Aa
post liver transplant/itch/fever
studyforhope
a dear friend of mine had liver transplant due to autoimmune cirrhosis/liver failure, everything fine about the transplant (only one episode of rejection right after transplant but managed promptly by cortisone and 2 immune suppressive drugs).so liver function is ok but we have a very big problem with very heavy itch and fever from 37 to 38°
all blood tests from liver transplant unit are ok and doctors have no clues of what this is, they actually say everything is fine but such a chronic fever and heavy itch is not.she will give me all details tomorrow because she is very bad with fever today.
a dear friend of mine had liver transplant due to autoimmune cirrhosis/liver failure, everything fine about the transplant (only one episode of rejection right after transplant but managed promptly by cortisone and 2 immune suppressive drugs).so liver function is ok but we have a very big problem with very heavy itch and fever from 37 to 38°
all blood tests from liver transplant unit are ok and doctors have no clues of what this is, they actually say everything is fine but such a chronic fever and heavy itch is not.she will give me all details tomorrow because she is very bad with fever today.
i suggested to check vit d25oh and pth since i noticed another transplanted close person to me had many infections till a severe sepsis, her vitd25oh was 10ng/ml but after we did vitd25oh around 30ng/ml we never saw any type infection again for years til now.maybe a normal vit d just will help with antibiotic response
i just have a feeling but dont know if this can be real because i have zero knowledge on how biliary system works, what if the disease she had before transplant, primary biliary cirrhosis, is coming back after the transplant?
i just have a feeling but dont know if this can be real because i have zero knowledge on how biliary system works, what if the disease she had before transplant, primary biliary cirrhosis, is coming back after the transplant?
Before transplant she had cirrhosis from both autoimmune hepatitis type 1 and primary biliary cirrhosis with portal vein calcification
she had transplant end of 2015
17 dec 2015 alt 189 ggt 219, biopsy moderate acute rejection, increse of immune suppressive drugs didnt work so they used other steroid drugs steroid drugs and alt lowered to 71 ggt 252
08 jan 2016 severe itch all over the body, increase of cholestasis tests and cytolytic tests so by ultrasound they saw the biliary problems and started antibiotics
13 jan 2016 they put 1 stent since then she had fever 39,5° and itch
22 feb 2016 they removed the stent but fever and itch did not improve
06 april 2016 hemoglobin 10 mcv 73 mch 22,9 inr 2,85 albumin 3,00 ast 40 alt 66 ggt 179 fa 310 bilirubin normal
they put 2 stents later but fever and itch still there, i guess sometime in april
sub hepatic hilum non anastomotic stenosis
liver US is ok nothing abnormal,gallbladder removed, intrahepatic biliary ways are a little enlarged 2-3mm and 2 stents are present
kinking of hepatic artery with accelerated flow to 300cm/sec.
All other descriptions are norm, pancreas is normal
Spleen is enlarged diameter 16cm
translation of ultrasound results is quite complicated since i never studied biliary system so i dont understand what italian words mean too
i just report abnormal tests or important tests for liver on 10 may 2016, i dont see any advanced blood tests, just easy routine tests, strange for a very good university hospital, anyway
microcytosis positive
total protein 68 (65-83)
LOW albumin 28g/l (34-48)
HIGH alt 35 (female)
total bilirubin 0,7 (0,3-1,2)
LOW hemoglobin 9,2g/dl (12-15)
LOW mcv 74 83-101
mch 23,3 27-32
mchc 31,2 31,5-34,5
LOW platelets 147 150-450
white blood cells 4,05 4-10
LOW red blood cells 3,96 4,5-5,5
immune blood counts are normal
phosphorus 5 2,5-4,5
HIGH GGT 96 5-36
LOW magensium 1,5 1,8-2,4
HIGH alkaline phosphatase 193 35-104
prothrombin time 11,7sec 87% INR 1,07
aPTT 38,4sec ( norm 20-38) ratio 1.24
HIGH derived fibrinogen 574 (200-400)
she had transplant end of 2015
17 dec 2015 alt 189 ggt 219, biopsy moderate acute rejection, increse of immune suppressive drugs didnt work so they used other steroid drugs steroid drugs and alt lowered to 71 ggt 252
08 jan 2016 severe itch all over the body, increase of cholestasis tests and cytolytic tests so by ultrasound they saw the biliary problems and started antibiotics
13 jan 2016 they put 1 stent since then she had fever 39,5° and itch
22 feb 2016 they removed the stent but fever and itch did not improve
06 april 2016 hemoglobin 10 mcv 73 mch 22,9 inr 2,85 albumin 3,00 ast 40 alt 66 ggt 179 fa 310 bilirubin normal
they put 2 stents later but fever and itch still there, i guess sometime in april
sub hepatic hilum non anastomotic stenosis
liver US is ok nothing abnormal,gallbladder removed, intrahepatic biliary ways are a little enlarged 2-3mm and 2 stents are present
kinking of hepatic artery with accelerated flow to 300cm/sec.
All other descriptions are norm, pancreas is normal
Spleen is enlarged diameter 16cm
translation of ultrasound results is quite complicated since i never studied biliary system so i dont understand what italian words mean too
i just report abnormal tests or important tests for liver on 10 may 2016, i dont see any advanced blood tests, just easy routine tests, strange for a very good university hospital, anyway
microcytosis positive
total protein 68 (65-83)
LOW albumin 28g/l (34-48)
HIGH alt 35 (female)
total bilirubin 0,7 (0,3-1,2)
LOW hemoglobin 9,2g/dl (12-15)
LOW mcv 74 83-101
mch 23,3 27-32
mchc 31,2 31,5-34,5
LOW platelets 147 150-450
white blood cells 4,05 4-10
LOW red blood cells 3,96 4,5-5,5
immune blood counts are normal
phosphorus 5 2,5-4,5
HIGH GGT 96 5-36
LOW magensium 1,5 1,8-2,4
HIGH alkaline phosphatase 193 35-104
prothrombin time 11,7sec 87% INR 1,07
aPTT 38,4sec ( norm 20-38) ratio 1.24
HIGH derived fibrinogen 574 (200-400)
Sorry to hear all that. I m praying for her. Belive she will recover.
Was she managing hepatitas before?any treatment? Wasnt any chance to stop liver failure? She is so young
Was she managing hepatitas before?any treatment? Wasnt any chance to stop liver failure? She is so young
she also told me fever is not 37-38 but constantly 38-39°, antihistamine drugs dont work at all on itch
thanks for your feedback, she had autoimmune hepatitis cirrhosis since she was a teen, now at about 38yo there was no liver left and also transplant was not usual
i also think it is an infection she will send me all tests and diagnosis, strange one of the best hospital in italy is not managing this thing the best way
i also think it is an infection she will send me all tests and diagnosis, strange one of the best hospital in italy is not managing this thing the best way
sorry i posted fast and didn t recheck it can be misunderstood
her case was very difficult with low probability of success because vena porta was blocked but when they open during surgery they saw another vein got as big as vena porta so they could attach new liver there
she had biliary problems after the transplant so they put a stunt and so bilirubine lowered to normal levels and itch resolved but the stunt made a bacterial infection detected by tests, so they removed the stunt, did antibiotics and then put 2 stunts again and after this infection/itch started back again
now despite bilirubin is normal she has itch anyway, fever and i guess infection too.bacteria blood test should be ready by a week.
medical team is from one of the best university hospital in italy but despite this she has this continuous itch/fever/infection 6 months and also a cytomegalovirus infection treated by antivirals
her case was very difficult with low probability of success because vena porta was blocked but when they open during surgery they saw another vein got as big as vena porta so they could attach new liver there
she had biliary problems after the transplant so they put a stunt and so bilirubine lowered to normal levels and itch resolved but the stunt made a bacterial infection detected by tests, so they removed the stunt, did antibiotics and then put 2 stunts again and after this infection/itch started back again
now despite bilirubin is normal she has itch anyway, fever and i guess infection too.bacteria blood test should be ready by a week.
medical team is from one of the best university hospital in italy but despite this she has this continuous itch/fever/infection 6 months and also a cytomegalovirus infection treated by antivirals
1 Comments
Despite the normal bilirubin, the itch must be the result of elevated bile acids due to cholestasis. they should be measured. For this itch antihistamins will not help.
A now chronic cholangitis perpetuated by insufficient bile flow due to mechanical/ anatomical problems is most likely the source of the long term fever.
The only hope is normalization of bile flow and treatment of the bacterial cholangitis. This would also remove the itch.
It seems that the original transplantation surgery did not go very well.
Trapping of some bile acids by cholestyramine or Colesevelam might reduce the bile acids somewhat, but the cholestasis is now caused not only by the discontinuity in the bile duct, but also by inflammation in the smaller bile vessels. I cannot imagine that this will get better without intense antibiotic therapy and bile flow restoration.
A now chronic cholangitis perpetuated by insufficient bile flow due to mechanical/ anatomical problems is most likely the source of the long term fever.
The only hope is normalization of bile flow and treatment of the bacterial cholangitis. This would also remove the itch.
It seems that the original transplantation surgery did not go very well.
Trapping of some bile acids by cholestyramine or Colesevelam might reduce the bile acids somewhat, but the cholestasis is now caused not only by the discontinuity in the bile duct, but also by inflammation in the smaller bile vessels. I cannot imagine that this will get better without intense antibiotic therapy and bile flow restoration.
Friend of my family had a liver transplant back in 2006. Had very similar liver issues- itch and fever. Spent months in hospital. It was bacteria- just spoken to him now. Fully recovered.
Is yr friend's liver failure caused by hbv? Our friend didnt have hbv..
Is yr friend's liver failure caused by hbv? Our friend didnt have hbv..
@stephen that's what I thought when I read the first page. Thanks Studyforhope for ur support & fast recovery to stef2011 friend.
Our thoughts and best wishes are with Studyforhope.
1 Comments
Excellent sense of humor...
where could we look at?i think she took antibiotics and itch/fever was cleared for sometime but then fever and itch got back
to me it is an unresolved infection which cannot be detected by normal blood tests, anyway tomorrow she will tell me all details and tests she did
to me it is an unresolved infection which cannot be detected by normal blood tests, anyway tomorrow she will tell me all details and tests she did
1 Comments
Since the condition has responded once to antibiotics, a bacterial infection is very likely.
A test of C reactive protein, Interleukin 6 and tumor necrosis factor alpha, all available, should help to clarify the bacterial origin.
While the transplant related immunosuppression can skew the classical signs of infection, these test should still give fairly high above normal results if the condition is caused by a locally stimulated infection focus even in the absence of marked leukocytosis.
It seems to be important to guide the decision to re-initiate antibiotic therapy in such a delicate stetting.
A test of C reactive protein, Interleukin 6 and tumor necrosis factor alpha, all available, should help to clarify the bacterial origin.
While the transplant related immunosuppression can skew the classical signs of infection, these test should still give fairly high above normal results if the condition is caused by a locally stimulated infection focus even in the absence of marked leukocytosis.
It seems to be important to guide the decision to re-initiate antibiotic therapy in such a delicate stetting.
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