treatments

[Bill200]

Hi Doctor, what is the normal course of treatment or actions taken when ALT/AST continues to rise (e.g., 500~600) post-transplant due to HCV (and not rejection)?  If suppressants are at the correct trouph levels, say, Prograf and Rapamycin, what are the next steps - switch suppressants, treat?  

[Thomas D Schiano, MD]

if its HCV and nothing else I wouldnt rush to treating you but would let things play out as the therapy can be difficult and cause a lot of side effects.  there may also be new meds available soon in the post-liver transplant setting.

[Bill200]

Dr Schiano, somehow it is not getting it across:  *NOT* rejection.  

If it is HCV-caused elevated enzymes - to 600 levels - what are the typical next steps - switch immunosuppressants, treat?  

[Thomas D Schiano, MD]

additional agents such as mycophenolate (cellcept) may be necessary or in cases of severe rejection a medication such as thymoglobulin may be needed.

[Bill200]

No the opposite.  HCV caused and not rejection, so same question, what actions are normally taken or suggested if prograf and rapamyacin are already at "therapeutic" levels?

[Thomas D Schiano, MD]

i presume that a liver biopsy confirmed the presence of rejection and not HCV.  If so, then the treatment is optimizing doses and levels of cellcept and prograf and trying to minimize the use of parenteral corticosteroids.