An unfortunate turn of events

July 5, 2007

Wish I continue reporting positive news about my recovery, but a

serious complication was discovered this week. Late Sunday night my

JP-drain suddenly filled with over 100cc of fluid (the previous 48

hours it had only collected 30cc). I thought that is weird, emptied it

and went to bed. In two hours another 100cc of bile colored fluid had

been collected. At 3am I called the transplant center because I knew

there was a bile leak that had to get fixed. I was told to come into

the ER where we were met by a resident on the transplant service, run

through the ER admitting process and eventually sent up to a room.

Monday I had a hida scan (to see where the bile was flowing), doppler

ultrasound to examine blood flow to and from the liver - in this test

the hepatic artery flow could not be found. This led to an angiogram

of the hepatic artery (where therapy to unblock it was unsuccessful).

The doctors on Tuesday lay out the likely scenario of what happened -

clots form and block the hepatic artery, which supplies blood to the

bile ducts, the bile ducts, starved for nourishment and oxygen, die.

Sunday night the dead bile duct tissue fails, releasing bile into the

abdominal cavity where it is collected by the JP-drain.

With the main bile ducts dead, there are no good options for this

liver. The best option is to retransplant within a few weeks - before

adhesions make the removal more difficult. This will require UNOS

granting an exception, since the liver continues to function well on

just the portal blood flow and my natural MELD is around 10, not a

number that would get a transplant any time soon. If an exception

isn't granted then I get along as best as possible with this liver.

With the bile ducts shot, it is an increased risk of infections. The

doctors worry that because of this, if we wait for MELD to increase as

the liver fails, by the time I would get to the top of the list,

widespread infections might preclude getting a transplant.

As you can imagine, I was quite discouraged by these developments. But

I am quite hopeful that the exception will come through from UNOS and

I can move forward quickly with a good liver.

Tim R, ltx 4/98 & 6/07

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