Similar Symptoms and Transplant Success?

I realize you all are busy, but I would be immensely grateful if you would give a few thoughts regarding  some matters of great concern to me.  

I have autoimmune hepatitis - 22 YO male.  Never drank alcohol, taken drugs, or done anything that would have exposed me to hepatitis C (blood tests confirmed).  

Per my biopsy of about 18 months ago, I am in stage 2 bridging fibrosis - although my LFTs have been elevated since then.

About 3 months ago, I started getting a terrible pain in my upper right side.  It came on strongest after eating (the more I ate the worse the pain), and would always dissipate as my stomach cleared out.  A ultrasound and upper endoscopy came back totally normal (no stones in gallbladder or ducts and no ulcers).  The pain went away suddenly about a month ago and only comes back slightly on occasion.

I have recently developed hundreds of tiny pinprick or bigger red dots on my chest and back - cherry angiomas.  I've heard these are a side-affect of the imuran and told me doctor, who was unconcerned.  However, these are new after 14 months of being on imuran (my CBC values are normal - probably ruling out thrombocytopenia).

Belching has been a chronic issue - hundreds per day.  It seems to be triggered by movement, and I've tried eliminating everything supposed to cause aerophagia.  I am unsure if this is the beginning of esophageal varices.

When I stand up, I almost always black out and have fainted several times (orthostatic hypotension), despite my RBCs and platelets being almost normal.  

This may be unrelated, but I get sharp bursts of pain all over - never last more than a few seconds.  The pain is usually enough to lay me on the ground.

Has anyone had similar symptoms?  

Am I a candidate for liver transplant?

Does a body who rejects it's own liver have a chance of successful transplant?

I feel I'm getting brushed off by my doctor until I start showing classic symptoms of liver failure (not sure I can blame him).

[Thomas D Schiano, MD]

some of your symptoms could conceivably be related to the medical therapy.  are you also on prednisone?  autoimmune hepatitis is unusual in a 22 year-old man so i would consider getting a second opinion about the diagnosis, i.e. read of the liver biopsy.  you do not need a transplant and hopefully never will.

[liverbelching]

Hello:

No,
I am not on prednisone.  I was initially, but was tapered off prednisone and onto imuran completely.  I never had any of my side affects when on prednisone, or even on imuran until recently.  I was diagnosed at University of North Carolina and when I moved to Denver, this was confirmed by another hepatologist.  My AST/ALT levels were 2200/1300, which I've read is rare in any chronic disease except autoimmune hepatitis.  The levels are now back down to around twice that of normal in response to prednisone and now imuran (which I think was the final confirming factor).   I really haven't made any progress on understanding the belching, which is  quite severe (makes it difficult to talk sometimes).  Only headway I've made is possibly a swollen liver is irritating the phrenic or vagus nerve causing it.  However, my ultrasound specifically noted that my liver and abdominal viscera are not enlarged.  

Here is a link that seems to confirm my cherry angiomas and associated skin problems are related to the imuran.

http://www.askapatient.com/viewrating.asp?drug=16324&name=IMURAN
(Search "pinprick")

Thank-you again.

[Thomas D Schiano, MD]

imuran can definitely cause GI problems but I have not seen belching as a usual one.