answers to some questions

[Ruth590]

Hello All, First I did email MikeSimon and answered the same day he is  a great guy. And for Brent and the others asking questions here is the story. My husband had a liver transplant March 2007. When we found out  he had hepc he was too sick to treat. The Hep c starting attacking the new liver 4 months after the transplant. The doctors kept him on interferon shots 0.5mcg and 800 mg ribavarin for 18 months. Usually they say 12 months but since he is a transplant patient they will keep him 18 months on a lower dose. After the 18 months he is considered a nonresponder. He was off the shots for 1 month and his bloodwork went crazy. ALT400s, AST300s, GGT568 and viral load 4 million. They did a biopsy and it showed rejection and also hepc attacking new liver. So he is starting alll over again with cellcept, more prednisone, more prograf. As far as the hepc we have an appointment in March to discuss what to do about that. We're both very depressed as we are starting all over again and I don't see a light at the end of the tunnel, but it helps to have people that will listen cause most of our friends and family don't know what to say and we don't want them to keep feeling bad. At least most of you have been through what we have and understand our feelings. Thanks so much for listening, Ruth

[IAmTheWalrus]

Mike is a great guy, but don't tell him I said that :-)

[IAmTheWalrus]

I have also been told that it is very difficult to distinguish between HCV and rejection on tissue biopsy. I had one that showed "no conclusive evidence of rejection" but when they doubled my dose of Prograf, my liver enzymes and GGT came back to normal. I was fortunate that this was all that was needed. I did not have to go back to the Cellcept and Predinisone (nasty stuff), and was able to continue HCV treatment.

I hope things work out the best possible way. Hang in there.

Brent

[mikesimon]

I've mentioned to you that after I was transplanted I was informed that distinguishing HCV recurrence from acute cellular rejection on biopsy was difficult - the liver histology looks the same in both cases.

I found this article today. It's something you can bring up with your transplant if you have any doubts about the diagnosis. It appears from the meds your Husband is taking that they are treating it as rejection. I base that on the increased Prograf, the addition of Cellcept and the increased prednisone.

"Using an immune functional assay to differentiate acute cellular rejection from recurrent hepatitis C in liver transplant patients.
Cabrera R, Ararat M, Soldevila-Pico C, Dixon L, Pan JJ, Firpi R, Machicao V, Levy C, Nelson D, Morelli G.

Hepatobiliary Section, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.

In transplant recipients transplanted for hepatitis C, presentation of abnormal transaminases can herald the presentation of recurrent hepatitis C, cellular rejection, or both. Given the sometimes ambiguous histology with these 2 entities, the ability to distinguish them is of great importance because misinterpretation can potentially affect graft survival. We used an immune functional assay to help assess the etiology of abnormal liver function test results in liver transplant recipients. Blood samples for the immune functional assay were taken from 42 recipients prospectively at various times post-transplant and compared with clinical and histologic findings. In patients whose liver biopsy showed evidence of cellular rejection, the immune response was noted to be very high, whereas in those with active recurrence of hepatitis C, the immune response was found to be very low. This finding was found to be statistically significant (P < 0.0001). In those patients in whom there was no predominant histologic features suggesting 1 entity over the other, the immune response was higher than in those with aggressive hepatitis C but lower than in those with cellular rejection. In conclusion, these data show the potential utility of the ImmuKnow assay as a means of distinguishing hepatitis C from cellular rejection and its potential usefulness as a marker for outlining the progression of hepatitis C. (c) 2009 AASLD."

See: http://tinyurl.com/cavop6

Mike

[Trinity4]

My heart goes out to you and your husband Ruth.  I wish the best for you both.  There are some extraordinary people on this forum such as Mike and Brent who will give the best possible advice about TP and so many other members that provide a tremendous amount of support and encouragement.  Please know we are here for you.
Trinity