Aa
End Stage Liver Disease
I have end stage liver disease, have had esophogeal varices, etc. I am presently doing treatment for HCV, and at last RnA Quant. there were no signs of the virus. If I clear the HCV from my liver, do I still have ESLD and should I remain on the transplant list?
I've been worried about the old dates popping up. Not sure how folks are finding them.
Probably trolling through nursing homes and retirement trailer parks, plying the oldies with promises of prune exilyr.
Or maybe Geritol with Viagra - that's how you get and old date to pop up.
Probably trolling through nursing homes and retirement trailer parks, plying the oldies with promises of prune exilyr.
Or maybe Geritol with Viagra - that's how you get and old date to pop up.
Youse guys know that hippiemom posted this 3 years ago?
just thought I'd let you know.
I've been worried about the old dates popping up. Not sure how folks are finding them.
just thought I'd let you know.
I've been worried about the old dates popping up. Not sure how folks are finding them.
I am guessing you are genotype 2. I see no problem with geno 2's not getting a biopsy before treating. The course of treatment can be really brief for geno 2's (12 weeks or so) and lead to acceptable odds for svr. Your doctors could monitor you more frequently than non-cirrhotics on tx and use that information to stop your treatment if it looks like you are not handling it well.
If I were a geno 1 and out to treat for 48 or 72 weeks, though, I would want to know what condition my liver were in before starting. I don't think biopsies for geno 1's who have bled is an irresponsible approach at all, and in general (if their liver is compensated, inr and platelets not at dangerous levels, etc.) I would not discourage someone in that situation from getting one if they were leaning towards tx and wanted more information to make the decision.
If I were a geno 1 and out to treat for 48 or 72 weeks, though, I would want to know what condition my liver were in before starting. I don't think biopsies for geno 1's who have bled is an irresponsible approach at all, and in general (if their liver is compensated, inr and platelets not at dangerous levels, etc.) I would not discourage someone in that situation from getting one if they were leaning towards tx and wanted more information to make the decision.
Some of the posts here are concerning. There happens to be some misinformation and misunderstanding. I am happy to share what I know. First of all whoever said that it takes 7 yeasrs to go from Child's Class A to Child's Class B, I'd like to know where you got that infomation. I was diagnosed with Stage 4 Cirrhosis and Child's Class A in 1992. I am still Stage 4 and I am still well-compensated.
I was fortunate enough to have the ear of Dr Shiffman in May. He is one of the lead investigators on the HALT C Trials. Here are some of the things he told me. By the way, the HALT C info is going to be presented for the first time at AASLD in November. He said that approximately 80% of cirrhotics are still doing well 10 years after diagnosis. During the trials they biopsied 100's of patients at the start and finish of treatment and 5 years later. This is what they found. If a person was Stage 4, and they got an SVR, 5 years after treatment ended, 20% have a reduction in fibrosis, usually just one stage. If they were Stage 3, 80% had a small reduction. If they had minimal fibrosis, Stage 1 or 2, all of them had a reduction in fibrosis, some of them to Stage 0.
Also, biopsy is important for those who do not want to treat unless they have lots of liver damaqe. There are peoople who can pinpoint when they were infected. If biopsy shows Stasge 1 20 or 30 years later, they can safely choose not to do treatment at this time and maybe never. I am very pro treatment personally but I would never push anyone with a small amount of dammage to do it if they've had the disease a long time. Only 20% or so of patients will progress if not treated. That leaves a lot of people, if they take care of themselves, to do quite well, grow old, and die of something else.
Please be careful of all information on the internet. Always check with your doctor.
I was fortunate enough to have the ear of Dr Shiffman in May. He is one of the lead investigators on the HALT C Trials. Here are some of the things he told me. By the way, the HALT C info is going to be presented for the first time at AASLD in November. He said that approximately 80% of cirrhotics are still doing well 10 years after diagnosis. During the trials they biopsied 100's of patients at the start and finish of treatment and 5 years later. This is what they found. If a person was Stage 4, and they got an SVR, 5 years after treatment ended, 20% have a reduction in fibrosis, usually just one stage. If they were Stage 3, 80% had a small reduction. If they had minimal fibrosis, Stage 1 or 2, all of them had a reduction in fibrosis, some of them to Stage 0.
Also, biopsy is important for those who do not want to treat unless they have lots of liver damaqe. There are peoople who can pinpoint when they were infected. If biopsy shows Stasge 1 20 or 30 years later, they can safely choose not to do treatment at this time and maybe never. I am very pro treatment personally but I would never push anyone with a small amount of dammage to do it if they've had the disease a long time. Only 20% or so of patients will progress if not treated. That leaves a lot of people, if they take care of themselves, to do quite well, grow old, and die of something else.
Please be careful of all information on the internet. Always check with your doctor.
ESLD is determined by your symptoms and lab values. What is your MELD score ? Have you had any varices banded ?
Generally, the only reason to treat with ESLD is to hopefully become undetectable before transplant.
Treatment has never been linked to a reduction in portal hypertension in cirrhotics as far as I know. It HAS been linked to pushing compensated cirrhotics into decompensation and ESLD, and is contraindicated in those with ESLD. However, many hepatologists are treating those with ESLD. Others won't. My doc developed LADR (low accelerating dose regimen) for those with ESLD. He has met with success in clearing those pre-tp and maintaining SVR post-tp. The numbers aren't great yet, but at least there is some hope against re-infection post-tp.
The only way to get taken off the list is by choice, or the failure to meet the minimum requirements required for listing at your tp center. A minimum of a MELD score of 6 is the lowest UNOS requires.
Best regards,
Mr Liver
Generally, the only reason to treat with ESLD is to hopefully become undetectable before transplant.
Treatment has never been linked to a reduction in portal hypertension in cirrhotics as far as I know. It HAS been linked to pushing compensated cirrhotics into decompensation and ESLD, and is contraindicated in those with ESLD. However, many hepatologists are treating those with ESLD. Others won't. My doc developed LADR (low accelerating dose regimen) for those with ESLD. He has met with success in clearing those pre-tp and maintaining SVR post-tp. The numbers aren't great yet, but at least there is some hope against re-infection post-tp.
The only way to get taken off the list is by choice, or the failure to meet the minimum requirements required for listing at your tp center. A minimum of a MELD score of 6 is the lowest UNOS requires.
Best regards,
Mr Liver
I can understand that you don't want a biopsy and I think you have a point about the greater risk with ESLD. Have you thought about getting a Fibroscan? They're not available everywhere yet, but it's an alternative to biopsy that can be very accurate and completely painless and risk free. If you live in a major city you may have that option.
Some of the people on this forum (Kalio, for one) have had them done. There is a doctor, Hepatitis Researcher, who occasionally visits this forum, who actually has the machine.
Some of the people on this forum (Kalio, for one) have had them done. There is a doctor, Hepatitis Researcher, who occasionally visits this forum, who actually has the machine.
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