Post Liver Transplant - Elevated enzymes, creatinine

Hello everybody,

I have been following the forum for a long time now. I am glad I have joined today.

My sister ( 39 years) had her liver transplant on 12th January 2012, just about 10 months ago. Doctors refer to it as cryptic for they did not find a Virus or bacteria that have damaged her liver. However most of us believe that a medication she took from a dermatologist for about 8 months for Vitiligo have caused her liver issue. Prior to her liver transplant she had jaundice symptoms, her biluribin shoot upto 25 for about 50 days and had ascetics.

Her liver transplant was a success. However post transplant, her drain did not stop until 3 months. It was terrifying. She had ascetics. Doctors tapped the drain out a couple of times and put her on Dytor and Lacilactone for sometime. All the tests including Tuberculosis was done and was found negative. She had to fight urine infection -klebsiella for about 2 months and that was precisely why she had ascetics. She was on antibiotics of different kinds for months.

She was recovering well until a couple of months ago. Her liver enzymes have started fluctuating. This month it has gone up to - 66 AST, 99 ALT, 250 AK phos, and Creatinine 0.99. Doctors also put her on antibiotics for a brief period. Her TLC is 7.5 so far. Her tac level is 7.

Doctors have increased her doses yet again - Prograf - 3 and 2.5 mg per day and Wysolone 10 mg OD. and cellcept 1000 mg twice a day. Doctors are not very worried at this point. Most of the patients we spoke to said first year the enzymes and other numbers fluctuates. It takes a few years for some to get normalised.

Her calcium appears to be in a normal but towards the lower end of the range. Sodium and Potassium is within the range. Her uric acid was 6.5 last week which is on the higher side.

I am very anxious at the point. I pray things will get better eventually. It breaks my heart when i think about the pain she had undergone past year. Your inputs would be valuable. I already feel better, relaxed.

Regards
Jubi

Jubi,
Welcome to HW. I had a transplant 3 years back and have had a few minor setbacks, though at present all is well. If you'd like to email me, I'll send you the address of a transplant forum, where you might find more people who have been through the same problems as your sister. I adjusted to my meds within three weeks. They have been changed slightly over the years, but now I take 1 mg. of prograf twice a day.

Thanks David. I will touch base with you. My email ID is [email protected]. I found your email ID in your profile page [email protected]. Is it ok if I write to you here.

Regards
Jubi

There are over the counter meds your sister could have taken to damage her liver. Several people on that transplant forum I'm on, had liver failure for no foreseeable reason. Sometimes there's no way to know what the cause of liver failure is.

Its amazing how different each individual is. My husband is post TP almost 8 months, and he is still 4/4 Prograf. His #'s according to the doctors are doing really good, only 1 time was there a questionable bloodwork evaluation, and it was considred to be a glitch . . high Prograf level. he is still doing bloodwork every other week, and before we see GI the next time, they are going to ck Viral Load.

I wish all of you the best, and continued success in recovering from this terrible illness!!

Debbie

Yes Connie, I read your blog-Post Transplant. I will revisit.
ML, I wish Mike well.
Debbie, i thought so. Every person reacts differently to medication. What else is your husband taking apart from Prograf?

Today our Transplant Surgeon, recommended the following doses for my sister:

Same doses for Progarf and Cellcept

Prograf - 3 mg and 2.5 mg per day
Cellcept - 1000 mg - 1000 mg per day

He has increased Wysolone from 10 mg :
- 40 mg OD for 3 days then
- 35 mg OD for 3 days
Asking to repeat blood work for CBC/LFT Creatinine after 3 days.

Lets see what happens.
Regards
Jubi

Hi Connie,

This is what it is:

Ingredient matches for Wysolone
Prednisolone
Prednisolone is reported as an ingredient of Wysolone in the following countries: India

My sister is in India. Its a Steroid.
She has sent her blood sample to check her Tac level today. Subsequently she plans to do her blood work, probably in a day or two. She wants to check her new numbers first before jumping at 40 mh Wysolone kind of doses. Lets see. We would consult the transplant surgeon and hepatologist moment we have the new results. I am anxious. Keep the faith...very hopeful.

Regards
Jubi

Certainly Connie. I would let you know.

Hi Debbie,
My good wishes...God bless.

Why long term antibiotics are recommended? I am also curious to know why 81 mg asprin is given.
My sister is on antibiotics off and on now ..her TLC/WBC keeps fluctuating and doctors recommends antibiotic when it goes up....her latest report indicates a spike in TLC/WBC (9.34) and i am sure she has to be on antibiotics yet again.

Connie,

Blood work result are out..

After taking prograf 3 mg and 2.5 mg per day, Cellcept 1000 mg twice a day and Wysolone 10 mg, for 7 days her liver enzymes have come down to SGOT 46 and SGPT 42. Her TLC/WBC however is 9.34 indicating may be infection.. If it exceeds 10mark, i think she will be given antibiotics..

Have you taken a flue shot? Is it OK to take a flue shot as it is dead virus vaccination?

Regards
Jubi

Hi Connie,

I was relieved to see her new numbers.

TLC is Total Leukocytes Count or White Blood count. The result is indicated while doing Complete Blood Count ( CBC). Total WBC range is 4,500 - 10,000. If it is more than 10,000 it indicates infection. My sisters new TLC is 9,3400.

Antibiotic is not recommended unless the patient is infected. They gave antibiotics when my sister had urine infection and flue after her surgery. This is an interesting piece of information. Now that her TLC is rising I am sure they will ask her to take antibiotics. I think mandatory antibiotic doses helps curbing infection of any kind when immunosuppresants doses are high. I will let sis know and she can take it up with her doctor.
She continues to take high doses of immunosuppresants and hence her TLC and subsequently enzymes keeps rising without any protection.

I want to know if you had to take antibiotics all 7 days for 6 months? Debbie's husband has completed 8 months post transplant and he takes antibiotics 3 days. Do you think it depends on person to person..? This will help in our discussion with our doctor.

By the way I live in Chicago. My sister is in India. I communicate with her everyday via skype.

Thanks and take care

Connie

Mike is 17 months post transplant.  He takes an antibiotic once a week.

It makes me wonder why they took me off antibiotics entirely some months ago.

Hugs,
Connie

I only take 1 mg of Prograf twice a day. It has been at that dosage for many months and the level in my blood is 7, which is exactly what they want.

Hugs,
Connie