Liver Transplant Expert Forum
PULM HYPERTENSION/LIVER/KIDNEY TRANSPLANT
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PULM HYPERTENSION/LIVER/KIDNEY TRANSPLANT

My husband is 60 years old, 7 years post liver transplant for hep C.  Hep C recurred, and the new liver suffered damage--stage 3 or 4. He went through a couple of years of hep c treatment, and has been virus undetectable for 2 years.  When his liver failed 7 years ago, his kidneys failed, and never came back. He has been on dialysis since then.  He has been in "inactive" status on the kidney list since 2007, and has been undergoing testing to clear him for kidney transplant. He thought he was doing well.  Now, our world has been rocked.  As a result of a cardiac cath, he has been dx with pulmonary hypertension, "moderate to severe."  His portal pressures are mildly elevated. His albumin has dropped somewhat (from 3 something to 2 something) in the last several months, and his bilirubin is up to 23.  Kidney transplant says they won't do a kidney transplant without a liver transplant. (His liver is failing???!!)   Liver won't do a transplant with the pulmonary hypertension.  We feel blindsided.  We went to the doc's office expecting to hear, "all is clear for the kidney" and instead, we seem to be going down a terminal path, all of the sudden.  It seems the first step must be treat the pulmonary hypertension. My husband has been routinely left 1-2 kilos over his "dry" weight as he's been going in and out of the hospital for the last 3 months (surgery for repair of his dialysis fistula--reduction of a "pseudo aneurysm", cath, VATS for pleural effusion).  He's now back to his dry weight, and feeling MUCH better.  When asked the LIver and Kidney docs for suggestions for next steps, we were told to get a second opinion from another transplant center.  Do you have any suggestions?  We live  in Virginia, 50 miles south of Washington DC, and 50 miles north of Richmond, VA.  Do you have any suggestions for follow up care?  Transplant centers that specialize/have interest in, kidney/liver transplant in the presence of pulm hypertension?
517301_tn?1229801385
i am sorry to hear this.  Georgetown or University of PA are large centers in your vicinity that might consider the transplant.  especially in people who have renal failure, there can be fluid overload and pulmonary pressures may be elevated due to the fluid; this may not be true pulmonary hypertension which would preclude any type of surgery.  The assessment of the pulmonary hypertension should be re-done after dialysis has removed a lot of volume.Unequivocally, pulmonary hypertension must be adequately treated before any attempt at transplantation is made.
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Avatar_m_tn
Thank you, doctor.  To add insult to injury, the cardiologist who ordered, evaluated, and interpreted the cath, specifically stated that from his perspective, transplant was a go, that he felt the hypertension was due to fluid overload.  The sudden about face by Transplant is apparently based on an emailed request from us describing his fluid overload symptoms, and requesting an office visit!  All but one of his medical professionals who were onboard with his initial transplant, have moved on to other places.  The lost time in having to start over at another facility is heartbreaking.
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517301_tn?1229801385
i am sorry to hear this--I am confident he will be accepted at another transplant program
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517301_tn?1229801385
Thomas D Schiano, MDBlank
The Mount Sinai Medical Center
New York, NY
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