Gall Bladder Surgery for Pre-Transplant Liver

[susiedanny]

My husband has hep C and is on the Liver Transplant List at the Mayo Clinic.  His MELD scores have been 8 to 11 for a couple of years (his health has improved dramatically since he stopped drinking 5 years ago)   His plateletts are still 40 to 45... He is doing so well, one Dr. said he may have dogdged the bullet...and could possible never have to get a transplant...
He has had several gall bladder attacks...we saw a surgeon who specializes in gall bladder removal, and he wouldn't touch him.....the Mayo Clinic told him to cut out the fats..etc.  He was just in the emergency room last week for another severe attack.  
How dangerous is removing someone's gall bladder who has low plateletts...His family dr. and I want him to have surgery now instead of waiting for his condition to worsen...because I am worried the surgery will be alot more dangerous at that point...Thanks

[gilmane]

I had a somewhat similar situation while waiting for my transplant. I needed my gall bladder removed ASAP but could not qualify for a cadaveric liver (this was before meld scores). I also had extremely low platelets, slightly lower than your husband, but not much.  When they performed the Transjugular Intrahepatic Portsystemic Shunt (TIPS) procedure to stabilize me I almost bleed to death. I used up every available pint of compatible blood that day. I went in for what was scheduled as a one to two hour procedure and came out 14 hours later and they said I was lucky to make it through.
The Transplant team told me I needed a Living Liver Donor ASAP so that they could do the Liver Transplant and the gall bladder removal at the same time. There was no way I would survive a gall bladder removal until I had a new liver. I was lucky enough to have a donor volunteer and the transplant team expedited the donor testing and performed both procedures at the same time.
You may want to ask the Transplant team if they think a Living Donor Transplant is warranted in your husband's case if the gall bladder surgery is absolutely necessary .
Good luck

[Thomas D Schiano, MD]

there is no easy answer here.  you are absolutely correct in stating that it would be better to have the gallbladder removed when you are not as sick,  However, even though the MELD score is low you may have Child's B cirrhosis which would give you a lot of morbidity and mortality with a cholecystectomy in the setting of what appears to be appreciable portal hypertension.  Unfortunately waiting things out may be the most prudent approach.