suitable for liver transplant?

[Sharp7]

Dear Doctor,
My dad, 68-years old, was admitted for vomiting blood since early morning. He was bleeding from the food pipe which was closed with endoscopy.
My parents and brother are in India, and I am in Europe. Because of this, I cannot talk to my dad's doctor myself. My brother is doing all he can. My dad's doctor (Dr. Naresh Bhat) seems to be well-known, and well-regarded.

My dad has been feeling very cold (for the last few months!) even on warm days, and has had swelling in his legs due to fluids accumulation. For the last couple of weeks, he has been complaining of indigestion and a feeling of fulness on eating even a small amount of food. He has a history of diabetes, approx. 15 years. (I don't remember exactly.)

Right now, he is still at the hospital, and on medication to reduce his ascites. The doctor has informed us that a liver transplant is not advisable, given my dad's age. My dad has A+ blood, and my brother and I have O+. However, my brother has diabetes and a history of a heart-condition, and is now on blood-thinners. I am 35 years old, and have Hep B, which is now under control with Entecavir. My dad does not have a history of either heart-disease or Hep B (or C). I don't know if he has enough HBsAb to be considered immune.

I'd still want to know if my dad can use a part of my liver. I weigh about 63kg and my dad, about 75kg. If I am not a suitable donor, do you have any idea how easy it is to get a donor for a cadaveric transplant? How advisable is it in my dad's case? I'd be grateful for your comments on the prognonsis too!

I'll paste the detailed lab reports in the next message.

[Thomas D Schiano, MD]

you would not be a candidate to be a live donor because of safety issues with your remaining liver.  it sounds like your dad does need a transplant.  his age itself is not a contraindication but the presence of the diabetes (which may have already affected the kidneys as evidence by his elevated creatinine) is a concern. In india i beleeve almost all liver transplants are performed using live donors.  he would be acandidate for either type.  i wish you and him the best.

[Sharp7]

Thank you, Dr. Schiano. I will ask for my dad to be put on the waiting list for a cadaveric transplant -- my family members seem to be unsuitable as donors.

[Sharp7]

2011-10-08 11:00

HAEMOTOLOGY
RBC: 2.07 million/cu mm
Haemoglobin: 7.1 g/dl
Packed cell volume: 20.9%
Mean corpuscular volume: 101.1 fl
Mean corpuscular haemoglobin: 34.3 pg
Mean corpuscular haemoglobin conc.: 34 g/dl
Red cell distribution width: 15.3%

Total WBC: 7800 cells/cu mm
Neutrophils: 57.8%
Lymphocytes: 28.8%
Monocytes: 12.1%
Eosinophils: 1.0%
Basophils: 0.3%

Platelet count: 161,000 /cu mm
ESR: 79 mm/1st hour

Prothrombin Time: 16.2 sec
Control: 11.3 sec
INR: 1.34

Peripheral smear examination: erythrocutes show macrocytes and hypochromia. Increased rouleaux seen. Leukocytes are normal in number and distribution. Platelets are adequate. No abnormal cells or paracites seen
Impression - Macrocytic anaemia


LIVER FUNCTION TEST
Total protein: 6.5 g/dl
serum albumin: 2.4 g/dl
serum globulin: 4.1 g/dl
A/G ratio: 0.6:1
Total bilirubin: 1.66 mg/dl
Direct bilirubin: 0.47 mg/dl
Indirect bilirubin: 1.19 mg/dl
SGOT (AST): 90 IU/L
SGPT (ALT): 31 IU/L
Alkaline Phosphate: 73 IU/L
Gamma GT: 49 IU/L


2011-10-08 21:30
Platelet count: 125,000 /cu mm
Haemoglobin: 8.3 g/dl


2011-10-09 05:20
KIDNEY FUNCTION
Serum sodium: 135 mmol/l
Serum potassium: 4.1 mmol/l
Serum chloride: 106 mmol/l
Serum urea: 89 mg/dl
Serum creatinine: 1.77 mg/dl
Serum uric acid: 5.86 mg/dl

2011-10-10 17:30
URINE EXAMINATION
Colour: brown
Appearance: Clear
pH: 5.0
specific gravity: 1.020
Protein: 1+
Glucose: -
Bilirubin: -
URO bilinogen: -
Ketone bodies: 1+
Nitrites: -
Leukocytes: 10-12 /hpf
Erythrocytes: 8-10 /hpf
Epithelial cells: 4-6 /hpf
Casts: -
Crystals: -


2011-10-12 05:10
Serum potassium: 4.1 mmol/l
Serum creatinine: 1.56 mg/dl

Haemoglobin: 9.9 g/dl

2011-10-12 17:10
ASCITIC FLUID ANALYSIS
Volume: 05 ml
Appearance: clear
protein: 349 mg/dl
glucose: 324 mg/dl
Xanthochromia: -
Clot: -
RBC: 115 cells/cu mm
WBC: 65 cells/cu mm
Cell type: lymphocytes
Cytology: The smear shows mesothelial cells and a few lymphocytes. No malignant cells seen.


2011-10-13 06:10
Alpha Feto Protein: 20.21 ng/ml