Aa
Enlarged varicies...6 bands
Hey all as u all know my husband relapsed on Sovaldi/riba month ago. Today he went in for a check up down his throat to check it out. He was banded 6 times. Before he started treatment he was banded 8 times first time 3 second time and none the third time. They said they would check it out every 6 months. My question is what does this all mean? Will they ever go away? Should we be pushing for a liver transplant soon? I love my husband and I just feel so lost and confused about this all I feel like nothing is getting better and that I will lose him. His MELD score was a 15 last time they checked.
COMMUNITY LEADER
Thank you for your comments.
I had hep C for 45 years which lead to my cirrhosis (ascites, HE, varices, etc for many years)and then I developed liver cancer and luckily got my life-saving liver transplant 18 months ago. I was recently cured of my hep C a few months ago after my 3rd treatment in the last 7 years.
I am sorry to hear of your situation. I lived for many years with those complications and know it can be very rough.
Have you thought about treating and curing your hep C? At my transplant center we are treating lots of folks with hep C and cirrhosis. Many who are awaiting transplant. (Hopefully once cured they won't need a transplant). Even those with decompensated cirrhosis are being successfully treated. Something unimaginable until very recently.
Current Hep C treatment in cirrhotics is highly effective.
Compensated cirrhosis:
12 week of Harvoni treatment
SRV rates of 94%+
Decompensated cirrhosis (Child-Pugh class B):
12 weeks of Harvoni + RBV
87% SVR rate
The other very important observation from this trial was the quite drastic clinical improvement of the patients with successful HCV therapy which was documented by an improvement in MELD score as well as an increase in serum albumin all indicative of an improvement of liver synthesis function
Hang in there!
Hector
I had hep C for 45 years which lead to my cirrhosis (ascites, HE, varices, etc for many years)and then I developed liver cancer and luckily got my life-saving liver transplant 18 months ago. I was recently cured of my hep C a few months ago after my 3rd treatment in the last 7 years.
I am sorry to hear of your situation. I lived for many years with those complications and know it can be very rough.
Have you thought about treating and curing your hep C? At my transplant center we are treating lots of folks with hep C and cirrhosis. Many who are awaiting transplant. (Hopefully once cured they won't need a transplant). Even those with decompensated cirrhosis are being successfully treated. Something unimaginable until very recently.
Current Hep C treatment in cirrhotics is highly effective.
Compensated cirrhosis:
12 week of Harvoni treatment
SRV rates of 94%+
Decompensated cirrhosis (Child-Pugh class B):
12 weeks of Harvoni + RBV
87% SVR rate
The other very important observation from this trial was the quite drastic clinical improvement of the patients with successful HCV therapy which was documented by an improvement in MELD score as well as an increase in serum albumin all indicative of an improvement of liver synthesis function
Hang in there!
Hector
COMMUNITY LEADER
If my husband was to attain SVR would his enlarged Varicies ever get any better? Or will he always have to be banded every month?
Every person's cirrhosis is different so no one can predict 100% what may happen in one particular case. But that said...in many cases of cirrhosis caused by hep C infection once a person is cured of their hep C infection the complications of their cirrhosis get better as the liver heals and many are avoiding the need for transplant.
When I asked the Dr that yesterday he said they will get better when he gets a liver transplant.
Well of course. Most if not all the complications go away, literally, overnight when a person has a new, healthy liver inside them. But transplant is always the final resort, only when all other options have run out is transplant required. Since hep C is now a curable infection with current treatments, more and more people are not needing transplants because they are able to stop the liver damage from going beyond the point of no return and either liver failure or liver cancer.
So if my husband does ever reach SVR will he still eventually have to have a liver transplant?
No one can predict the future.Of course the sooner the damaged to his liver is stopped the better chance his liver disease will be reversible. Also the chances of him developing liver cancer (which will require a transplant to be treated) is also reduced when SVR is achieved. So SVR is a win-win situation. Again, everyone is different. But for the first time ever we are seeing people on transplant waiting lists routinely being cured and not progressing as previously soon to needing a transplant.
There are new treatments for genotype 2 now being studied in clinical trials so there is always hope.
* ABT-493 and ABT-530 With and Without RBV
* Sofosbuvir 400 mg/GS-5816 100 mg FDC tablet administered orally once daily
* LDV/SOF FDC+RBV for 24 weeks
Take are.
Hector
Every person's cirrhosis is different so no one can predict 100% what may happen in one particular case. But that said...in many cases of cirrhosis caused by hep C infection once a person is cured of their hep C infection the complications of their cirrhosis get better as the liver heals and many are avoiding the need for transplant.
When I asked the Dr that yesterday he said they will get better when he gets a liver transplant.
Well of course. Most if not all the complications go away, literally, overnight when a person has a new, healthy liver inside them. But transplant is always the final resort, only when all other options have run out is transplant required. Since hep C is now a curable infection with current treatments, more and more people are not needing transplants because they are able to stop the liver damage from going beyond the point of no return and either liver failure or liver cancer.
So if my husband does ever reach SVR will he still eventually have to have a liver transplant?
No one can predict the future.Of course the sooner the damaged to his liver is stopped the better chance his liver disease will be reversible. Also the chances of him developing liver cancer (which will require a transplant to be treated) is also reduced when SVR is achieved. So SVR is a win-win situation. Again, everyone is different. But for the first time ever we are seeing people on transplant waiting lists routinely being cured and not progressing as previously soon to needing a transplant.
There are new treatments for genotype 2 now being studied in clinical trials so there is always hope.
* ABT-493 and ABT-530 With and Without RBV
* Sofosbuvir 400 mg/GS-5816 100 mg FDC tablet administered orally once daily
* LDV/SOF FDC+RBV for 24 weeks
Take are.
Hector
Hector your information is always so helpful to me as I get so confused about this disease and all that comes with it.
We found out yesterday that our Dr is leaving the transplant team and also leaving the state so in May when we go back we will be seeing another dr (3rd times a charm) I'm hoping anyway. We always seen the PA hardly ever the actual Dr so when we asked him about it yesterday he said my husband is not sick enough to see the dr everytime instead of the PA.
I am praying our new Dr will be the one to cure him of hep c. If my husband was to attain SVR would his enlarged Varicies ever get any better? Or will he always have to be banded every month? When I asked the Dr that yesterday he said they will get better when he gets a liver transplant. So if my husband does ever reach SVR will he still eventually have to have a liver transplant?
We found out yesterday that our Dr is leaving the transplant team and also leaving the state so in May when we go back we will be seeing another dr (3rd times a charm) I'm hoping anyway. We always seen the PA hardly ever the actual Dr so when we asked him about it yesterday he said my husband is not sick enough to see the dr everytime instead of the PA.
I am praying our new Dr will be the one to cure him of hep c. If my husband was to attain SVR would his enlarged Varicies ever get any better? Or will he always have to be banded every month? When I asked the Dr that yesterday he said they will get better when he gets a liver transplant. So if my husband does ever reach SVR will he still eventually have to have a liver transplant?
My daughter was going to donate part of her liver when I was on the transplant list at Duke Cancer Center but the insurance would not pay for a living donor's operation, so I didn't go through with it. That was 20 years ago when I had varices veins banded and a stint put into my portal vein. Did not have any treatments to cure my Hep C. Still have cirrhosis and a small lesion on my liver which they monitor every 4 months with an MRI. Besides lack of energy and tiredness, my albumin and platelet count are low resulting in excessive fluid retention (35lbs.) and slow clotting. I'm 80 now living day by day. Thank you for your incites and comments. Your certainly well versed on Hep C.
COMMUNITY LEADER
At many transplant centers a MELD score of 15 is required to get listed. While MELD score can vary over time hopefully they will consider him "ill enough" to be listed. Being listed involves being evaluated to make sure he is eligible to get a transplant. Basically meaning he doesn't have any other medical conditions that would rule out a transplant and that he has the social network of people to help him with his condition and care for him after his transplant.
It involves meeting lots of different folks in many departments in liver transplant and having many tests to confirm is ability to have the surgery.
All cirrhosis is stage 4 liver disease. There are different degrees or classes of cirrhosis.
Early cirrhosis is when someone doesn't have much portal hypertension and complications from their cirrhosis. This is called compensated, class A cirrhosis.
Decompensated cirrhosis is the next stage or Child-Pugh class B cirrhosis. This is when someone has complications of cirrhosis and portal hypertension; ascites, bleeding varices, hepatic encephalopathy etc. Each person' s cirrhosis complications manifest differently and need to be addressed for that individual.
So your husband having large varices and a MELD score of 15 would be categorized with has mostly class A cirrhosis with some signs of decompensation (class B). As indicated by his MELD score (blood livers) and his varices are large and in danger of bleeding. This is more advanced liver disease than someone with asymptomatic cirrhosis who liver is still able to perform all of its functions.
End-Stage Liver Disease is the final stage of liver disease as the name says. This is called Chilkd-Pugh class C cirrhosis. Commonly called End-Stage cirrhosis. These people need a liver transplant soon in order to continue to live. These are people with MELD scores in the mid to upper 30s or higher.
As far as hep C just because there is no cure now for his hep C doesn't mean he can't be cured. Many of use treated multiple times and failed before being cured. Remember getting a transplant can take a long time. Many months at minimum to many years. One basic truism about the liver transplantation process is... NOTHING happens quickly. It is a waiting game. I was on two waiting lists being very ill with ascites, varices and HE with liver cancer for 4 very long years before I got my new liver just in time. Hepatitis C and its treatment is one of the most rapidly changing field of medicine. What seemed impossible a year ago is now standard treatment. New treatments are being tested in clinical trials and the transplant center will be possibly involved in these trials as there are many others who also need treatment for their hepatitis C as well at the hospital.
In the last year many people who have been on transplant waiting lists have been treated and cured and hopefully won't even need transplants. This wasn't possible until just last year. Beside all people that get transplants either need to be cured before or after transplant. If a person is infected with the virus it will return after transplant and start destroying the new liver. Sooner or later the virus must be eliminated. As the cirrhosis progresses the suffering gets way worse and can be life-threatening. So If anyone can avoid a transplant it is certainly better to at least try to do so.
The transplant center will explain all of the options that are available for your husband based on his particular situation.
I was listed at two transplant centers on both coasts and have helped a number of people through the process of getting listed. So if you have any questions just let me know.
Take care.
Hector
It involves meeting lots of different folks in many departments in liver transplant and having many tests to confirm is ability to have the surgery.
All cirrhosis is stage 4 liver disease. There are different degrees or classes of cirrhosis.
Early cirrhosis is when someone doesn't have much portal hypertension and complications from their cirrhosis. This is called compensated, class A cirrhosis.
Decompensated cirrhosis is the next stage or Child-Pugh class B cirrhosis. This is when someone has complications of cirrhosis and portal hypertension; ascites, bleeding varices, hepatic encephalopathy etc. Each person' s cirrhosis complications manifest differently and need to be addressed for that individual.
So your husband having large varices and a MELD score of 15 would be categorized with has mostly class A cirrhosis with some signs of decompensation (class B). As indicated by his MELD score (blood livers) and his varices are large and in danger of bleeding. This is more advanced liver disease than someone with asymptomatic cirrhosis who liver is still able to perform all of its functions.
End-Stage Liver Disease is the final stage of liver disease as the name says. This is called Chilkd-Pugh class C cirrhosis. Commonly called End-Stage cirrhosis. These people need a liver transplant soon in order to continue to live. These are people with MELD scores in the mid to upper 30s or higher.
As far as hep C just because there is no cure now for his hep C doesn't mean he can't be cured. Many of use treated multiple times and failed before being cured. Remember getting a transplant can take a long time. Many months at minimum to many years. One basic truism about the liver transplantation process is... NOTHING happens quickly. It is a waiting game. I was on two waiting lists being very ill with ascites, varices and HE with liver cancer for 4 very long years before I got my new liver just in time. Hepatitis C and its treatment is one of the most rapidly changing field of medicine. What seemed impossible a year ago is now standard treatment. New treatments are being tested in clinical trials and the transplant center will be possibly involved in these trials as there are many others who also need treatment for their hepatitis C as well at the hospital.
In the last year many people who have been on transplant waiting lists have been treated and cured and hopefully won't even need transplants. This wasn't possible until just last year. Beside all people that get transplants either need to be cured before or after transplant. If a person is infected with the virus it will return after transplant and start destroying the new liver. Sooner or later the virus must be eliminated. As the cirrhosis progresses the suffering gets way worse and can be life-threatening. So If anyone can avoid a transplant it is certainly better to at least try to do so.
The transplant center will explain all of the options that are available for your husband based on his particular situation.
I was listed at two transplant centers on both coasts and have helped a number of people through the process of getting listed. So if you have any questions just let me know.
Take care.
Hector
COMMUNITY LEADER
As far as treatment for genotype 2 the transplant center would be the place that would know of all of the latest treatments that may be available for someone with genotype 2 and failed treatment. Particularly any trials that may be coming up. The good news is that now with our newer and safer treatments with DAAs treatment even folks with advanced cirrhosis, decompensated and even End-Stage Liver Disease (ESLD) can still be treated. This is a completely new option for those on liver transplant waiting lists. Either way, folks have much better options for curing their hep C pre or post transplant than ever before and it will only get better in the future. Very importantly while he awaits a new hep C treatment, the folks at the transplant center are THE experts in helping your husband to manage his cirrhosis and its complications so he can stay as healthy as possible for as long as possible. Hopefully giving him enough time to cure his hep C and avoid a transplant.
When a person gets a transplant is based on their MELD score, blood type and most importantly where they are listed. So the sickest (the person who has the highest MELD score in the region with a compatible blood type with the available organ) gets a transplant first. Each transplant center has an average MELD score that they typically transplant at. When your husband gets listed they will give you an idea of how high his MELD score needs to be to be close to the top of the list.
People at California and New York City transplant centers wait the longest the waiting lists have many people awaiting transplant so a person with blood type O for example will need a MELD score in the lower to mid 30 (33) for example. I had to wait until my MELD score was 36. Unheard of anywhere else in the country for someone with liver cancer (HCC). While in other regions people with MELD scores in the low to mid 20 can get transplants. So there is no fairness in the present allocation system as it is based on where you live or more precisely where a person gets listed. This is why Steve Jobs went to Memphis, Tennessee to get his liver transplant. If he stayed here in California he would have died before ever getting his transplant. Luckily UNOS, the organization that allocates organs in the US will finally be addressing this MELD score inequality issue soon and we are hoping to see more equality of care. The current MELD system has been in place since 2002. Any changes that make toward equity for assess to organs will be life saving for many folks that I see who literally have to be near death here in California before getting a donor cadaver liver. Sadly some people I see at our center have life ending complications while waiting. Being in Dallas is definitely an advantage as you have better access to organs there than in other regions of the country.
Baylor University Medical Center at Dallas has the best reputation in the transplant community. You can contact them at (214)820.2050.
“Partial liver transplant” is a living donor liver transplant (LDLT). This is where a matching donor agree to give a part of their liver to the recipient. A great option for those who have the option as the surgery is a scheduled surgery so there is no waiting on the waiting list. The transplant can usually be performed in months after all the prelimary workups have been done. I know a number of folks who have had family members donate a part of their liver to the recipient.
Live Donor Liver Transplants
Living donor liver transplantation can be an alternative to deceased donor liver transplantation for some patients on the waiting list. The ideal candidates are patients who foresee a long wait on the deceased transplant list and experience complications of liver disease, such as ascites and encephalopathy and patients diagnosed with hepatocellular carcinoma.
What is a Living Donor Liver Transplant?
Living donor liver transplantation requires an operation to remove a portion of a healthy person's liver and put it into a person who has a sick liver. The liver has a right and left side that functions as a unit, although it can be separated in surgery. During a hepatectomy, the liver is divided and either the right or left side is removed and donated for transplant. Within approximately 6-8 weeks both half- livers (of donor and recipient) will grow to full size.
What are the Benefits?
Living donor liver transplantation may be an option to any person who is presently on the liver transplant waiting list. Living donor liver transplantation offers immediate organ availability and is a planned operation which can avoid the progression of the recipient's disease and its life threatening complications. Additionally:
• A living donor liver is the best quality liver.
• A living donor transplant will eliminate the long wait time on the national deceased donor waiting list.
• Living donation maximizes the chance for a recipient to receive a transplant before a recipient’s condition dramatically worsens.
• The surgery can be timed for optimal health of the recipient and for donor convenience.
Who Can Be a Liver Donor?
The Transplant Team is extremely careful in selecting living donors. Potential donors must meet the following criteria:
• Be in excellent medical and psychosocial health
• Be between the ages of 18 and 60
• Cannot have uncontrolled high blood pressure, liver disease, diabetes or heart disease
• Be a compatible blood type with the recipient
• Be emotionally related to the recipient
Hector
When a person gets a transplant is based on their MELD score, blood type and most importantly where they are listed. So the sickest (the person who has the highest MELD score in the region with a compatible blood type with the available organ) gets a transplant first. Each transplant center has an average MELD score that they typically transplant at. When your husband gets listed they will give you an idea of how high his MELD score needs to be to be close to the top of the list.
People at California and New York City transplant centers wait the longest the waiting lists have many people awaiting transplant so a person with blood type O for example will need a MELD score in the lower to mid 30 (33) for example. I had to wait until my MELD score was 36. Unheard of anywhere else in the country for someone with liver cancer (HCC). While in other regions people with MELD scores in the low to mid 20 can get transplants. So there is no fairness in the present allocation system as it is based on where you live or more precisely where a person gets listed. This is why Steve Jobs went to Memphis, Tennessee to get his liver transplant. If he stayed here in California he would have died before ever getting his transplant. Luckily UNOS, the organization that allocates organs in the US will finally be addressing this MELD score inequality issue soon and we are hoping to see more equality of care. The current MELD system has been in place since 2002. Any changes that make toward equity for assess to organs will be life saving for many folks that I see who literally have to be near death here in California before getting a donor cadaver liver. Sadly some people I see at our center have life ending complications while waiting. Being in Dallas is definitely an advantage as you have better access to organs there than in other regions of the country.
Baylor University Medical Center at Dallas has the best reputation in the transplant community. You can contact them at (214)820.2050.
“Partial liver transplant” is a living donor liver transplant (LDLT). This is where a matching donor agree to give a part of their liver to the recipient. A great option for those who have the option as the surgery is a scheduled surgery so there is no waiting on the waiting list. The transplant can usually be performed in months after all the prelimary workups have been done. I know a number of folks who have had family members donate a part of their liver to the recipient.
Live Donor Liver Transplants
Living donor liver transplantation can be an alternative to deceased donor liver transplantation for some patients on the waiting list. The ideal candidates are patients who foresee a long wait on the deceased transplant list and experience complications of liver disease, such as ascites and encephalopathy and patients diagnosed with hepatocellular carcinoma.
What is a Living Donor Liver Transplant?
Living donor liver transplantation requires an operation to remove a portion of a healthy person's liver and put it into a person who has a sick liver. The liver has a right and left side that functions as a unit, although it can be separated in surgery. During a hepatectomy, the liver is divided and either the right or left side is removed and donated for transplant. Within approximately 6-8 weeks both half- livers (of donor and recipient) will grow to full size.
What are the Benefits?
Living donor liver transplantation may be an option to any person who is presently on the liver transplant waiting list. Living donor liver transplantation offers immediate organ availability and is a planned operation which can avoid the progression of the recipient's disease and its life threatening complications. Additionally:
• A living donor liver is the best quality liver.
• A living donor transplant will eliminate the long wait time on the national deceased donor waiting list.
• Living donation maximizes the chance for a recipient to receive a transplant before a recipient’s condition dramatically worsens.
• The surgery can be timed for optimal health of the recipient and for donor convenience.
Who Can Be a Liver Donor?
The Transplant Team is extremely careful in selecting living donors. Potential donors must meet the following criteria:
• Be in excellent medical and psychosocial health
• Be between the ages of 18 and 60
• Cannot have uncontrolled high blood pressure, liver disease, diabetes or heart disease
• Be a compatible blood type with the recipient
• Be emotionally related to the recipient
Hector
Hector yes he is on a beta blocker his blood pressure usually is ok not been running high. Last time I asked the dr about putting him on a transplant list they said he wasn't sick enough his MELD score is 15, from what I've read he's considered to be in the range to be listed so I don't understand why they haven't yet.
We have no idea about his grading of the cirrhosis just was told he was considered stage 4. When I read about stage 4 it's not good, end stage? I am just so confused because why even try to treat his hep c if he's already in end stage? I've read there's no cure so I don't understand why they would treat him if his liver is already stage 4. Why not enlist on the transplant list instead?
I just dont know what to do I feel like we have no other options and that there's no cure for his condition. I've read everywhere that geno 2 only has one treatment option if he's already failed that then what else do we do? I can't stand the thought of losing my husband.
Dr said they will retreat him with Sovaldi/Riba again but this time for 24 weeks instead of 12. Is there anyone who has re-treated with this combination and had success after previously relapsing on it?
We have no idea about his grading of the cirrhosis just was told he was considered stage 4. When I read about stage 4 it's not good, end stage? I am just so confused because why even try to treat his hep c if he's already in end stage? I've read there's no cure so I don't understand why they would treat him if his liver is already stage 4. Why not enlist on the transplant list instead?
I just dont know what to do I feel like we have no other options and that there's no cure for his condition. I've read everywhere that geno 2 only has one treatment option if he's already failed that then what else do we do? I can't stand the thought of losing my husband.
Dr said they will retreat him with Sovaldi/Riba again but this time for 24 weeks instead of 12. Is there anyone who has re-treated with this combination and had success after previously relapsing on it?
Than you so much Hector for your information. Since he is geno 2 I'm not sure if or what they could treat him with. Failed interferon and also Sovaldi/riba treatment best to my understanding that's the only treatment option available for his genotype. We will for sure list him on the transplant list. How long is the average wait time and do u have to be basically dying before they will even do it? Can you do partial liver transplants?
COMMUNITY LEADER
Here is a brief explanation of Portal Hypertension and varices.
The scar tissue in the liver interferes with the normal blood flow through the liver back to the heart--- pressure can build in the portal vein ("portal hypertension"). That blood comes from the GI tract and the spleen. This causes the blood to flow through other veins around the liver to get back to the heart. These veins are not designed to handle so much blood flow so they enlarge and can burst if the pressure is too high. This causes varices to form along the GI tract and the spleen to enlarge.
---> As the spleen enlarges-- platelets are trapped in the spleen. (The platelet count in the bloodstream falls.IE A low platelet count.) (Platelets help our blood to clot. So as the platelet count falls... bleeding time is increased.)
---> Varices are dangerous because there's a risk that they can burst and bleed (hemorrhage) which can cause the person to vomit or defaecate blood. Which is an emergency situation requiring immediate medical intervention. The person should be taken to the nearest ER ASAP.
Variceal banding is used to prevent enlarged veins from bursting by tying off veins that appear to be in danger of hemorrhaging. Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed.
I hope this helps.
Hector
The scar tissue in the liver interferes with the normal blood flow through the liver back to the heart--- pressure can build in the portal vein ("portal hypertension"). That blood comes from the GI tract and the spleen. This causes the blood to flow through other veins around the liver to get back to the heart. These veins are not designed to handle so much blood flow so they enlarge and can burst if the pressure is too high. This causes varices to form along the GI tract and the spleen to enlarge.
---> As the spleen enlarges-- platelets are trapped in the spleen. (The platelet count in the bloodstream falls.IE A low platelet count.) (Platelets help our blood to clot. So as the platelet count falls... bleeding time is increased.)
---> Varices are dangerous because there's a risk that they can burst and bleed (hemorrhage) which can cause the person to vomit or defaecate blood. Which is an emergency situation requiring immediate medical intervention. The person should be taken to the nearest ER ASAP.
Variceal banding is used to prevent enlarged veins from bursting by tying off veins that appear to be in danger of hemorrhaging. Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed.
I hope this helps.
Hector
COMMUNITY LEADER
Hi and welcome.
What this means is that as long as his hepatitis C is active and continues to cause further damage to his liver he will continue to have worsening of his cirrhosis and its resulting complications.
Varices is but one of many complications of advanced cirrhosis and portal hypertension. Like many other complications of cirrhosis (ascites, hepatic encephalopathy, etc.) varices (enlargement of the veins along the GI tract) is caused by the portal hypertension that develops as the scarring of the liver progresses. Caused by the replication of the virus and the damage to the liver it does. Unfortunately only by curing his hepatitis C infection, thus stopping the ongoing damage to his liver, can his cirrhosis and his varices improve.
With a MELD score of 15 he is now eligible to be listed for a liver transplant. In my opinion he should get listed for two purposes. One, he should be being treated by a hepatologist who understands and works daily with folks with cirrhosis this advanced and secondly, as a backup plan should his cirrhosis continue to progress to the point where transplant is the only option. Of course the first priority of the transplant center will be retreatment with the latest best hep C treatment for his Hepatitis C as soon as possible to stop the progression of his cirrhosis if at all possible as curing the hep C is the key to his health improving. If that means a clinical trial they would be the ones who can get him into a trial.
Please contact your liver transplant center and start the process of evaluation for getting listed for a liver transplant.
I assume his portal hypertension is being managed with a nonselective beta-blocker such as Nadolol or Propranololin addition to banding? Perhaps the dose can be increased more to lower his blood pressure and prevent a bleed? The transplant center will be familiar with all of the he can do to manage his cirrhosis, treat his hep C and if needed get him through the transplant process.
Best of luck to you and your husband.
Hector
What this means is that as long as his hepatitis C is active and continues to cause further damage to his liver he will continue to have worsening of his cirrhosis and its resulting complications.
Varices is but one of many complications of advanced cirrhosis and portal hypertension. Like many other complications of cirrhosis (ascites, hepatic encephalopathy, etc.) varices (enlargement of the veins along the GI tract) is caused by the portal hypertension that develops as the scarring of the liver progresses. Caused by the replication of the virus and the damage to the liver it does. Unfortunately only by curing his hepatitis C infection, thus stopping the ongoing damage to his liver, can his cirrhosis and his varices improve.
With a MELD score of 15 he is now eligible to be listed for a liver transplant. In my opinion he should get listed for two purposes. One, he should be being treated by a hepatologist who understands and works daily with folks with cirrhosis this advanced and secondly, as a backup plan should his cirrhosis continue to progress to the point where transplant is the only option. Of course the first priority of the transplant center will be retreatment with the latest best hep C treatment for his Hepatitis C as soon as possible to stop the progression of his cirrhosis if at all possible as curing the hep C is the key to his health improving. If that means a clinical trial they would be the ones who can get him into a trial.
Please contact your liver transplant center and start the process of evaluation for getting listed for a liver transplant.
I assume his portal hypertension is being managed with a nonselective beta-blocker such as Nadolol or Propranololin addition to banding? Perhaps the dose can be increased more to lower his blood pressure and prevent a bleed? The transplant center will be familiar with all of the he can do to manage his cirrhosis, treat his hep C and if needed get him through the transplant process.
Best of luck to you and your husband.
Hector
Have an Answer?
You are reading content posted in the Cirrhosis of the Liver Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
