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bile duct problems
7 months after living doner liver transplant Still having bile duct problems they put 4 more stents in today on the right side of liver but the left side has never needed any stents can this be fixed with stenting??? Or will this be a problem that will cause her to need new liver? It is the ducts up in her liver on right side dr won't say just said wait and see and they want her back in 4 weeks to repeat ERCP can anyone give any advice on what to expect dr even said it is possible that the right side of liver will shrink and left side will grow bigger and be ok it sounds far fetched to me ??
It's a wonderful thing that someone was willing to share their liver and save a life. That is such an incredible gift.
Hector has given you a very extensive explanation on the bile duct complications which can occur and why.
My husband had a liver transplant two years ago. A month after transplant the doctors discovered through labwork that something was wrong. Further investigation found that he had a blockage of the hepatic artery. They took care of the blockage but it resulted in extensive bile duct damage. Stents were put in and replaced several months later. Not long after, he developed a bacterial infection and needed to have the stents removed. They made the decision not to replace the stents as the risk for another bacterial infection was too great. Unfortunately, he also had recurrent Hep C, so in the months following, his new liver was damaged not only by the bile duct damage but the the Hep C. A year and a half post transplant, a biopsy in Dec, 2013, showed cirrhosis of the new liver.
He has been on Hep C treatment (Sovaldi plus Ribavirin) for 18 weeks now. His billirubin has improved over these weeks from a high of 3.3 to 1.1.
Our hope is that since the virus has been undetected since week 6, the liver is repairing itself as best it can, resulting in the improvement in the billirubin.
Only time will tell.
I am writing his story because I'm hoping that it will be helpful in someway to you. Time does help heal the complications of transplantation. Bile duct problems are common. Her doctors will continue to monitor her progress and
do what needs to be done to avoid infection and help her heal.
Best of luck
Nan
Hector has given you a very extensive explanation on the bile duct complications which can occur and why.
My husband had a liver transplant two years ago. A month after transplant the doctors discovered through labwork that something was wrong. Further investigation found that he had a blockage of the hepatic artery. They took care of the blockage but it resulted in extensive bile duct damage. Stents were put in and replaced several months later. Not long after, he developed a bacterial infection and needed to have the stents removed. They made the decision not to replace the stents as the risk for another bacterial infection was too great. Unfortunately, he also had recurrent Hep C, so in the months following, his new liver was damaged not only by the bile duct damage but the the Hep C. A year and a half post transplant, a biopsy in Dec, 2013, showed cirrhosis of the new liver.
He has been on Hep C treatment (Sovaldi plus Ribavirin) for 18 weeks now. His billirubin has improved over these weeks from a high of 3.3 to 1.1.
Our hope is that since the virus has been undetected since week 6, the liver is repairing itself as best it can, resulting in the improvement in the billirubin.
Only time will tell.
I am writing his story because I'm hoping that it will be helpful in someway to you. Time does help heal the complications of transplantation. Bile duct problems are common. Her doctors will continue to monitor her progress and
do what needs to be done to avoid infection and help her heal.
Best of luck
Nan
For questions regarding liver transplantation I would recommend the Medhelp "Liver Transplant Expert Forum"
http://www.medhelp.org/forums/Liver-Transplant/show/274
Dr. Schiano is a very knowledgeable and experienced hepatologist at Mt. Sinai in New York City who is familiar with all aspects of liver transplantation.
Be well.
Hector
http://www.medhelp.org/forums/Liver-Transplant/show/274
Dr. Schiano is a very knowledgeable and experienced hepatologist at Mt. Sinai in New York City who is familiar with all aspects of liver transplantation.
Be well.
Hector
HI.
Unfortunately with LDLT there is an increased risk of bile duct complications due to the nature of the surgery. Obviously LDLT is a very complex operation as all transplant surgery is. Exactly why this is happening I can't say only the surgeon would know.
ERCPs are often repeated when needed in hopes that over time the bile duct problem can improve or resolve itself. Also she is still healing from the surgery. Performing more invasive procedures at this time presents risk and is usually avoided unless necessary. I am also 7 month post transplant and aware of our vulnerabilities so soon after transplant. I have a few friends with post deceased donor transplant biliary issues that are now having periodic ERCPs and may decide to have surgery instead of more repeated ERCPs. But each case is different and needs to be decided on based on the particular circumstances. There is no one answer to post transplantation complication issues.
Only the surgeon treating her knows what the current status is and what the prognosis is. Talk to them to learn more of what can be expected in the future. Each person is unique and there circumstances are unique.
I hope her issues stabilize and she can better enjoy her second chance at life!
Here is explain that may help you to understand how a LDLT is performed from one of my surgeons. It will explain some of the issues involved.
"For the recipient, the patient who is going to get the transplant, there are different risks associated with getting a living donor transplant versus a cadaver transplant. A picture is worth a thousand words, but think of the blood vessels in the bile ducts entering the liver with a trunk. They have kind of a big round part of the blood vessels and bile ducts.
As they come into the liver, they divide in branches very similar to the way a tree branches. When we take out part of the living donor liver, we leave the trunk of the tree and the branch to the part of the liver we leave behind because without it the donor couldn't survive. We can only use a branch to say the right side of the liver. We get the branch of the bile duct and the branch of the blood vessels to that side of the liver, and as with branches in a tree, the size of the branch is always less than the trunk, so you have a small branch versus a large trunk. In surgery, when we sew things together, it's easier to sew things together that are bigger, have a bigger diameter like the trunk of a tree, than things that are smaller in diameter like a branch.
When we sew together the branches of the blood vessels and the bile ducts, there's a greater chance that things can go wrong. Most of those problems that occur are problems with sewing the bile duct together because it's very thin and doesn't have a very good blood supply.
Patients who get a living donor transplant have an advantage in that they don't have to wait until they get really sick. They can get transplanted kind of on an elective basis, but the risk of complications related to where we sew together the bile duct is about twice as high as if you got a cadaver liver. That's the main difference between getting a piece of a liver and a whole liver. The branches we work with are smaller and there are more troubles associated with them.
It doesn't mean that those problems lead to the recipient losing their new piece of liver, but it can mean more time in the hospital, more time with the radiologists as we try and take care of these problems and potentially a return trip to the operating room. But over time, all these things usually heal and it just means more time in the hospital and in the physicians offices until these things heal."
I hope her issues can stabilize and she can start to better enjoy her second chance at life.
Hector
Unfortunately with LDLT there is an increased risk of bile duct complications due to the nature of the surgery. Obviously LDLT is a very complex operation as all transplant surgery is. Exactly why this is happening I can't say only the surgeon would know.
ERCPs are often repeated when needed in hopes that over time the bile duct problem can improve or resolve itself. Also she is still healing from the surgery. Performing more invasive procedures at this time presents risk and is usually avoided unless necessary. I am also 7 month post transplant and aware of our vulnerabilities so soon after transplant. I have a few friends with post deceased donor transplant biliary issues that are now having periodic ERCPs and may decide to have surgery instead of more repeated ERCPs. But each case is different and needs to be decided on based on the particular circumstances. There is no one answer to post transplantation complication issues.
Only the surgeon treating her knows what the current status is and what the prognosis is. Talk to them to learn more of what can be expected in the future. Each person is unique and there circumstances are unique.
I hope her issues stabilize and she can better enjoy her second chance at life!
Here is explain that may help you to understand how a LDLT is performed from one of my surgeons. It will explain some of the issues involved.
"For the recipient, the patient who is going to get the transplant, there are different risks associated with getting a living donor transplant versus a cadaver transplant. A picture is worth a thousand words, but think of the blood vessels in the bile ducts entering the liver with a trunk. They have kind of a big round part of the blood vessels and bile ducts.
As they come into the liver, they divide in branches very similar to the way a tree branches. When we take out part of the living donor liver, we leave the trunk of the tree and the branch to the part of the liver we leave behind because without it the donor couldn't survive. We can only use a branch to say the right side of the liver. We get the branch of the bile duct and the branch of the blood vessels to that side of the liver, and as with branches in a tree, the size of the branch is always less than the trunk, so you have a small branch versus a large trunk. In surgery, when we sew things together, it's easier to sew things together that are bigger, have a bigger diameter like the trunk of a tree, than things that are smaller in diameter like a branch.
When we sew together the branches of the blood vessels and the bile ducts, there's a greater chance that things can go wrong. Most of those problems that occur are problems with sewing the bile duct together because it's very thin and doesn't have a very good blood supply.
Patients who get a living donor transplant have an advantage in that they don't have to wait until they get really sick. They can get transplanted kind of on an elective basis, but the risk of complications related to where we sew together the bile duct is about twice as high as if you got a cadaver liver. That's the main difference between getting a piece of a liver and a whole liver. The branches we work with are smaller and there are more troubles associated with them.
It doesn't mean that those problems lead to the recipient losing their new piece of liver, but it can mean more time in the hospital, more time with the radiologists as we try and take care of these problems and potentially a return trip to the operating room. But over time, all these things usually heal and it just means more time in the hospital and in the physicians offices until these things heal."
I hope her issues can stabilize and she can start to better enjoy her second chance at life.
Hector
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