To Your Good Health: When liver transplant is necessary
TO YOUR GOOD HEALTH

To Your Good Health: When liver transplant is necessary

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A liver transplant is necessary with advanced disease

DEAR DR. ROACH: My son is 62 years old and has cirrhosis of the liver. He does not drink. Years ago, he had a blood transfusion that turned out to have hepatitis C. He cannot get a liver transplant. He has ascites, which needs to get drained once a week. It is very painful. I heard that someone compatible could donate part of his or her liver. Would this be beneficial?

ANSWER: A viral disease that is spread in North America mostly through blood transfusions or the use of infected needles, hepatitis C is one of the most common causes of cirrhosis and end-stage liver disease. Fortunately, in the past few years, highly effective treatment for hepatitis C has been developed. In the future, fewer people should go on to develop cirrhosis due to hepatitis C.

With very advanced cirrhosis, the only curative treatment is a liver transplant. A transplant can come from a deceased donor, but also from a living donor. A few hundred living donor transplants are done per year in the U.S. In adult-to-adult transplant, the right lobe of the liver is donated, with a mortality risk to the donor of about 0.5%. One major advantage to living donor donation is that it can be done usually much faster than waiting for a compatible liver to become available.

The criteria for receiving a living donor transplant are the same as they are for a deceased donor transplant. I don't know why your son isn't able to get a liver transplant. Severe liver disease — such as needing drainage of ascites, a fluid buildup in the abdomen indicative of high pressure and severe cirrhosis of the liver — is the key reason to get it. It may be that he has another disease that would make surgery too dangerous.

You need to find out from his liver doctor why he isn't considered a candidate for liver transplant.

DEAR DR. ROACH: I went to my doctor for some blood tests, but the assistant who drew my blood put in the wrong code and tested me for herpes, which came back positive for HSV-2. I have been married for 26 years. I haven't been with anyone in all those years, and never had any symptom. Now, I feel so sick I can't concentrate. I can't believe this. My doctor told me that I could have the herpes antibodies from the chickenpox or could have come in contact with it somewhere else in my life. Can you please help me understand this? Also, I just found out my mom had herpes. 

ANSWER: HSV-2 is the usual cause of genital herpes, and HSV-1 is the usual cause of oral cold sores. Chickenpox is a related herpes virus, but is not HSV.

Let me make a few important points. The first is that the test isn't perfect, and it could be just wrong. The test is 97% specific, but when used for a low-risk population, people like you, many or most of the positives are false positives.

If your test results are indeed correct, your exposure to herpes could have come before you were married. Most people with herpes never have had an outbreak and don't know that they are infected and potentially infectious. Another possibility is that some people have HSV-2 on their lips: If your mom did, contact with her could be how you were exposed.

Most importantly, you aren't a different person now than you were when you didn't know this test result. I am sure you will feel better talking to your spouse, if you haven't already.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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This is the second in a series of three columns on the biggest mistakes parents make (and how to stop making them). Last week, I identified giving children explanations for parental instructions, giving children lots of choices, putting wonderful relationships with one's kids at the top of one's parenting priorities and thinking the "experts" know what they're talking about. (For last week's column, go to JohnRosemond.com.)

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