Published: Feb. 12, 2010
Updated: Feb. 12, 2010
When a family member has liver disease and their liver fails, it can be stressful both for the patient and their family. Talking with family members, your doctors and nurses, a social worker, counselor, or clergy person may help you sort out your feelings and worries.
The information below is about donating a part of your liver to a family member. You should discuss this with your family members as well as the doctors and nurses you will see at the Transplant Clinic.
When is it time to think about donation?
Usually someone must lose 80 to 90 percent or more of their liver function before they need liver replacement therapy. There is no hepatic dialysis, so patients with progressive, acute, or chronic liver failure either become transplanted or die. Sometimes liver failure happens suddenly. It also may happen slowly over many years. Either way the patient and their doctor will discuss the best options for them.
Who can be a living donor?
Living liver donors must be over 18 years old. Donors must be healthy, less than 50 years of age, and must have a compatible blood type. The donor must meet minimum hepatic volume requirements for the recipient (they must match in size).
The most common donors are related members of the family. These people are usually parents, children, or brothers or sisters of the person needing the transplant. Sometimes other family members, like grandparents, cousins, aunts, or uncles can be a donor.
In some cases, a husband or wife may be considered as a donor. Other non-related persons who have a very close emotional bond to the recipient are sometimes appropriate for donation of part of their liver.
How will I know if it’s okay for me to be a donor?
After the blood typing is done we will know if you are a compatible match with your relative. Then we will talk with you in detail about being a donor.
First, you must decide if you want to be evaluated as a donor. If you do, then we will do several tests to make sure you are healthy and it is safe for you to donate part of your liver. This testing will take about two or three days, but you do not have to stay in the hospital for the tests. You will have these tests done: Blood samples (if compatible blood types), chest x-ray, EKG, volumetric abdominal CT scan, liver biopsy, and arteriogram.
You will see these people:
■ Hepatologist -- a liver specialist who will do a physical exam and talk with you about your family and medical history. The hepatologist may request a liver biopsy to be done after he has examined you.
■ Transplant nurse -- Will talk with you about the surgery and your hospital stay.
■ Social worker or psychiatrist -- Will talk with you about your feelings and concerns.
If all of these tests and evaluations show it is safe for you to continue we will schedule the last day of tests. You will be evaluated by a surgeon, and we will schedule an arteriogram. This is an x-ray test used to look at the blood vessels to the liver.
In this test a small tube is inserted into a blood vessel in your groin area and passed up to the blood vessels going to your liver. A small amount of dye is injected and pictures of the blood supply to your liver are made. You will need to remain in an observation area for up to six hours after this test is completed. If everything is okay with this test then we can schedule a transplant. Sometimes we may need to do some other tests, before the arteriogram.
Are there risks to me if I donate a part of my liver?
With any surgery there are risks of bleeding or infections. There is also some risk associated with being put to sleep for surgery. The risk of death from this surgery is less than 1 percent. The reason we do lots of tests on possible donors is to see that they are healthy and that it is safe for them to donate. We want to be as sure as we can that donating a part of your liver now is not likely to cause you harm in the future.
How much will this cost me?
The tests, surgery, hospital stay, and your return visit will not cost you. They are charged to the recipient’s insurance or Medicare. Your relative’s insurance or Medicare will not cover your time away from work or travel. Your only direct expense may be for some discharge medicines, such as pain medication and antibiotics. These usually cost less than $75.
Are there benefits to me as a donor?
Many people feel donating a part of their liver is rewarding and satisfying. It is quite normal to have some concerns over donating a part of your liver. Often talking over your feelings and concerns with your family members and the medical staff can ease those concerns and worries. You may find it helpful to talk with someone who has donated an organ to a family member. Ask the transplant nurse if that is possible.
What if I decide not to donate part of my liver?
Deciding to donate a part of your liver should be your decision without family pressure. It is up to you to decide if donating is right for you. You need to consider all the facts, the risks, and the benefits to decide what is right for you. Also the person with liver failure who needs a transplant has a right to decide that they do not want a transplant or they do not want to ask you to donate.
Who else can donate a part of their liver?
Sometimes other family members or friends ask if they can donate a part of their liver. We do evaluate other family members such as wives, husbands, or more distant relatives. Talk with your transplant nurse or doctor if you are interested in this option.
Source
November 27, 2010
New HCV Therapies on the Horizon
Clinical Microbiology and Infection
DOI: 10.1111/j.1469-0691.2010.03430.x
Copyright © 2010 European Society of Clinical Microbiology and Infectious
Accepted Article (Accepted, unedited articles published online for future issues)
Author Information
Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany
*Correspondence: Christoph Sarrazin,
*Correspondence: Corresponding author: Christoph Sarrazin, MD Medizinische Klinik 1 Klinikum der J.W. Goethe-Universität Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany Phone: +496963015122; Fax: +4969630183112 Email: sarrazin@em.uni-frankfurt.de
Abstract
Improved understanding of the hepatitis C virus (HCV) life-cycle has led to the discovery of numerous potential targets for antiviral therapy. HCV polyprotein processing and replication have been identified as the most promising viral targets. However, viral entry and fusion, RNA translation, virus assembly and release and several host cell factors may provide alternative attractive targets for future anti-HCV therapies.
Inhibitors of the HCV NS3/4A protease are currently the most advanced in clinical development. Monotherapy with protease inhibitors revealed high antiviral activity but was associated with a frequent selection of resistant HCV variants, often resulting in viral breakthrough. However, there is encouraging evidence from phase 2/3 trials, indicating that the addition of a protease inhibitor (e.g. telaprevir and boceprevir) to pegylated interferon-alfa/ribavirin substantially improves sustained virologic response rates in both treatment-naïve and -experienced patients with HCV genotype 1.
Nucleos(t)ide inhibitors of the HCV NS5B polymerase have shown variable antiviral activity against different HCV genotypes but seem to have a higher genetic barrier to resistance compared to protease inhibitors. In addition, several allosteric binding sites have been identified for non-nucleoside inhibitors of the NS5B polymerase. However, development of a substance with high antiviral activity and a high genetic barrier to resistance seems to be difficult. Among the different host-cell targeting compounds in early clinical development, cyclophilin-inhibitors have shown the most promising results.
Although advances have also been made towards the improvement of interferons, combinations of antiviral agents with different mechanisms of action may lead to the eventual possibility of interferon-free regimens.
Source
DOI: 10.1111/j.1469-0691.2010.03430.x
Copyright © 2010 European Society of Clinical Microbiology and Infectious
Accepted Article (Accepted, unedited articles published online for future issues)
Author Information
Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany
*Correspondence: Christoph Sarrazin,
*Correspondence: Corresponding author: Christoph Sarrazin, MD Medizinische Klinik 1 Klinikum der J.W. Goethe-Universität Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany Phone: +496963015122; Fax: +4969630183112 Email: sarrazin@em.uni-frankfurt.de
Abstract
Improved understanding of the hepatitis C virus (HCV) life-cycle has led to the discovery of numerous potential targets for antiviral therapy. HCV polyprotein processing and replication have been identified as the most promising viral targets. However, viral entry and fusion, RNA translation, virus assembly and release and several host cell factors may provide alternative attractive targets for future anti-HCV therapies.
Inhibitors of the HCV NS3/4A protease are currently the most advanced in clinical development. Monotherapy with protease inhibitors revealed high antiviral activity but was associated with a frequent selection of resistant HCV variants, often resulting in viral breakthrough. However, there is encouraging evidence from phase 2/3 trials, indicating that the addition of a protease inhibitor (e.g. telaprevir and boceprevir) to pegylated interferon-alfa/ribavirin substantially improves sustained virologic response rates in both treatment-naïve and -experienced patients with HCV genotype 1.
Nucleos(t)ide inhibitors of the HCV NS5B polymerase have shown variable antiviral activity against different HCV genotypes but seem to have a higher genetic barrier to resistance compared to protease inhibitors. In addition, several allosteric binding sites have been identified for non-nucleoside inhibitors of the NS5B polymerase. However, development of a substance with high antiviral activity and a high genetic barrier to resistance seems to be difficult. Among the different host-cell targeting compounds in early clinical development, cyclophilin-inhibitors have shown the most promising results.
Although advances have also been made towards the improvement of interferons, combinations of antiviral agents with different mechanisms of action may lead to the eventual possibility of interferon-free regimens.
Source
AASLD: From Podium to Practice: Updates in HCV Treatment
Source: CCO Official Conference Coverage of the 2010 Annual Meeting of the American Association for the Study of Liver Diseases*
*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs
Capsule Summaries
*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs
Capsule Summaries
- Pilot Study Shows Robust Antiviral Activity With GS-9256 and Tegobuvir (GS-9190)–Based 4-Week Lead-in Regimens in Treatment-Naive Patients With Genotype 1 HCV
- After 12 Weeks of Telaprevir Treatment, PegIFN/RBV Can Be Shortened to 24 Weeks in HCV Genotype 1 Patients Achieving Extended RVR
- SPRINT-2: Boceprevir Plus PegIFN/RBV for 24 Weeks Improves SVR Rates vs PegIFN/RBV in Treatment-Naive Patients With Genotype 1 HCV
- PILLAR: TMC435 Plus PegIFN/RBV Demonstrates High Rates of RVR and EVR in Treatment-Naive Patients With Genotype 1 HCV Infection
- BMS-790052 and BMS-650032 Coadministration Associated With Undetectable HCV RNA After 12 Weeks of Therapy With or Without PegIFN/RBV in Genotype 1 HCV Null Responders
- ANA598 Improves HCV RNA Response to PegIFN/RBV in Treatment-Naive Patients With Chronic Genotype 1 HCV Infection
- Danoprevir Added to Standard PegIFN/RBV for 12 Weeks Associated With Rapid and Potent Viral Suppression in Patients With Genotype 1 HCV Infection
- PROPEL: RG7128 Plus PegIFN alfa-2a/RBV Demonstrates High Rates of RVR and cEVR in Treatment-Naive Patients Infected With Genotype 1/4 HCV
- Vaniprevir (MK-7009) With Peginterferon alfa-2a Plus Ribavirin Produces Higher RVR Rates in Treatment-Naive Genotype 1 HCV Patients
- ADVANCE: Telaprevir Plus PegIFN/RBV Associated With Significant Increases in SVR in Treatment-Naive Patients With Genotype 1 HCV
- RESPOND-2: High SVR Rates With Boceprevir and PegIFN/RBV Combination Therapy in Patients With Genotype 1 HCV Failing Previous PegIFN/RBV
- MK-5172 Demonstrated Potent Antiviral Activity in Patients With Chronic Genotype 1 or 3 HCV Infection
- Modeling Study Results Support IL-28B Genotype Stratification in HCV Clinical Trials of PegIFN/RBV Plus Direct-Acting Antivirals
- Peginterferon Lambda Demonstrates Promising Early Virologic Response and Favorable Tolerability for the Treatment of HCV Infection
- Higher Early Virologic Response With Telaprevir Plus PegIFN/RBV vs PegIFN/RBV or Telaprevir Monotherapy but Similar Rates of SVR in Treatment-Naive Patients With Genotype 4 HCV
Disclaimer: The materials published on the Clinical Care Options Sites reflect the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the CME provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
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