Decompensated Liver Due To Hepatitic C Virus

Q. My mother is 55 years old and suffering from decompensated liver due to hepatitic C virus. she has had 4 episodes of hepatic encephalopathy (3 minor and 1 major due to spontaneous bacterial peritonitis). She has had ascites since that episode. She was diagnosed with Hep C and compensated cirrhosis 2 years ago - she took Interferon but that did not prove effective. Now she has developed caries spine (TB). She is on second line drugs for 4 months which is not proving effective in eradicating the TB virus. Her current results are bilirubin 3.4, ALT 29, PT 14, albumin 1.9, ESR 108, platelets 47.

a) under this condition what would you advise us to do?

b) can she undergo transplant whilst she is on TB (tuberculosis) treatment?

c) would you suggest adding first line drugs for TB (that is rifampicin, pyrazinamide, isoniazid) - she took rifampicin but her bilirubin shot up to 6, so we discontinued.

d) also will hepatitis C re-infect the transplanted liver and if so how long on average does that take? I have heard re-infected hepatitis

C virus is more aggressive and damages the liver causing cirrhosis rapidly

e) I've heard that there are drugs for cirrhosis which are under trials - do you know at what stage these are?

A. a) Your mother has decompensated liver cirrhosis from hepatitis C and requires a liver transplant. Interferon treatment would not be tolerated in this situation. Medical treatment alone would not be adequate in the long run.

b) Yes - she can undergo the transplant on TB treatment if the TB is not active.

c) The use of anti-TB medication is difficult in patients with liver cirrhosis. Do you have the culture results of the TB? This will help the choice of medication. Second line medication may be needed if the first line medication cannot be tolerated.

d) Hepatitis C is likely to re-infect the new liver but treatment can be given after the liver transplant and is usually quite effective. In a very small group of patients, one can have a rapidly recurring form of hepatitis C but this is unusual.

e) There are currently no effective drugs that will treat cirrhosis specifically. Treatment is usually directed at the underlying cause of the liver disease. At the end of the day, we would need to assess the patient before giving you a final result.