tight and swollen discomfort upper right side

[stancarey]

Post transplant one year ten months.prograf levels 4.5 Stents taken out five months ago for bile duct stricture that has been treated since five days post transplant. About one month after stents removed started getting areas of pruritus and discomfort upper right side. Swollen and tight feeling transient in degree. Sometimes the discomfort is quite nagging and other times its barely noticeable except for a slight tightness. Bilirubin levels with stents averaged around.07.since stents were removed  bilirubin .06. /09/ 1.1 / 1.5 / 1.6 / .08 / 1.6 . liver labs good, alt and ast slight increase from mid twenties to mid thirties. They don't take ggt. Medication.. 1mg prograf twice daily. 300mg ursodiol twice daily. The only other anti rejection meds were prednisone first six months. Notes : Have reduced prograf levels in last 7 months from 8 and change to 4 and change ,from 3 mg twice to 1 mg twice. Could this have some bearing? Moved and changed post transplant care. Untreated pleural effusion for one year in hopes it would go away on its own.Once thorocentisis was initiated the first couple of times a liter was drained. Total seven thorocentisis were done the last two 300 cc were drained and they said the remaining fluid was lockulated . The pain associated with the fluid eventually went away. Umbilical hernia was not repaired during transplant, was told it was to big to repair at that time. Was in severe pain for several days after transplant before they realized it was coming from strangulated intestines. When they did the repair I was told the intestines pinked up. The repair was done about eight days post transplant.  An inguinal repair followed. When i started eating anything of substance about two months post tp i noticed my abdomen swelling.The proximity of my intestines to my liver and upper right side  i thought it worth mentioning. I am in the process of getting a surgical consult .I would very much appreciate any direction or input.

[Thomas D Schiano, MD]

this looks like mild recurrent HCV without fibroisis and is actually a good biopsy.  these findings do not explain your symptoms.

[stancarey]

There is sparse perivenular lymphocytic infiltrate surrounding 2 portal veins. no neutrophilis or eosinophils are identified. no signifigant endothelialitis or cholangitis is identified. Within lobules rare acidophil bodies end mild hepatocyte anisoncleosis are seen., but there is no significant inflamatory cell infiltrate. Occasional glycogenated nuclei are seen. there is no signifiicant cholestasis or steatosis. no significant fibrosis.Liver tissue within minimal histologic abnormality. biopsy done two months after stents were removed. my hep c is 60,000 per. What is your opinion about biopsy? Is a biopsy determinant or preclude any possible complications that could be causing these symtoms? Given  the previous information what would you suggest to rule out that these complications aren't coming from a bile duct problem , and any associated damage that this could be doing to my liver?  Thank You very much Dr Thomas Schiano

[Thomas D Schiano, MD]

all of this could be related to having bile duct problems.  what actually did the biopsy show--recurrence of HCV?

[stancarey]

I had biopsy and liver showed no rejection. tp for cirrhosis hep c . What do you think about bilirubin , pain and itching ? Could have any thing to do with bile ducts? stomach swells up after eating especially, but stays in the position as if im sticking my stomach out.its like my intestines are full of water.Could this have any thing to do with previous strangulated intestines? Thank you  Dr Schiano

[Thomas D Schiano, MD]

have you ever had a liver biopsy to make sure rejection is present?  what was the reason that you were transplanted in the first place?