Guest guest Posted July 18, 2004 Report Share Posted July 18, 2004 , Completely removing the common bile duct and gall bladder is standard procedure during liver transplantation for PSC patients. Even so in about 20 to 30% PSC recurs. In my case it became symptomatic after 4 years, in Steve R's case after 16 years. There are others on this list that fall somewhere in the middle. It may be that PSC is always present, but in most transplantees slows down so much that it isn't detectable above the normal fluctuations that a transplanted liver exhibits. Or as your doctor says, transplantation may be a " cure " for PSC. I view it as a trade off of a serious condition for a less serious but still chronic condition that involves lifetime use of expensive medications, increased risk of cancer and other disease due to immunosuppression and a requirement to be constantly vigilant about health issues. Tim R ltx 4/4/98, PSC recurrance 2002 > ... The doctor said I would be cured after the > transplant. He said they are going to remove my bile ducts and gallbladder > during the process and will connect the new liver directly to my small > instestine (duodenum). Has anyone had this type of transplant and did your > PSC come back? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 18, 2004 Report Share Posted July 18, 2004 That makes it easier for me to understand. So even though your common bile duct is removed you still have other bile ducts that were left behind and subsequently got reaffected by PSC? How exactly did it recurr? Where? I want to ask my transplant doctor about this for sure. Also, when your symptoms returned where they as bad as before? Does this mean you'll have to get another transplant or is there nothing else that can be done? -----Original Message-----From: Tim Romlein Sent: July 18, 2004 6:05 PMTo: Subject: Re: - transplant listing,Completely removing the common bile duct and gall bladder is standard procedure during liver transplantation for PSC patients. Even so in about 20 to 30% PSC recurs. In my case it became symptomatic after 4 years, in Steve R's case after 16 years. There are others on this list that fall somewhere in the middle. It may be that PSC is always present, but in most transplantees slows down so much that it isn't detectable above the normal fluctuations that a transplanted liver exhibits. Or as your doctor says, transplantation may be a "cure" for PSC. I view it as a trade off of a serious condition for a less serious but still chronic condition that involves lifetime use of expensive medications, increased risk of cancer and other disease due to immunosuppression and a requirement to be constantly vigilant about health issues.Tim R ltx 4/4/98, PSC recurrance 2002> ... The doctor said I would be cured after the> transplant. He said they are going to remove my bile ducts and gallbladder> during the process and will connect the new liver directly to my small> instestine (duodenum). Has anyone had this type of transplant and did your> PSC come back? ---Incoming mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.716 / Virus Database: 472 - Release Date: 05/07/2004 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.716 / Virus Database: 472 - Release Date: 05/07/2004 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 18, 2004 Report Share Posted July 18, 2004 > ... So even though your common bile duct is removed you > still have other bile ducts that were left behind and > subsequently got reaffected by PSC? Yes, the vast majority of the biliary tree is within the liver. Just as the woody part of a tree consists of both the trunk and the branches, the biliary tree has ducts both outside the liver (extrahepatic - common bile duct) and inside (intrahepatic). The intrahepatic ducts branch within each lobe of the liver until the final micro tubules are in contact with every liver cell. > How exactly did it recurr? Where? The " how " is unknown, the where is the intrahepatic ducts. A PCT cholangiogram revealed many strictures and beading throughout the biliary tree. A PCT stent has assisted drainage for the last 20 months. > I want > to ask my transplant doctor about this for sure. Also, when your symptoms > returned where they as bad as before? Does this mean you'll have to get > another transplant or is there nothing else that can be done? My symptoms of fatigue and pruritis seemed to escalate more rapidly during the past 2 years than they did the first time around. Because bilirubin has been steadily creeping higher I will start evaluation for another transplant next week. As with PSC pretransplant there is no established therapy that will slow the progression of PSC, so a transplant is the only option when liver failure sets in. Tim R Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2004 Report Share Posted July 20, 2004 Thanks for the information and I will ask my doctor about the percentage of patients he transplanted where PSC recurred. I definitely hope that you feel better the second time around. I certainly hope that my PSC will not recur after my transplant. > > > ... So even though your common bile duct is removed you > > still have other bile ducts that were left behind and > > subsequently got reaffected by PSC? > > Yes, the vast majority of the biliary tree is within the liver. Just > as the woody part of a tree consists of both the trunk and the > branches, the biliary tree has ducts both outside the liver > (extrahepatic - common bile duct) and inside (intrahepatic). The > intrahepatic ducts branch within each lobe of the liver until the > final micro tubules are in contact with every liver cell. > > > How exactly did it recurr? Where? > > The " how " is unknown, the where is the intrahepatic ducts. A PCT > cholangiogram revealed many strictures and beading throughout the > biliary tree. A PCT stent has assisted drainage for the last 20 > months. > > > I want > > to ask my transplant doctor about this for sure. Also, when your > > symptoms > > > returned where they as bad as before? Does this mean you'll have to > > get > > > another transplant or is there nothing else that can be done? > > My symptoms of fatigue and pruritis seemed to escalate more rapidly > during the past 2 years than they did the first time around. Because > bilirubin has been steadily creeping higher I will start evaluation > for another transplant next week. As with PSC pretransplant there is > no established therapy that will slow the progression of PSC, so a > transplant is the only option when liver failure sets in. > > Tim R > > > > > Quote Link to comment Share on other sites More sharing options...
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