he appears to have cirrhosis from drinking with hopefully some reversibility occurring with ongoing sobriety. HBV is very common so he should be screened for this as well as having a scan if possible to make sure there is no liver cancer. this is a very low MELD score (normal is 6) so hopefully transplant will not be needed.
afp could detect recurrent cancer anywhere in the body, if it were (+) before the transplant. Recurrent hepatitis has no impact on recurrence of the cancer. PIVKA ll is definitely bot standard of care as i am aware
she has probably developed resistance to lamivudine which is not unexpected. Entecavir is an option but i would prefer viread or truvada--this should be started ASAP. The URSO will not help--the lamivudine is no longer working
I would actually try and contact the companies as they might be willing to provide compassionate use medication for this indication. Janssen may also be starting a study here in the US using this combination of medications
if the HCC did not produce AFP prior to the transplant a recurrence would not elevate it. Pivka ll is definitely not standard of care to follow--I am sorry if I cant give you further specifics about it
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