PBC and OVERLAP

[DeeDee051]

I have been told that I am at the near the end of stage three of the liver disease and am border line fibrosis and cirrosis but that there is still quite a large window to work with.  At the moment my ALTs are fairly good at 49.  They have dropped substantially.  I am on 1 g Mycophenalate Mofetil twice daily, 750g Ursodeoxycholic Acid three times daily and Ezetimbe 10g daily for cholesterol.  I feel clinically fit and weigh 9 st 3 lb.  The disease is progressing but I wonder if there is any timescale on this as regards prognosis and if I am able to have a transplant with having both PBC and Overlap.  I am a 51 year old female.
I have to have an MRI or CT scan soon as I have a lot of nodules in the liver they need to check up on.

[Thomas D Schiano, MD]

i think then you should stay on the current regimen. make sure you have received hepatitis a and b immunizations if appropriate. good luck.

[DeeDee051]

Thank you for that.  Yes I had a reaction to both Azathioprine and also Mercaptopurine. I have had 2 bi opsys read and fibro scans and ultra sound.  look pretty poor but I feel absolutely fine on the meds.

[Thomas D Schiano, MD]

overlap syndromes are extremely difficult to treat.  azathioprine is often used instead if cellcept but I am using the latter in patients intolerant to azathioprine.  i think that you are receiving adequate medical therapy.  Please make sure that your liver biopsy has been read by an excellent liver pathologist for a second opinion.