liver failing after SVR

[ruby555]

My husband had Hep C and was treated successfully in 2008.  Since then, labs slowly declining.  MELD was an 11 at start of treatment, has recently risen to a 20!  No docs can figure out why things are getting worse despite clearing the virus. He drinks NO alcohol at all, eats relatively well, sneaks an occasional cigarette but it not a heavy smoker.  He has been tested for other liver diseases and all negative. Any thoughts as to what could be happening?  He's been seen by liver specialists at Hahnemann Hospital and UPenn in Philadelphia - no answers except now its time to evaluate for transplant.  We were told to expect liver to remain stable and even get a little better after SVR. Have you ever seen this happen?
Thank you!

[Thomas D Schiano, MD]

good luck--I am hopeful things will be fine

[ejoli]

    Well, thank you Dr. Schiano for answering my questions. Most of the time I don't think about it too much. I do wonder what will happen though. I have had cirrhosis at least 10 years but I could be a lot worse.     Sorry I jumped in your post ruby555. It seemed like we had a similar problem.
                                  Thanks again!

[Thomas D Schiano, MD]

unfortunately all we can do for now is expectant management

[ejoli]

       So, what do I do now?  Just wait to see if it gets worse?  I am monitoring for HCC every six months.    My Dr. says that hopefully the cirrhosis won't progress too fast.  Does that mean it will progress?    I guess we won't really know. Watch and wait.    Thanks for your comments.

[Thomas D Schiano, MD]

monitoring for HCC remains important

[ruby555]

Thanks for the reply - his kidneys are in good shape - it's the bilirubin that has shot up over the years. They had never mentioned fatty liver before....our doc says in a very small percentage of people the damage progresses despite SVR, I guess we are one the the unlucky ones.

[Thomas D Schiano, MD]

unfortunately yes

[ejoli]

   I have what my Dr. says is "persistence of cirrhosis"  I did one of the victrellis trials and am SVR for almost 2 years now.  I developed HE after my treatment and have a few varices.(grade 1)  At least if I end up transplanting I won't have the virus anymore. Meld is 12.   Have you heard of this?

[Thomas D Schiano, MD]

i am not really sure why unless he has baseline fatty liver that has worsened. Creatinine assesses renal function and is a prt of the MELD equation so its also possible that the increase in MELD is reflective of worsening renal function as opposed to worsening liver functions.