplant is done ?      
Thanks
Dr Kukreja

[Thomas D Schiano, MD]

unequivocally she should be considered for liver transplantation ASAP.  she is too ill to receive interferon treatment.  HCV can recur severely in 20-30% of cases but most people do OK post-transplantation.  she has several medical co-morbidities that could complicate matters but things will only get worse the longer she waits.  i think she may develop a fatal complication soon without transplantation.

[Laurie75]

I have similiar situation and need to know if I can tolerate transplantation being 5'10" and 380 pounds.  The liver dr in OKC, OK said I need to loose 100 plus before I can put on transplant list.  However, my dau and son have same blood type as me and a second dau and heard they do live liver transplants in Dallas, and I live same distance to Dallas as OKC  I have tried for this past 5 yrs to get the wt off and have 40 ponds lost was 420.  I am in stage IV., caused by Hep C from blood trans in 1988, had interferon bad side effects in 2003 to 2004, for six mos, and the drs said I may have 2 yrs in 2003 without a transplant but doing ok have had low white blood cell and pneumonia problems, some diabetes but controlled.

[Thomas D Schiano, MD]

i agree that you should try and lose weight, even though i know its easier said than done.  the weight may ultimately lead to progression in your liver disease as well as increase the risk for HCC.  in your case i would try and hold off on transplantation as long as possible,.