chronic liver rejection

[mkess]

My ex, father of my children, had liver cancer with Hep C history.  Liver transplant Dec. 2010.  Hep C return with 20 million viral load reduced to 7 million on interfuron and reduction of immunosuppressant drugs.  However, his billirubin began climbing and biopsies began showing small signs of rejection.  Now he is in hospital again with billirubin count of 20, new biopsy confirmed chronic rejection and Hep C viral load is up to 13.  he tells me the dr. is now going to icrease immunosuppressant drugs and probalbly try some new not FDA approved trial drugs.  I am trying to get a handle on how serious this is as i am in NY with the kids (14 and 16 yrs. old) and he is in Fl. and I need to know what to tell the kids and when to take them to see him.  He thinks he will be able to fly up in Aug to see them but he is so weak now (135 ponds at 5' 8") I can't see how that will happen.  I am not sure if he knows how sick he is or he just doesn't want me to be upset.  I speak to him 2-3 times a day, is there anything I should ask him.  I did ask what the prognosis was and he said the doctor said worse case scenerio is two years.  Is that true or is he just protecting me or is the dr. protecting him?  Thank you.

[Thomas D Schiano, MD]

i think that you should have the kids see him soon if retransplantation is not an option.  the diarrhea can be related to the very abnormal liver tests.  the wt gain may be related to liver failure and any concurrent renal dysfunction.

[mkess]

thank you.  No new transplant is possible  He is also diebetic.  They are sending him home maybe tomorrow on icrease prograft med and still on meds for the hep c but he told me the billirubin is so high because the bile ducts are not working properly.  he just noticed yesterday that his ankles and feet and legs are swelling and he gained 7 pound in a week.  Must be water weight.  What is causing the water retention as he has constant diahhrea. He runs a fever, has chills and is in pain.  Doctor wants him to see pain management on Monday. How soon should I get his son and daughter to see him.

[Thomas D Schiano, MD]

unfortunately i am concerned if he has both chronic rejection and recurrent HCV.  the new medicines may be dangerous to use.  he may require another liver transplant if this is possible.  i am not sure if using the new medications in this setting.