HE and cirrohsis and liver transplant

[balzapoppin]

2 questions:

1. Do all hcv patients who have hepatic encephlopathy have cirrohsis, and....

2. Is it true that you can't get a liver transplant if you got HCV from intravenous drug use, even though you've been clean (completely) for over 20 years?  i live in nj if that matters.
thx

[ClippedWings]

  As always, Elaine and Hector give solid advice.  I had a transplant due to end stage liver disease resulting from HCV and cirrhosis.  To get listed for a transplant you will go through a battery of tests and interviews (with social workers, anesthesiologists, surgeons, financial counselors, and others).  The transplant team will tell you exactly what the exclusion criteria will be for their center.  Typically you must show abstinence from drugs and alcohol.  At my transplant center, tobacco use was also a "deal breaker".  Many transplant centers will have a maximum BMI that they will establish to be listed.  At every appointment with the Hepatologist I was checked for compliance with those policies.  I am not aware of any center that would exclude a person for drug use that occurred twenty years in the past.  Current drug or alcohol use is an entirely different matter.  To echo what Hector said few, if any, of us can tell with certainty how we contracted HCV.  The exposure risks are numerous: tainted blood products, improper sterilization at a medical or dental facility, tattoos, body piercing, using someone else's razor or toothbrush by accident, contact with another person's blood while administering first-aid or medical care, the list goes on and in many cases the Hepatitis C patient will have no knowledge of how he/she contracted the disease.  Although injection drug use is the most likely risk factor today, twenty years ago the risk from contaminated blood products was the most likely transmission source.
Good Luck to you.

[HectorSF]

1. Yes HE is a symptom of cirrhosis. Cirrhosis has two main phases. Compensated and decompensated. When compensated there may be no obvious indication of liver disease. Once the you experience symptoms of decompensation the disease has progressed to its final phase before liver failure. HE is a symptom of advanced cirrhosis. Decompensted cirrhosis. Other common symptoms include: ascites and edema, varices, bruising and bleeding, weight loss, etc. These symptoms indicate that the liver is so damaged (scared) it can no longer function properly. People with decompensated cirrhosis eventually develop many symptoms and complications that can be life threatening.

2. Is it true that you can't get a liver transplant if you got HCV from intravenous drug use, even though you've been clean (completely) for over 20 years?  i live in nj if that matters.
thx

2. There is no way of knowing how a person was exposed to HCV. Most transplants of the liver in the US are performed for persons with chronic HCV. Many people don't know how they came in contact with the virus. The second largest group of transplants are performed on patients who livers have been damaged from the use/abuse of alcohol. If you think about it there are many diseases caused by lifestyle choices. No one is denied treatment because of how they got the disease.

HE needs to be managed as does other symptoms of decompensated cirrhrosis. The current standard meds are lactulose and an antibiotic such as rifaximin. Please talk to a hepatologist about managing this and other symptoms of decompensated cirrhrosis. There are a number of factors that can make HE worse. A hepatologist will help you with this. Also keep in mind that as HE progresses it can lead to doing things you don't remember and eventually coma. Many patient with HE are told not to drive because of the unpredictable nature of HE.

Anyone with decompensated cirrhosis should be under the care of a hepatologist. Preferably at a transplant center. A liver transplant is the only option for treatment once the liver disease has progressed this far. Once the liver begins to show signs of decompensation life expectancy is greatly reduced. So you need a specialist who will work with you. They will help you manage the disease and get listed on a liver transplant list.

Hope this helps.
Best of luck.
HectorSF

[child24angel]

Hi,

Ammonia that is processed through the liver might
be higher in someone with cirrhosis.  If the liver is
starting to fail, as in cirrhosis, it can no longer clean out
the toxins etc.   Not everyone is the same, some
have high ammonia levels and don't show
symptoms of hepatic encephalopathy
They will usually give you lactulose to help with
hepatic encephalopathy if you show signs of forgetfulness,
confusion, unable to concentrate. Chances are if you
have hepatic encephalopathy, you may have cirrhosis and you
should be seeing a hepatologist, I hope.

2.  No....I've never heard of that before, as long as you're
clean now, you can still be a candidate for a TP.

Try and get listed in other regions/states if you can.

The higher your MELD score the higher up the list
you go.

I wish you the very, very best
Elalne