is there hope?

My mother in law is currently in the ICU.  She had been on the transplant active list X4 days and hospitalized for weeks...and then got an infection.  It started in the urine and went into her blood.  Since the infection took hold, she is now on a ventilator, has been in afib for days (cardioversion did not work), she has encephelopathy and went completely unresponsive, she is on meds to keep her HR down and blood pressure up.  Her doctors have expressed that they are very worried.  They are pumping her with lactulose which has brought down the ammonia levels, but she is still not waking up.  Her kidneys stopped working a few days ago and we were talking dialysis, but they have since started functioning again.  I guess my question is... is there any hope.  She is so very ill and has to be free of infection for 14 days before going back on the active list.  With all that I have described, can one come back from this?

Signed,
Very worried

[Thomas D Schiano, MD]

i am sorry to hear how poorly she is doing.  I definitely have had patients recover from this with transplant being the only option.  i think continued aggressive therapy seems warranted with some expectations, i.e if she cannot get off the vent in another week, she might not be able to and be predisposed to other complications.  occult infections are very difficult to detect sometimes so empiric antibiotics are often utilzed in this setting.