September 2003



Thomas Shaw-Stiffel, MD, MMM
Medical Director, Living Donor Liver Transplantation
Univ of Pittsburgh Medical Center
Presbyterian Hospital Center for Liver Diseases
Pittsburgh, PA


Question 1
I was wondering if the WBC's and the absolute neutrophils have anything
To do with PBC?

Answer 1
Neutrophils have no apparent role in this condition that I'm aware of. On the other hand, the other white cells (immunocytes such as t-lymphocytes) are implicated in most autoimmune diseases including pbc, although the exact mechanism remains unclear


Question 2
I know this disease varies from individual to individual, but from Stage 4 PBC, what is the "typical" range of life expectancy before transplant?  
Do younger patients get any preferential treatment on listing?

Answer 2
This also varies considerably. With ursodiol, the progression can be slowed and liver transplant even prevented according to the trials published in 1998. So without specific lab values to assess severity of disease, having stage 4 is less helpful in and of itself.

NO, younger patients do not get preferential treatment.


Question 3
Can thyroid medication increase the metabolism and therefore speed up the progression of PBC. What are your thoughts about that concept?

Answer 3
Interesting idea but I'm not aware of any literature on this topic. If anything, most patients with pbc have low thyroid function and need the meds, not reported to cause problems as long as given in correct doses and thyroid tests watched carefully by the patient's doctor.


Question 4
When I eat my stomach swells and I look so bloated. Is this common in liver disease?  Is there something I can do?  I walk about 4 miles per day.

Answer 4
Not likely liver related but proper evaluation by your physician for this would be very important


Question 5
Do hepatologists or gastroenterologists ever test pbcers for natural killer
Cell levels? If so, what are the findings?  Do you think this would be a
Useful test to do?

Answer 5
Not that I'm aware of.
This may be part of the immune attack that triggers or maintains the autoimmune process in pbc, but I'm not an expert on this.


Question 6
Could you explain how one determines what stage of PBC they are in?

Answer 6
Based on the liver biopsy, the pathologist assesses the degree of liver scarring and inflammation to determine the stage. However, this is often out of sink with how the patient feels or their labs, so not the ideal test to begin with.


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