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Liver & Pancreas Disorders Message Board


Liver & Pancreas Disorders Board Index


Re: Liver Disease??
Sep 29, 2005
Shane, tuff question!!!! But if I were in your shoes... I agree with your doctor and I would skip the biopsy and here's why:

1) Biopsies have risks associated with them (bleeding, puncturing the lung, etc...)
2) Biopsies are uncomfortable and unpleasant (every biopsy is different, some are better than others. Maybe all your previous biopsies were good but don't expect all of them to be good)
3) Biopsies should not be used to monitor the progression of a disease (or rejection). This is a diagnostic procedure to determine the presence of a disease/rejection only.
4) It is highly possible that there is NO rejection currently going on especially since your doctor changed you over to prograf. The liver damage has been done and your blood tests are truley reflecting 'no rejection'.
5) There are other indicators of rejection such as a low grade temperature, feeling bad (no energy), urinating less often, weight changes, Flu-like symptoms, etc... These might make a better rejection indicator than a biopsy.
6) Even if you did get a biopsy it is unlikely that you would truely see a significant difference from year to year given the slow progression of your type of rejection. Given a new liver, the rejection might be more obvious at the one year interval but once rejection has scared the tissue, the progression of rejection from year to year is very subjective and may not be consistant through out the liver (one biopsy site might reveal more scaring than another biopsy site making an objective diagnoses very difficult).

Your numbers look pretty good to me but what is your bilirubin count. This is an important number which also indicated the health of your liver. Biliriubin (bile) is the dead red blood cells that are extracted from the blood and reprocessed by the liver after the spleen has extracted the iron from these dead cells giving these once red colored cells a green color. When bilirubin builds up in the blood your skin and eyes look yellow. By measuring the liver's ability to process these cells out of your bloodstream will give you an indicator of the liver's health.

Your protein levels also indicate how well the liver is metabolizing your protein intake. If your protein levels were very high, it would indicate that your liver could not keep up with it duties. Also, your enzymes indicate to me that your liver isn't even 'breaking a sweet' in preforming some of it's other duties.

Shane, if you have no other symptoms of portal hypertension (edema. asidies, spleenomegoly, encephalopathy, esophigial vericies, etc...) I might guess that your liver damage is not as severe as you have been led to believe, but this is just my opinion. Most patients with stage 4 liver disease have at least some of these symptoms. Since you have a history of portal hypertension prior to your transplant, I would asume that you know some of these symptoms and would reccognize them if they occured. Any thoughts?
Re: Liver Disease??
Sep 30, 2005
[QUOTE=stud50]Shane, tuff question!!!! But if I were in your shoes... I agree with your doctor and I would skip the biopsy and here's why:

1) Biopsies have risks associated with them (bleeding, puncturing the lung, etc...)
2) Biopsies are uncomfortable and unpleasant (every biopsy is different, some are better than others. Maybe all your previous biopsies were good but don't expect all of them to be good)
3) Biopsies should not be used to monitor the progression of a disease (or rejection). This is a diagnostic procedure to determine the presence of a disease/rejection only.
4) It is highly possible that there is NO rejection currently going on especially since your doctor changed you over to prograf. The liver damage has been done and your blood tests are truley reflecting 'no rejection'.
5) There are other indicators of rejection such as a low grade temperature, feeling bad (no energy), urinating less often, weight changes, Flu-like symptoms, etc... These might make a better rejection indicator than a biopsy.
6) Even if you did get a biopsy it is unlikely that you would truely see a significant difference from year to year given the slow progression of your type of rejection. Given a new liver, the rejection might be more obvious at the one year interval but once rejection has scared the tissue, the progression of rejection from year to year is very subjective and may not be consistant through out the liver (one biopsy site might reveal more scaring than another biopsy site making an objective diagnoses very difficult).

Your numbers look pretty good to me but what is your bilirubin count. This is an important number which also indicated the health of your liver. Biliriubin (bile) is the dead red blood cells that are extracted from the blood and reprocessed by the liver after the spleen has extracted the iron from these dead cells giving these once red colored cells a green color. When bilirubin builds up in the blood your skin and eyes look yellow. By measuring the liver's ability to process these cells out of your bloodstream will give you an indicator of the liver's health.

Your protein levels also indicate how well the liver is metabolizing your protein intake. If your protein levels were very high, it would indicate that your liver could not keep up with it duties. Also, your enzymes indicate to me that your liver isn't even 'breaking a sweet' in preforming some of it's other duties.

Shane, if you have no other symptoms of portal hypertension (edema. asidies, spleenomegoly, encephalopathy, esophigial vericies, etc...) I might guess that your liver damage is not as severe as you have been led to believe, but this is just my opinion. Most patients with stage 4 liver disease have at least some of these symptoms. Since you have a history of portal hypertension prior to your transplant, I would asume that you know some of these symptoms and would reccognize them if they occured. Any thoughts?[/QUOTE]

Interesting. But Im telling you what the doctor has told me about how much liver damage I have. The first biopsy was stage3-4. And my last one, last year was on the border line of stage 4. The only other symptoms I have is bad stomach problems. Such as GERD, Bowel Porblems, and sometimes bad stomach pains, as far as the fatigue, I always feel that way. I have to get atleast 10-12 hours of sleep, If I don't, I have to take a nap, even with 8 hours I need a nap in between sleep. But other than that I don't have yellowing of the skin. I asked the doctor and he said I didn't have portal hypertension, I did when I was a kid, but I don't remember because I was 6 years old. When I had Liver Problems as a kid. I was diagnosed with Congenital Hepatic Fibrosis-Portal Hypertension. The doctor know thinks it was AutoImmune Hepatitis the whole time. I don't know. I keep getting flustered with the whole thing. Like now why Liver Numbers are great. Here's my bilirubin, and some others. Do you think it could be AutoImmune?? How's the rest of the blood work look??.

Total Bilirubin: 0.4
Direct Bilirubin: 0.1
Sodium: 137
Potassium: 4.2
Creatinine: 1.1
Platelet Count: 201





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