Is Transplant Necessary?

[Sky_King]

My husband has had hepatitis C for about 33 years and is in the early stages of cirrhosis. He has a mass on his liver.  On the ultrasound it was 3 x 3.6 cm, on the CT Scan 2.9 cm, and on the MRI 2.1 cm.  It seems as though it is getting smaller with each test. Biopsy showed almost all necrosis with some atypical cells.  It was diagnosed as probable HCC.  The hepatologist says it appears to have infarcted and has no blood supply.  The person who read the MRI thought that my husband already had chemoembolization.  The surgeon believes that my husband should still undergo a transplant even though the diagnosis of cancer is not definite.  He believes waiting is a greater danger than transplanting.  Resection is possible but we know that that is not the best solution.  Do you believe that a transplant is necessary?

[Thomas D Schiano, MD]

HCV can cause an elevation of AFP to 100-200.  we often repeat CT scan or MRI every 3 months looking for interval growth of lesions if we are not sure.

[Thomas D Schiano, MD]

this sounds like a hepatocellular carcinoma.  Is the AFP level elevated?  90 % of patients cannot have resection for their cancer because the liver will fail.  Transplant may very well be necessary.  if he has cirrhosis he loses nothing by being placed on the liver transplant waiting list.  the abnormal lesion can be followed expectantly during this process. Ultrasound is not a good study to look at liver cancer.  The difference in size betwen the MRI and CT scan is minimal.  Biopsies notoriously are unreliable in this setting with a lot of false negative results.

I hope this is helpful.

[Thomas D Schiano, MD]

fantastic news.  I am very happy to hear this. good luck and wish him my best.

[Sky_King]

Dr. Schiano,
Thank you for answering my questions.  You helped by confirming what our transplant teamed had told us.  My husband was placed on the transplant list on July 30 and had his transplant only 6 days later on Aug 5.  He is doing very well.  The pathology on his old liver was as good as one could want.  The mass was completely necrotic, no vascular invasion, nothing anywhere else in the liver, and no lymph node involvement. He is now dealing with high blood pressure and high blood sugar issues, but hopefully when the medication decreases those things will improve.
thank you for your advice.

[Sky_King]

Thank you for your help.  His AFP in mid-April was 18ng which is slightly higher than normal but not indicative of cancer.  We understand that hepatitis C can cause a slightly higher than normal AFP and that there is a 30-40% chance of a false negative. Last week he had more blood tests taken--15 vials worth--but we do not have the results yet.  That may tell us more.