Interferon Treatment

[antonfahmy]

My father is a liver transplant waiting patient with a MELD score of 17 at NYP in NY, just wanted to know his chances to get interferon treatment (since he had never had the treatment before)while waiting for a new liver to stop the virus form recurring after the transplant surgery.
His last Platelet count was 27000, and weights 120 lb.

[Thomas D Schiano, MD]

basically one's overall condition.

[antonfahmy]

Thanks Doc,
What else beside Platelet Count do you look for before treatment?
My dad is currently on:
Xifaxmin 200mg        (1200mg per day)
Midodrine 12.5mg     (37.5mg per day)
Lactulose 10g/15ml   (twice a day)
Cipro 500mg              (once a day)
Lantus                      (18 units a day)
Nexium 40mg            (once a day)

[Thomas D Schiano, MD]

we are OK with starting interferon if the platelet count is 50 thousand.  the additional issue is that infection and liver decompensation can be precipitated by the treatment.  people with MELD scores of above 15 should be treated very cautiously if at all.  I think its always better to try and treat prior to transplantation----if it is safe.  the treatment is somewhat difficult to tolerate after the transplant.

[antonfahmy]

What’s the threshold for the Platelet count? If his meld score was to down to 15 can you infuse him with platelet like we do every time for paracentises to make up the difference? After all, I understand that the treatment is supposed to last for 12 weeks only.

Also, what are the chances of achieving SVR taking treatment before versus after transplant? Isn’t easier to treat before transplant because you don’t have to worry about Immuno-suppression issues in your way?

Doc, please look at this link: http://www.wjgnet.com/1007-9327/14/6467.pdf
What’s the sickliest patient you’ve ever treated with Peg-interferon and didn’t regret ?

Thank you very much for your fast response

[Thomas D Schiano, MD]

if the platelets are 27,000 they are a bit too low to safely consider treatment.  When MELD scores are above 15, patients are typically a bit too sick for interferon therapy, which can lead to a lot of complications in the settting.