Alcoholic Cirrhosis - Transplant Needed

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Kartikey
New Member


Date Joined Oct 2016
Total Posts : 5
   Posted 10/29/2016 3:34 AM (GMT -6)   
Hi Everyone.

MY Father is 64 years old and is suffering from Liver Cirrhosis since 2012. He has a history of excessive alocohol consumption which he has stopped in 2012 only. In the initial 2 years, he had to stay in hospital several times due to Internal Bleeding but for last 2 years, his condition was almost stable with no sign of intestinal bleeding. His albumin ranges from 2.8 g/DL to 3.2 g/DL so he has been undergoing transfusion of Albumin twice daily. His creatinine ranges from 1.3 mg/DL to 1.7 mg/DL. In last 2 years, there are only a few rare occasions when his creatinine has dropped to the normal value which is less than 1.2 mg/DL. His Bilirubin ranges from 1.7 to 1.9 mg/DL.

Since February, 2016, he has developed the problem of Ascites and has to undergo Paracentises every 10 to 15 days where around 7 to 8 liters of water is tapped out of his body. Since February, he is going more and more weak and mass from his body is disappearing.

In spite of the decreasing health, his liver & kidney functions have stayed almost constant. Last week, he suddenly caught fever and was unable to pass the urine. On 3rd day, we came to hospital where they admitted him in Intensive Care Unit. Doctors told us that kidney is not working and creatinine has reached 4 mg/DL. in 4 days, they have performed dialysis twice on him and they are giving him Terlipressin Injection and trying to revive the kidney.

But they have clearly asked us to consider Liver Transplant very soon otherwise, he might lose his kidney also. My dad is very reluctant to take live donation from me since I have the same blood group. And waiting for Cadaver Donation might waste a lot of time. We have already wasted a lot of time. We have to very quickly decide the future course of action.

I am reading all sort of stories of post transplant recovery and the quality of life. Is the live donation better than Cadaver Donation in any sense? Because in India, you are not sure how long will you have to wait for a liver being on a waiting list. Are there chances of kidney revival to its full after the transplant since kidney is affected only due to the liver disease. I am very confused about every thing, donation, surgery & most importantly, post - op recovery.

If we do not go for transplant at all, how much more life should we expect? And how high are the rejection risks? Looking for advises and suggestions.

rolleyes rolleyes rolleyes rolleyes rolleyes

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 10/29/2016 2:46 PM (GMT -6)   
hello kartikey,
welcome to healingwell. Really sorry to hear your father is so sick. We are liver patients, and those who care for our family members.. I also, have a family member awaiting his fate. my twin brother has end stage cirrhosis, and liver cancer. I also had cirrhosis from alcohol and drugs. we both had hep c and drank alcohol.
I am very happy to hear that your father has been alcohol free for 4+years. and I see you are in India.

your dr has asked your dad to consider transplant soon.. Has his dr put him through transplant evaluation? Does he qualify? in the US we use the MELD score, which is an equation that calculates his pt/inr, creatinine, and bilirubin. liver cancer adds points also. do you know your dads meld?

You are right, live donor transplant would give your dad an earlier transplant. And your dad being cancer free, and no viral hep to overcome, is a big plus..and he is alcohol free. the biggest drawback, a dr will warn you about is, putting 2 lives in danger.. they will have to go thru some standard criteria to see if you are a good donor.. in the US, they will check the donor for;
being ingood physical and mental condition.
be between ages of 18 and 60
have a BMI of less then 35
have a compatible blood type
and must be free from the following;
no organ disease(heart, kidney, liver etc)
they will check for any ongoing malignancy
blood checks for HIV or HEPATITIS
active infections and any substance abuse
the donor will need a strong support team to rely on, as well as the recipient after surgery

waiting for cadaver livers in the US is a tough waiting game. my hapatologist recommends my brother going to a different state to get listed. we live in California, and the average meld needed to get to the top of the list is between 35 and 40. that is almost dead... other states can trans plant in at lower melds.

i hope our moderator is well enough to help. she has gone through the process and has 1st hand knowledge of rejection risks, and advise.

any thing you ask, i will try to answer or research with you. let me know

Kartikey
New Member


Date Joined Oct 2016
Total Posts : 5
   Posted 10/30/2016 8:59 AM (GMT -6)   
Hello ppm guy, I am sorry to hear about your brother and yourself. We all know how tough it is to fight this disease. May God give us strength & will power to fight back.

Yes, my father left drinking in 2012. His liver has recovered to the maximum level on its own but unfortunately, the recovery of liver is not what is required. In India also, a minimum of 14 MELD is required to qualify for a Liver Transplant. My father was ranging around a score of 15 to 17 for last couple of years. But as on today, his MELD has reached 22. So, he qualifies for a transplant.

We are still in hospital and waiting for the creatinine levels to get stable so that we can return home. Then, we have to start preparing for the surgery. Doctors are scaring me that mortality rate for donors is 2% but I won't think twice. 98% is enough motivating for me. I know that chances for my father is not good without transplant. I am only worried about the difficulties faced by the patient post surgery and the biggest risk of rejection.

Here also, they asses a donor on numerous factors and criteria. If we opt for Cadaver, we are being advised to go to another state in India where waiting is less. We live in New Delhi and we are being asked to go to South India - either Chennai or Hyderabad where donations are high and chances of getting a liver is good.

What life can we expect if the liver is accepted by the body? Because, without it, we should not expect anything as there are always chances of multi organ failure.

MamaLama
Forum Moderator


Date Joined Oct 2010
Total Posts : 4793
   Posted 10/30/2016 7:13 PM (GMT -6)   
kartikey. and I have been in touch via email.

I will post what I can about recovery. risk is highest immediately after surgery for rejection. once the first days at passed, the statistics for 1 and 5 year survival are very high...worth the risk in my opinion.

he was prepped for surgery while the cadaver organ was removed and tested. they did

Mike was in ICU for 5 days, then released to a transplant area in the normal hospital. then he was released home. He returned often at first for blood tests and follow uo. it has been over 5 years now. His follow uo visits are infrequent though they still require frequent blood tests.

At first he had trouble with blood sugar and needed insulin injections. That is resolved. He takes prograf (tacrolimus) to prevent rejection, but this can be hard on the kidneys. He is monitored often and may require dialysis then. they have continued to try the antirejection meds with no success, now they are gradually reducing the dose as much as possible.

He has had trouble with his artic valve, but this was a pre transplant condition that did not limit his qualification for tp. the valve was replaced post transplant and caused no liver complications.

post tp he was so much better than before tp, that I almost forget that phase. it was like any post major surgery. He was tired and rested. He began to get stronger right away.

we have not had a donor tp post step by step on this site. we would be so grateful if you could post your story as it unfolds.

Best to your dad and YOU for offering the gift of life.

MamaLama
MamaLama, Forum moderator - Hepatitis
Partner received liver transplant (May 1, 2011) FL
Hep C 1a Treatment - Sovaldi/Olysio (March - May 2014)
Undetected since week 4. Undetected 12 weeks post treatment.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 10/30/2016 8:54 PM (GMT -6)   
hi Karikey,
If you are definetly doing, a living donor transplant, I would assume that meld doesn't matter? except to use as a tool to assess his liver function.. Do you expect his meld to drop, when his creatinine stabilizes?

In the US, transplants happen at higher melds(25-40), depending on your location. According to American liver foundation, 75% of TP patients , live at least 5 years after surgery..post surgery, patients remain in the hospital, for a few weeks. Rejection and infection are the greatest risks. your dr will get your meds right before your dad goes home. Your transplant team, will monitor long term complications, that may arise. Some of these are hypertension, osteoporosis, diabetes, and cancers.

also from American liver foundation,30-40% of complications arise in the 1st 3 months. they go on to say, that most complications are treatable..

These numbers I gave you, are for patients that are sicker, than your dad. Let me know how things are going, and the very best to you and your father

Kartikey
New Member


Date Joined Oct 2016
Total Posts : 5
   Posted 10/30/2016 11:08 PM (GMT -6)   
We are still in hospital and he is being given Terlipressin Injection to bring the creatinine down to around 1.5. It is at present hovering around 2.2 - 2.3. They might also want to go for another round of Dialysis. According to doctors, kidneys are reviving. His abdominal fluid has build up but doctors are not taking the risk to tap it since it might effect the already damaged kidney.

MamaLama, how does the rejection process occur after TP? Is it a kind of sudden attack or a gradual deterioration in health? How does the patient knows that the new liver is being rejected by the body? I want to ask does the rejection gives time to return to the hospital or is it a sudden thing?

Hi ppm guy, you are right. In Live donor, MELD does not matter. Only the assessment of donor matters. If Creatinine drops, than MELD will automatically come down. Are the complications really treatable?

In India, we have another problem. Here, Liver transplant is considered one of the most dangerous and complicated surgery. People generally view it as a waste of money and resources. I am not talking about doctors but there are docs as well who do not recommend transplant even to patient with ESLD. Then comes the general people, they think its better to live like this than undergo transplant. And some consider live donation no less than suicide.. :) Reasons vary from ignorance and maybe not so advanced medical expertise when compared to more developed nations.

If his kidney recovers and comes anyway close to where they were earlier (1 month ago), they will discharge us and simultaneously, I am starting the process of shortlisting the best possible hospital and surgeon looking at our finances and other support.

Thanks.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 10/31/2016 4:50 PM (GMT -6)   
complications from liverTP, in the US, are very treatable.. it is a dangerous surgery, that takes many hours. But success rates are high.

the doctors that are treating your father gave you realistic chances of survival for you(2%). What chances of survival do they project for your father, getting surgery in India.

Kartikey
New Member


Date Joined Oct 2016
Total Posts : 5
   Posted 10/31/2016 9:16 PM (GMT -6)   
Yes, doctors gave me 2 % mortality rates for donor. But, I think the rate is for entire India. The hospitals which we have shortlisted have hardly any cases of donor deaths as they are highly advanced and one of the best in India. For my father, they are stating a survival chance of 90%.

There is another complication that is building up. His creatinine is not getting stable. They are planning for another dialysis round and doctors have said that if creatinine does not come down and kidney does not get stable. we might have to go for a liver + kidney transplant in one go. the statement itself has disturbed all of us. Multi organ transplant is very rare and much more complicated. Also, you need 2 donors for that surgery. I am going to meet a couple of other hepatologists and liver surgeon for second opinion.

We are really clueless right now. Doctors are saying that they will try for another couple of days to stabilize the kidney. Lets see how this all turns up. Fingers Crossed.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 11/1/2016 8:43 PM (GMT -6)   
After your last post, I was concerned with you being able to find quality surgery. The 90% survival rate ,sounds reasonable for a patient with your fathers meld..

the last round of dialysis, cut his creatinine level from 4.0 to 2.4.. hopefully another round, will get him to an acceptable level. I will also have my fingers crossed.

Kartikey
New Member


Date Joined Oct 2016
Total Posts : 5
   Posted 11/2/2016 4:47 AM (GMT -6)   
I have taken a couple of second opinions from some renowned doctors in city. All are in favor of simultaneous transplant of Liver & kidney at the same time. According to doctors, since he is on dialysis, kidney will not survive the liver transplant if done alone.

The success rate of CLKT (Combine Liver & Kidney Transplant) is further less than Liver Transplant. Also, now we will require 2 donors for kidney & liver. Until then, he will have to undergo dialysis in day care basis. Post - Op mortality rate is also high.

I have talked to some consultants and they are sure that they can arrange both deceased liver & kidney in another 20 to 30 days time.

Has any one else also faced a combined Liver kidney transplant situation? I am very worried now. Liver transplant was itself a big steep and now the kidney is also involved.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1080
   Posted 11/2/2016 10:20 AM (GMT -6)   
I googled clkt surgery, and read a couple web sites. yes the success rate drops, but it is still recommended.
UCLA, a large school in los angeles, had a study a few years back. they analyzed the combined surgery. the results were better than I anticipated. in 2006, 1,3,and 5 year survival rates were 76,72, and 70. a decade later I would think the process has gotten better. things that I couldn't find was dual donor TP.
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