Doctor says I now need a liver transplant

I thought you wouldn’t post the answer.

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Thanks @FaroukMiah But I don’t understand your statement

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I’m so sorry to hear what your doctor has advised.
You can seek a second opinion from another liver specialist to get a better understanding.
What do you think?

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Hi @Johnpaul_Ezeike
It’s been a week since I advised you to seek a second opinion. Have you been able to do that?
If you’re having troubles getting access to one, I can give you contact to some specialist if your location is Nigeria.

Thank you for your kind offer, @Janefrancis. I know that @Prince_Okinedo has been in contact with him in the past and might be able to pass on your offer.

Thomas

A post was split to a new topic: Hepatitis B in Nigeria: discussion thread

Hi John Paul
Remember I have done hepatectomy and my surgeon (the only liver surgeon in Kenya Dr Karan Gadhi) is competent to do liver transplant.The challenge probably can be cost.My surgery was @kes 2.3M can help you get in touch with him.He has been too good to me.
Kinoti

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Thanks kinoti.
Please can you connect me with the doctor
I would also like to speak with you in person. Thank you

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Hi @Kinoti,

I am glad to hear that you had your surgery. I don’t remember seeing an update. I am sure you are still recovering but it would be nice to read more about your whole experience with the surgery and what the outcome is so far. I am curious about your procedure and have a few questions:

-How much of your liver was resected?

-Did you have to have radiation therapy or chemotherapy before the procedure?

-Do you know if the procedure was done using laparotomy or laparoscopic surgery?

-How long ago was the procedure and how long were you in ICU before you got to go home?

-How painful has recovery been?

I hope you heal well and look forward to hearing more. I read that it can take up to 3 months for full recovery, so don’t feel you need to respond to all these questions until you feel well enough.

My last question is for the @scienceexperts and @healthexperts because my curiosity has gotten the best of me. The scenario would be basically what Kinoti has gone through. The patient has CHB and HCC. Let’s say hypothetically that 60% of the liver was resected. I read that the liver CAN heal or regenerate 2/3’s of its volume within a few weeks but can take up to several months. Let’s say that it has been as long as necessary for the liver to regenerate fully. Does the 40% of the liver that still had HBV, replicate that to the rest of the regenerated portion of the liver or does having more than half a healthy liver help eradicate the smaller infected portion. This patient was on antivirals prior and currently. Will being on antivirals help keep the lesser portion of the liver from infecting the larger regenerated portion?

Live long and prosper Kinoti,

-Paul

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Hi all,

From a basic science perspective, it would be likely that the regenerating liver would be re-infected by virus in the blood that continues to be made by the remaining infected cells. That would be suppressed in 2 ways: 1) Effective nucleoside analog therapy can suppress infectious virus in the blood to nearly (but not completely) zero. Second, reinfection would be affected by the efficacy of the person’s immune system. If sufficient cytotoxic T cells were around and/or if enough anti-HBs antibodies were being made (or provided by HBIG treatment), reinfection would be further slowed. These variables would be different for each person, and I don’t know how they work out in real-life clinical practice.

John

Hi @john.tavis,

Thank you for your quick response. I think I was hoping that it was possible that the antivirals would keep the infected portion of the liver at bay and that the new majority portion would stay cleared and because the majority of the liver was good, that it could possibly fight against the infected portion and heal it. It was just a little hope because I can see the better chance that as the resected portion starts growing that HBV would spread to it as it grows.

I wonder if there would be any difference if, instead of the resected portion slowly growing and being infected as it grows, what would happen if instead it was actually replaced with a donated good portion of liver. Would that make any difference because the good portion is more instantaneous versus the slow regrowth from an already bad liver.

Thanks again for your response and your scientific expertise.

-Paul

Hi @PuallyHBV,

The situation with a transplanted liver is similar to a resected liver, but without the reservoir of infected cells that continue to produce virus. Without antiviral interventions, the new liver is infected about 100% of the time. With pre- and post-therapy nucleoside analog treatment plus relatively long-term HBIG, reinfection can be stopped the majority of the time. I cannot remember the statistics offhand, but re-infection can often be stopped in this case with careful medical care.

John.

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Hi puallyHBV
I am happy to read your concerns and questions
Remember my surgery was in November last year and took 6hours in the theater because I bled alot according to my surgeon. I stayed in the ICU for 4 days and one day in HDU. As the the volume that was reseted I can’t give it accurately but the tumor was Large as it occupied section six and seven of the liver.
Was the experience painful?. Honestly, it was extremely painful! For the months of December and January I lay on the floor with my mattress. I couldn’t walk straight, my Tummy was and is still numb. I developed burning sensation on my thumbs and both pointing fingers… horrible. I had no appetite.
Right now, I am ok. The last time I had an ultrasound, there was a cyst of 22ml volume on the surgical site. My doc told me it will clear on its own. I am due for another ultrasound on June. I experience some slight pain where surgery was done. I haven’t meet my doc to know why.
Hope I have answered nearly all your concerns. Be free to chat and ask me anything. Also know that if another hepatectomy is necessary I will still go for.
Kinoti

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@Kinoti

Best wishes. My heart is with you.

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Hi listowel
Thanks my brother. Let’s me pray God will keep me long to encourage others.
Kinoti

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Hi @john
I find you have introduced in your writing an abbreviation strage to me HBIG. What does it mean please.
Kinoti

Hi @Kinoti,

I remember that you were going to have surgery but wow, that was about 6 months ago. It didn’t seem like it was so long ago, but my memory isn’t always the best. What a journey you have been on. I am glad that you made it through without much complication.

Converting centimeters to inches (we use imperial measurements for the most part in the U.S.) your resection was around 4 inches. When I read it as inches, that is quite large. When you get labs (ultrasounds and whatnot) do they check how much of the resection has grown back? After 6 months you could have grown a good portion back.

I am no stranger to pain but I can only imagine what you have gone through and the fortitude it took you to make it through the months of recovery.

It’s quite possible that other members have had to deal with HCC and possibly resection, but regardless, you are definitely a pioneer of sharing such an experience with us. I hope you have a good support system. Please tell me you had family or people to help you through this. Sleeping on a mattress on the floor couldn’t have been the most comfortable thing, especially having the surgery and having to get up and down from the floor and put pressure on the surgical area.

Thanks for answering my questions as this situation and process could always be in mine or other members futures. Hopefully not, but it’s only practical that a small percentage of us will have to deal with such extremes like resection or transplant someday.

Peace be with you,

-Paul

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Yes, I will connect you by giving you his number. Give me some time.
Kinoti

Hepatitis B Immunoglobin = HBIG. It is antibodies purified from people who have either cleared HBV, or more likely, had a really good response to the vaccine. It “passively transfers” (ie, provides through injection) anti-HBsAg antibodies. It has been used for many years and can be really useful in situations like trying to block infection of a transplanted liver. It is likely to be supplanted relatively soon by either Bulevirtide (Hepcludex, Mycludex B) which is an injectable HBV entry blocker that has the same biological effect, or by a number of anti-HBsAg monoclonal antibodies that are being developed.

John.

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Hi @john.tavis,

Would HBIG not be useful in a resection? Is it only helpful with transplant? If not, could you explain why. Also, since HBIG comes from people within what I assume is a small subset, is HBIG rare to get a hold of, maybe even more so than a liver for transplant? Would Bulevirtide not require antibodies from people and be more accessible once approved?

Sorry if these questions seem ignorant.

-Paul