Re: Question about Live Donor Transplants

July 1, 2008

Ruth Blatt wrote:

> Hi all,

>

> I know that supposedly I'm a long way off from this, but I can't help

> thinking about it... Can any PSC patient get a live donor transplant?

Yes, several people here have had them with good results

>

> What are the contraindications (I think Chaim mentioned something in a

previous post about small duct PSC- I have intrahepatic PSC, is that the same

thing?).

Intrahepatic means inside the liver, but as far as I know it wouldn't

necessarily synonymous with small duct PSC. If you had extrahepatic

(outside the liver) PSC then you'd know for sure that you didn't have

small duct PSC, because the ducts outside the liver are large. I'm not

sure about all the contraindications for living donor transplant (I

think previous transplant is one), but small duct PSC isn't a

contraindication.

> Also, If PSC is a disease of the bile ducts, doesn't

> a transplant have to include the bile ducts?

It has to include the bile ducts that are inside the liver, but they

sort of come along with it anyway, and yes I suppose in a living donor

transplant they'd regenerate along with the liver. The bile ducts

outside the liver are generally removed when a transplant is done and

they do a procedure where they hook the duct directly to a loop of

intestine as it exits the liver.

> Do those regenerate too?

> What part of the donor's liver are taken out?

The liver is in to lobes, and they take one of these.

> At what point do people

> decide to go through a live donor transplant (assuming they have a

> donor) - I assume it's sooner than it would be if it were not a live

> donor.

I considered this and was actively looking into it before I got my

transplant. Theoretically you don't consider a transplant at all until

the risk of death due to liver failure is greater than the risk of

transplant. In real life there are other issues, such as quality of

life that play into it. It's also not always easy to determine the risk

of death due to liver failure. Sometimes a person with PSC can look

reasonably healthy if you look at their labs, but be much worse off in

real life. In cases like that it's very frustrating because with good

labs it's hard to get a transplant, but really you need one. A lot of

times its people in this kind of situation who end up going the living

donor route.

athan

July 2, 2008

Ruth,

When I spoke about small duct PSC, I was

speaking about the hypothetical situation of donating myself part of my liver. My

liver is mostly fine now. If it would be possible to remove part of my liver

now, freeze it, and then use it for a LDLT for myself later, then small duct

PSC would be a reason not to use your own liver, as it would be if the DONOR

had small duct PSC in a normal LDLT. As far as I know small duct PSC in the

recipient is not a contraindication for LDLT.

Regards,

Chaim Boermeester, Israel

From: [mailto: ] On Behalf Of Ruth Blatt

Sent: Tuesday, July 01, 2008 19:36

To:

Subject: Question

about Live Donor Transplants

Hi all,

I know that supposedly I'm a long way off from this, but I can't help

thinking about it... Can any PSC patient get a live donor transplant?

What are the contraindications (I think Chaim mentioned something in a

previous post about small duct PSC- I have intrahepatic PSC, is that

the same thing?). Also, If PSC is a disease of the bile ducts, doesn't

a transplant have to include the bile ducts? Do those regenerate too?

What part of the donor's liver are taken out? At what point do people

decide to go through a live donor transplant (assuming they have a

donor) - I assume it's sooner than it would be if it were not a live

donor. Any thoughts about what leads up to this are appreciated.

Thanks!

Ruth

July 2, 2008