Liver transplant - Let's support each other

@stella25 Your son has not had any HE episodes, correct? I would think they may not put him on anything unless he does experience them. I sincerely hope that your son, like many people who have cirrhosis, never have to go through that. As I said before, if someone is a victim of HE episodes the caregiver has to try to be understanding as difficult as it may be. My first HE episode lasted for a relatively short amount of time but since it was so odd my husband brought me to the ER and then afterward I had to see my PCP. She called me on the phone after I had an appointment with her and told me she thought I had Alzheimer's! Two other doctors, one a neurologist, were stunned that she would do that. A lot more has to be done before Alzheimer's is diagnosed. After that I did some research to find a new doctor.
JK

@contentandwell 3 weeks was long for an HE episode and the lingering effects was 3 months. My last MELD score before transplant was 30. After the initial transplant they found the artery from my liver to my heart was kinked. I had an angioplast to correct it but it splintered the artery and I had to have a 2nd surgery 2 weeks later.
Some of my blood work is not trending and I had to have another CT Scan today. So...not out of the woods yet.

@contentandwell 3 weeks was long for an HE episode and the lingering effects was 3 months. My last MELD score before transplant was 30. After the initial transplant they found the artery from my liver to my heart was kinked. I had an angioplast to correct it but it splintered the artery and I had to have a 2nd surgery 2 weeks later.
Some of my blood work is not trending and I had to have another CT Scan today. So...not out of the woods yet.

@gaylea1 That was one long HE episode. The most mine lasted were the ones that put me in the hospital and that was generally for two or three days, but it sure seemed longer.
After my transplant, when I was feeling some pain, my husband would say "no more lactulose" to make me feel better. It really is miserable stuff. My daughter would make me laugh by pronouncing it in a very odd manner. You have to do whatever you can to find something to laugh about.
You were fortunate that the medications prevented you from having any more episodes. What was your MELD at transplant? It sounds as if you are doing very well, that's wonderful. I did very well too. It really does seem like a miracle.
JK

@rosemarya and @contentandwell and others,
Great discussion about the transplant list and deceased donors versus living donors. I spoke with our medical director and she may be able to help clarify why the need for all patients to be listed. Doctors perform a thorough evaluation on the recipient whether they are getting a deceased donor or a living donor transplant. The qualifications for receiving a transplant need to be met by the recipient for both deceased and living donation. The reason he is placed on the list is mostly a logistic reason – the United Network for Organ Sharing (UNOS) tracks transplants and patients for both deceased and living donation, and there is only one list. Every patient getting a transplant is placed on the UNOS list. The doctors determine if patients qualify for transplant, and then they determine if living donor transplant is the best option for that patient, but the list we enter the patient into tracks all the information for future use. I hope that makes sense. Please ask if you have more questions.

@rosemarya I am sure, as you say, that the evaluation must be the same and that would include being physically able to undergo surgery, but what seems odd is that he would need to be put on the list for a cadaver liver. If he has a living donor then before anything that person would also undergo testing to determine if they were a good match. From what I understand the main criteria for a live donor for liver is blood type and size, but of course there is also health, both physical and mental. If the criteria is satisfied, why would he need to be put on the list for a cadaver liver? That's what I do not understand.
JK

Stella, I do not fit the mold! I also do not have the IBS that many patients with PSC have. I do have a history of some autoimmune conditions on my mom's side of the family. For example, I have an autoimmune skin condition (vitiligo) as did my mom and grandpa.
I have located 2 older discussions where members are talking about PSC. They might contain something to let you know that there are others.
In the Digestive Health Group -
https://connect.mayoclinic.org/discussion/primary-schlerosing-cholangitis/
In the Healthy Living Group - PSC of the liver
https://connect.mayoclinic.org/discussion/psc-of-the-liver/
If you haven't already seen in Mayo's Patient Care & Health Information: Diseases & Conditions: Primary sclerosing cholangitis
https://www.mayoclinic.org/diseases-conditions/primary-sclerosing-cholangitis/symptoms-causes/syc-20355797
I was originally treated in Kentucky, but was sent to Mayo Rochester to see one of the doctors who is featured in the PSC Pages. Will your son be treated at on of the Mayos?

@stella25 I was diagnosed with cirrhosis while in a life threatening HE episode. Took 3 weeks to come out of it and i still never regained full cognizance. I was on lactuose for 2 years and rifaximin as well. I didn't have any HE episodes there after. I just had my transplant 1 month ago and am so happy no lactuose anymore.

Oh my, I'm so sorry you had to go through those episodes. How scary for you & your loved ones. There was another medication my son's hepatologist considered but I don't remember what is was. Could be the xifaxan you were taking. It was during that office visit they discovered he had a blockage in the bile ducts and was admitted to the hospital for an emergency ERCP. They decided to hold off on the HE meds for now. He will have a follow-up ERCP in two weeks and we will readdress it at that time.

@stella25 After a few HE episodes, two which landed me in the local hospital, the neurologist (my PCP thought I had a neurological problem) suggested that he thought the problem might be my liver so they tested for ammonia, which was high so they put me on lactulose. I then had a CT scan which confirmed the cirrhosis diagnosis. I was on lactulose for a couple of months until I was able to get in to see a hepatologist at MGH (Mass General Hospital). The hepatologist prescribed xifaxan, and I was able to discontinue lactulose.

Lactulose did not entirely control the HE episodes but it was better than nothing. I would have to look back on the dates but I think it did keep me out of the hospital for a while. After getting on xifaxan I had no HE episodes for almost a year, then I had another one. We thought it was because of "the perfect storm" as my son dubbed it because a number of things had happened that can lend themselves to increasing the odds of an HE episode -- a very difficult ablation, followed by norovirus, and probably not holding my medications down due to the norovirus. So at that point, I had to resume taking lactulose along with the xifaxan. I guess the doctor was right, that the HE episode happened due to my cirrhosis progressing, because I then had another in the summer even though I was on both medications. If you have any other questions about it, please just ask. If you would like I will look up exact dates of when the various things took place.

Thank you for your good wishes, I wish you the same. I hope your son is able to get through without the HE episodes. To me, they were the worst thing possible. If he does get them, please remember he is not in his right mind when he has one. Some were not too severe, and I could go to bed (they always made me tired and gave me a stomach ache) and wake up much better, just sort of fuzzy. The more severe ones left me totally irrational and difficult to deal with. Even now I get tears in my eyes just thinking of how I was. The strange thing is that I actually recognized at times that I was irrational but I couldn't help myself! Except for a couple of the severe ones that landed me in the hospital I have a pretty good recall of them, and how irrational I was. One time I even tried to hit my husband which is so unlike me. That was before we knew that I had cirrhosis so we had no idea what was causing this behavior. My daughter happened to be there and for a long time I felt like she was somewhat hostile to me, even after it was discovered that when I had these episodes I was not of my right mind.
JK