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| Guest |
 Posted: Fri Feb 11, 2005 12:36 pm |
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Is it possible to donate part of your liver to someone with HCV? Who is
doing this? What matching is required? What is the outcome?
Zee |
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| David Rind |
| Posted: Fri Feb 11, 2005 8:47 pm |
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Guest
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zwalanga@yahoo.com wrote:
[quote:6045c7aa2f]Is it possible to donate part of your liver to someone with HCV? Who is
doing this? What matching is required? What is the outcome?
Zee
[/quote:6045c7aa2f]
It is possible, although people worry about the ethics (particularly
with unrelated donors) because there is a significant risk to the donor.
That said, I think most major transplant centers in the US will consider
doing this.
I don't know the exact matching requirement, but other than in
emergencies ABO blood-type matching is generally required. I think the
outcomes depend on a whole bunch of variables and is better answered by
a given center looking at a particular patient.
--
David Rind
drind@caregroup.harvard.edu |
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| Guest |
| Posted: Fri Feb 11, 2005 9:04 pm |
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I did not know if it was even possible.
If this was done, is there a stage at which it would be best for the
recipient? I mean, should it not be done until they are very ill, or
would it be better as soon as possible?
Zee |
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| David Rind |
| Posted: Sat Feb 12, 2005 12:48 pm |
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zwalanga@yahoo.com wrote:
[quote:0ca7a64d7d]I did not know if it was even possible.
If this was done, is there a stage at which it would be best for the
recipient? I mean, should it not be done until they are very ill, or
would it be better as soon as possible?
[/quote:0ca7a64d7d]
I'm no expert in this, but a liver transplant carries a substantial risk
of immediate death for the recipient, and then the need lots of ongoing
care and immunosuppressive medications.
So if someone is doing okay without a liver transplantation, it's hard
to imagine that they would want to get it done pre-emptively. Thus
people who get liver transplants are typically very ill. I'd agree,
though, that you would ideally want to do the procedure before someone
is so sick that the risk of performing the surgery increases (though
lots of transplants are done in people who are pretty close to death).
--
David Rind
drind@caregroup.harvard.edu |
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| Guest |
| Posted: Sat Feb 12, 2005 2:15 pm |
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Do you have any experience of what helps keep a liver functioning well
in someone with cirrhosis and Hep C? We have been told many things;
but what do you see in your patients or know about? Zee
David Rind wrote:
[quote:1cc312ac7e]zwalanga@yahoo.com wrote:
I did not know if it was even possible.
If this was done, is there a stage at which it would be best for
the
recipient? I mean, should it not be done until they are very ill,
or
would it be better as soon as possible?
I'm no expert in this, but a liver transplant carries a substantial
risk
of immediate death for the recipient, and then the need lots of
ongoing
care and immunosuppressive medications.
So if someone is doing okay without a liver transplantation, it's
hard
to imagine that they would want to get it done pre-emptively. Thus
people who get liver transplants are typically very ill. I'd agree,
though, that you would ideally want to do the procedure before
someone
is so sick that the risk of performing the surgery increases (though
lots of transplants are done in people who are pretty close to
death).
--
David Rind
drind@caregroup.harvard.edu[/quote:1cc312ac7e] |
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| David Rind |
| Posted: Sat Feb 12, 2005 5:07 pm |
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Guest
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zwalanga@yahoo.com wrote:
[quote:83c41c0bed]Do you have any experience of what helps keep a liver functioning well
in someone with cirrhosis and Hep C? We have been told many things;
but what do you see in your patients or know about? Zee
[/quote:83c41c0bed]
The only thing that is really known to matter that affects the
progression of Hep C is avoiding alcohol. People with Hep C probably
should drink zero alcohol.
In terms of cirrhosis itself, it's hard to give a general answer to
this, as a lot depends on how severe the cirrhosis (from any cause) is.
If the liver is doing okay, there probably aren't specific actions
that make a big difference. With severe liver problems, certain measures
may reduce the likelihood of bleeding from esophageal varices or of
developing hepatic encephalopathy or kidney failure.
From a prior thread, it sounds like the person was not tolerating
treatment with interferon. (And that they were being treated with
interferon suggests that the cirrhosis is not all that severe, since
most people with decompensated cirrhosis are not treated.) Intolerance
of interferon is a common issue, but if at all possible treatment with
pegylated interferon plus ribavirin is preferable to going on to liver
transplantation (not to suggest that the treatment works anywhere near
100% of the time). Patients frequently have severe depression with
interferon, and around here are often started on antidepressants at the
same time interferon is started.
I think support groups and medical providers who take care of a lot of
Hep C and are used to the drugs' side effects can sometimes get patients
through the course of treatment better than when these things are not
available. I don't know how things are set up in Canada, but I'm a fan
of having people with Hep C treated at major liver centers whenever
possible.
--
David Rind
drind@caregroup.harvard.edu |
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| Guest |
| Posted: Sat Feb 12, 2005 6:03 pm |
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No major liver centre nearby. When he is well enough, he is touring.
When he is not, he lives in a very isolated area. I do not know if he
will tour again, and that may be adding to the depression.
He is trying St. John's Wort and fish oil for the depression and if
they do not help then may go back to a SSRI.
Yes he goes off and on the medication you have mentioned. This past
time 11 months. It gets harder and harder.
He doesn't like to talk about it. He will only do so with two of us,
rarely.
Zee |
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| Guest |
| Posted: Sat Feb 12, 2005 6:54 pm |
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!! Gabepentin !! He's asking about gabepentin for the depression! Zee
David Rind wrote:
[quote:d084cef771]zwalanga@yahoo.com wrote:
Do you have any experience of what helps keep a liver functioning
well
in someone with cirrhosis and Hep C? We have been told many
things;
but what do you see in your patients or know about? Zee
The only thing that is really known to matter that affects the
progression of Hep C is avoiding alcohol. People with Hep C probably
should drink zero alcohol.
In terms of cirrhosis itself, it's hard to give a general answer to
this, as a lot depends on how severe the cirrhosis (from any cause)
is.
If the liver is doing okay, there probably aren't specific actions
that make a big difference. With severe liver problems, certain
measures
may reduce the likelihood of bleeding from esophageal varices or of
developing hepatic encephalopathy or kidney failure.
From a prior thread, it sounds like the person was not tolerating
treatment with interferon. (And that they were being treated with
interferon suggests that the cirrhosis is not all that severe, since
most people with decompensated cirrhosis are not treated.)
Intolerance
of interferon is a common issue, but if at all possible treatment
with
pegylated interferon plus ribavirin is preferable to going on to
liver
transplantation (not to suggest that the treatment works anywhere
near
100% of the time). Patients frequently have severe depression with
interferon, and around here are often started on antidepressants at
the
same time interferon is started.
I think support groups and medical providers who take care of a lot
of
Hep C and are used to the drugs' side effects can sometimes get
patients
through the course of treatment better than when these things are not
available. I don't know how things are set up in Canada, but I'm a
fan
of having people with Hep C treated at major liver centers whenever
possible.
--
David Rind
drind@caregroup.harvard.edu[/quote:d084cef771] |
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| David Rind |
| Posted: Sat Feb 12, 2005 11:31 pm |
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zwalanga@yahoo.com wrote:
[quote:647017a713]!! Gabepentin !! He's asking about gabepentin for the depression! Zee
[/quote:647017a713]
People are using gabapentin for just about everything these days, but I
can't say I've ever seen it used for the depression/fatigue associated
with interferon. I don't think the drug has much of a track record in
depression even unrelated to interferon. But perhaps someone with more
experience treating hep C can comment....
--
David Rind
drind@caregroup.harvard.edu |
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