Speaker Emil Miskovsky, M.D.

University of Texas Medical Branch Galveston, Texas

Medical Director Hepatology & Liver Transplantation

Topic:  Transplant and PBC

Summary by PBCer Beth Wolf

Key Points:

1. Transplant is not the only option for us but a very viable alternative. The first Liver transplant occurred in 1963 and was approved by the FDA in 1983. The most common transplant is kidney but liver is #2.

2. The numbers of liver donors has remained constant over the years, but more of them can be used due to better preservation techniques.

3. Liver Allocation Priority

• Size and blood type matters.  Consequently someone lower on the list may receive a liver sooner than someone higher if the right match is found.

• The priority is for use of a donor liver locally, regionally and then, nationally. If you live in a region rich in organ donors, you are better off.

• Medical Emergency Status is a priority:
  • Status 1 - at home @ 10% of those on list
  • Status 2 - needs continuous med. care but still outpatient - 40% of those on list
  • Status 3 - Continuously hospitalized - @25%
  • Status 4 - critical - @ 25%

• It's best to be referred to a transplant center earlier rather than later. You can always come off the list!

• Waiting time for a liver varies from <1 year to between 1 and 6 years.

4. Indications of severity

• Hepatic encephalopathy - can be mild to coma
• Variceal bleeding
• Fluid retention not responding to diuretics
• Hepatorenal syndrome (kidney involvement)
• Infection of abdominal fluid (peritonitis)
• Cholangitis
• Hepatic Osteodystropy

5. Physicians measure:

• bilirubin
• albumin
• PT (clotting time)
• cholesterol

6. Contraindications to Transplant

• Infection, hepatic Cancer, Cardiopulmonary disease and AIDs. Some of these are not absolute but relative, for example, an infection that clears is no longer a contraindication.

7. Recent experience with live person liver donations have been highly successful.

8. The biggest concerns after transplant are infection and rejection. Both need constant monitoring.

9. Closing comments

• A transplant center should do at least 20 liver transplants a year, so ask at yours.
• PBCers and those with cirrhosis from alcohol do the best with transplantation.
• People with liver cancer do the worst. Liver cancer is not common in PBCers.
• In general younger people do better related more to their other health problems.
• Recurrence of PBC after transplantation is 4-8% and does not cause problems for those people.