Transplant and hep c

[dickl]

I have hep c and cirrhosis and my liver is about shot . My liver doc says treatment for the virus would probablt be fatal due to the fragile state of health I'm in . I fortunately have been stable and take 2 diuretics and follow fluid restriction and low sodium diet to fight moderate acitese. I am some what active and get out and about which is a blessing from Feb. when I was in the hospital with liver failure and acute acitese. My doc says transplant is probably inevitable and since I'm not ancient ( 59 ) would be preferable to waiting too long. I've been drug and alcohol free for over 3 months and I think the doc might be waiting to get a few months further to guarentee I show no signs of narcotis use before going before a tansplant board . My questions are what happens to the untreated hep , does it improve if the transplant is successful or after I recover do I look at treatment for the virus. Many days I feel like I've got the flu and this could be from virus , the meds, or the acitese . I would hope if the transplant works I might enjoy better health and not have this draconian fluid restriction lifted . I'm probably very naive about what's in store , although my son had  a marrow transplant for AML ( leukemia ) in 96 . It was really rough,  many complications , eye opening . He is 20 now and been cancer free since the transplant , it probably took 1-2 yrs. before he was active and healthy . I assume this is quite possible for a 59 yr. old. I welcome any input and please be candid I'm thhick skinned and prefer no candy coating.

                                                                                                     Thanks,
                                                                                                      dickl

[nygirl7]

Dickl

You'll find a few people in here who are experienced in this matter and have been transplanted and are doing wonderfully - living life to the fullest!

I'm sure they will let you know all the details but since I haven't been a transplant patient I hesitate to answer to that because it's not something I'm familiar with.

I just wanted to congratulate you on being drug free for 3 months.  It's not easy (I know).  I had a friend who was transplanted and IMMEDIATELY went back to partying. He developed liver cancer, had a leg amputated because of his diabetes and then he died.

Sometimes that helps keep me on the straight and narrow so to speak.  If the hep is left untreated you will need to make sure you stay on the same long boring road as me (i have been clear of the disease for 18 months after 72 weeks of treatment) - it's not a fun road to be on but with liver damage and disease we just gotta be there.

I wanted to wish you all of the best.

Deb

[mikesimon]

I believe that a longer period of abstinence will be required before you will be considered for an organ transplant. Most centers that I am familiar with require 1 year of absolute abstinence and I would guess that will be the requirement at the center(s) in your area.
The virus recurs almost universally post transplant so HCV will likely be an issue. I can't predict how it will affect your new liver. Some people get along well for years without treatment while other people don't and decide to treat post transplant. The success rate - the percentage of post transplant patients who achieve SVR - is around 26% to 30% - I think that's pretty accurate but I may be off a few percentage points. I would expect that your ascites would resolve post transplant because your new liver would be functional but recovery is not always trouble free. There are too many issues for me to go any further here but there is a lot of information on the net and you might start trying to educate yourself. Look up a center nearby and see if they list there exclusionary factors - eg. length of abstinence etc.. Then Google "liver transplant" and you should be able to learn a lot.
Good luck, Mike

[HCA]

The new liver does indeed become infected,so most transplant recipients take anti-virals.
That's a way down the road though.Good luck-I have read many encouraging stories on this forum from people who have returned to good health from the place you are at now.

[HectorSF]

I'm sorry to hear about your illness. You appear to have a great attitude considering what you are dealing with. I give you a lot of credit for doing so well. This is also something the transplant center will be looking for as it show a willingness to fight the good fight and overcome the odds. Plus giving up the drink and drugs show you are on the right path. Congratulations!

I believe that it is common experience that between 5 and 10 years post treatment the liver disease will cause to liver to fail again. This process happens much more quickly then the decades it takes for Stage 4 liver disease to originally progress. What happens is that the anti-rejection drugs bring the virus back in a big way because they lower the immune systems response in order to not reject the new liver.

One hopeful sign is that there is now a trial (here at UCSF) where they treat patients just before transplant for just long enough to get an undetectable level of virus, then they do the transplant. I have heard this is highly successful in stopping HCV from reappearing in the new liver. This could save many many lives if it turns out to be something that becomes standard practice.

Best wishes to you!
Hector

[mikesimon]

You said:
"What happens is that the anti-rejection drugs bring the virus back in a big way because they lower the immune systems response in order to not reject the new liver."
While immunosuppression is a factor, I believe that fibrosis progression post transplant is a bit more complicated than you suggest. There are other factors such as donor age, VL, genotype and host factors that are thought to play a role in fibrosis progression. Donor age for example is thought to be a very significant factor in the virulence of HCV recurrence post transplant.
Mike

[HectorSF]

Mike, point well taken. Thanks for pointing that numerous factors that are involved in the reoccurrence of HCV in the donated liver. The point I was trying to make (and wasn't clear about) was that by modifying a variable factor that can be controlled, namely the amount of immunosuppressant therapy, it may be possible to slow the advancement of the HVC liver disease in the post transplant patient and thus have a better long term outcome. Since the majority of liver transplant patients in the US have liver disease caused by HCV, any improvements in the outcome of post transplant patients with HCV will have a major positive impact on thousands of patients.

"Management of Recurrent Viral