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transplant issues

My friend had a liver transplant 6 months ago. He had a liver biopsy recently and was told that his new liver is already in
some stage of cihrosis. He is not recovered enough from surgery to start TX. Thoughts anyone.
17 Responses
Avatar universal
I was not aware that stage advancement could occur so quickly!

This type of thing is one reason why I've been apprehensive of even considering this route, particularily since I have been unable to clear the virus.  It will be interesting to see what other response this thread receives.
Avatar universal
"Patients with HCV-related liver disease have a 23% increased rate of mortality and a 30% increased rate of graft loss at 5 years post-transplantation as compared to patients transplanted for other indications.[1] Cirrhosis is reported in up to 30% of recipients within 5 years,[2] and progression is not linear.[3] Once cirrhosis is established, patients are at high risk for complications, with up to 42% developing liver decompensation within 1 year.[4] Retransplantation, the only definitive therapy for recurrent disease with decompensation, is controversial in patients with HCV, as their survival is inferior compared to patients with non-HCV indications.[5,6]"
See: You must be registered to view but it's free and easy to register.
<A HREF="http://www.medscape.com/viewarticle/523521_1/">Management of Hepatitis C in Liver Transplant Recipients(2/28/2006)</A>

Mike
Avatar universal
My friend, my late friend, Jack Slater detailed his transplant stuggle and death in the Seattle Times.  He also is wtiting a book about his experience-well he was b/now his wife is finishing it.

He waited several yrs and didn't tx before hand.  His new liver began failing w/in 6 mos and he was dead 17mos after transplant.  The hep c just overwhelmed his system-much faster, much harder and much more visious.

You can go online and read his articles @ Seattle Times.com.

Probly not what you wanted to hear.  B/it might help you know what he's going thru and what he's thinking about it.  Also Deb's perspective as a caregiver to the end.
Avatar universal
My friend's transplant was from a young person who also had
Hep C. I suppose that since the virus is already in your system that hep c transplant recipients are likely to get a donor also with the disease. He was told initially that at some point he
would begin tx. Not sure now with this new diagnosis.
Avatar universal
Thanks mike for the info. Will check the site later. Gotta run now.
Ocala gal
Avatar universal
While HCV positive recipients have received HCV positive livers this isn't generally the case in my experience. As a matter of fact none of the HCV positive recipients I know have received an HCV positive liver. Mike
Avatar universal
It seems dangerous to be transplanting an infected organ into anyone even though the recipient may already be infected. Especially given the millions of quasi-species that HCV is thought to mutate to and that the recipient may acquire a tx resistent quasi-species which may turn what may have been a treatable infection into a nonresponder situation.
Avatar universal
<A HREF="http://www.medscape.com/viewarticle/543528_1/">Sensitivity to Antiviral Therapy May Change After Liver Transplantation in Patients With Chronic Hepatitis C Virus Infection</A>

"Fixation of mutations within the HVR1 were not associated with the changes in response to therapy. Although fixation of mutations within the NS5A occurred preferentially in patients in whom sensitivity to antiviral treatment changed after LT, it also occurred in some patients in whom the pattern of response to antiviral therapy remained unaltered.
These results suggest that the changes in sensitivity to antiviral therapy after LT cannot be exclusively attributed to variations in the viral quasispecies that occur after transplantation. The implantation of a graft with its own genetic background may also influence the 'sensitivity' of HCV to antiviral therapy. This is supported by different studies that propose that gene expression profiles of the liver might modulate the response to IFN.[27,28] The potential role of the host is sustained by the different spontaneous outcome of HCV infection as well as the different response to antiviral therapy in individuals infected with the same HCV strain in the setting of HCV outbreaks.[31,32].......
In conclusion, the sensitivity to antiviral treatment may change after LT. Importantly, patients who were nonresponders to previous treatments may become responders after transplantation. This possibility needs to be taken into account when antiviral therapy is considered in patients with recurrent hepatitis C after LT"
Mike
Avatar universal
Thanks Mike for your insights and the valuable information.

I'm trying to stay positive and keeping my eyes and ears open to any and all possibilities on kicking this insidious disease while trying to not allow it become an obsession which controls me and degrades my quality of life.

I'm not diametrically opposed to the TP option, just expressing the major reservations with which I've been struggling with on it.  Bascially, exploring the ethical and moral implications and working to come to terms with it should it become the only option.

Thanks again for sharing your experience and it certainly does appear as though you were blessed on all counts with respect to the TP and kicking the virus.
Avatar universal
You're very welcome. I wish you good fortune. Mike
Avatar universal
If you gave a part of your liver what remained would regenerate to approximately its original size - you'd get back to "normal". The part donated at the very best would never regenerate to a size larger than its original size. That's off the top of my head and could and probably is dead wrong so my advice to you is to research the subject. I would but I gotta run. If you learn about it post it and if I check and don't see anything I will find out for you and post it. One of the crucial features that must be right is the size. You can't put a liver in if the cavity won't be large enough to accommodate it and conversely, you can't use too small of a liver either. Size, in this case, does matter. Mike
Avatar universal
Thanks Mike, on the surface this study seems to confirm my suspicions on quasi-species with respect to transplanting infected organs.  I tried reading the entire report, but seemed to have problems getting WebMD to advance past the first page or provide a printable version.

I guess the good news is that there currently is no evidence of cross genotype mutations occurring.  As I've researched the area of HCV quasi-species I've become completely amazed at how resilient this virus truly is and how it almost seems to be sentient in how to replicates and mutates to ward off threats to exterminate it.  Small wonder there is no vaccine and why tx options are so limited.  From what I've seen of most meds on the horizon it would appear that they may be too direct in their attack to prevent replication and may cause mutations which explains why most of them seem to only be considered a partial augmentation to existing tx rather than a replacement or complete addition to the current tx med cocktail.
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