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Cirrhosis of the Liver Community
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When is it too late for transplant?

My mother has been diagnosed with cirrhosis. As far as I can tell she is stage 4. I don't know much as I live far away but when I was home for Christmas I was told by her and my father that the doctor said her liver is too far gone for transplant. She has  had your get fluid drained from her twice in the last 18 months. She seemed like normal when I saw her 6 months ago  but it seems she has gotten alot worse since then. I just want to know if it's true that your liver can be too scarred for a transplant as I can't find the information online. Thank you.
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446474 tn?1446347682
COMMUNITY LEADER
I am sorry to hear that your mother has been diagnosed with stage 4 liver disease otherwise most commonly known as “cirrhosis of the liver”. A diagnosis or cirrhosis covers a very wide range of disease. From those people who have early cirrhosis and no symptoms or complications from the disease. Who can  live for many years with their cirrhosis, to those with End- Stage Liver Disease (ESLD) who many only have a very short time (months, weeks or days) to live without a liver transplant.

When is it too late for a liver transplant?
Only a liver transplant center can evaluate your mother’s liver disease and decide if she meets the qualifications to be listed for a liver transplant. There are many reasons a person can be denied a transplant, but having too advanced liver disease is not a common reason to be refused a transplant. For a persons cirrhosis to be too advanced for transplant such a person is deadly ill. Often are hospitalized in an ICU. If at home they will be disabled and often bed-ridden and deadly ill. Even in those cases it is possible for people in the ICU at the hospital to be stabilized long enough so that, if they are qualified for a transplant, they can be listed for transplant and receive an organ before they become too ill for transplant. Since a person in this situation is so ill because of their liver disease, if they are qualified, they will be on the top of the waiting list. The sickest people on the waiting list (those with the highest MELD score which is used to evaluate the extent of the liver disease) they are the first to receive a compatible organ. I have seen this happen numerous times at my transplant center. Where a person goes from ICU to transplant surgery.  (“if it's true that your liver can be too scarred for a transplant”)

People whose liver disease is too advanced have End-Stage Liver Disease (ESLD) and are deadly ill. They are typically hospitalized and may be in and out of the ICU with multiple life-threatening complications (uncontrollable fluid retention where fluid draining doesn’t work, life-threatening infections, internal bleeding, brain issues including stupor and coma) and only have weeks to live. Thankfully it doesn’t sound like this is your mothers condition from what you say.

Having to have the fluid of ascites drained 2x in the last 18 months is not uncommon in pre liver transplant patients awaiting a new liver. Most of us transplant patients have had many paracentesis (fluid drainage) before our transplants often on a regularly scheduled basis. Often multiple times a month for many months before transplant. So having ascites is no bar to transplant. Ascites if the most common complication of cirrhosis and can usually be managed until a person gets a transplant even if management requires multiple drainage procedures on a regular basis.

Your mother should be seen at a liver transplant center where a teams of  doctors and others (a hepatologist, a transplant surgeon, a social worker, a psychiatrist, etc.) there can make an evaluation to determine if she is qualified for liver transplant. No other private doctor (primary doctor, gastroenterologist, etc.) can decide or determine if someone is eligible for a liver transplant.

Make sure your mother has been evaluated at a liver transplant center. If she is not eligible for a transplant they will tell her why she is not qualified.

Good luck to your mother and family.
Hector

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