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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Autoimmune Hepatitis Patient

Hi, I am writing regarding my mother-in-law who is 50+ yrs old diabetic,thyriod and cholestrol patient(All of them are under control now).
She is a possible Autoimmune hepatitis patient, which is now at cirrhosis stage including fluid retention in the abdomen with billirubin count 22.
Her Hepatologist says that she is weak and she can't take steroids right now and need to wait until she gains strength. But she is so nauseated and her body is so weak,
we are not sure when she will be able to take medication.Keeping all the existing conditions if you can suggest some thing which would make her better with no additional side effects it would be a great help.
Appreciated for any help!
Preethi
Thu, 31 Jul 2014
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Gastroenterologist, Surgical 's  Response
Hi Preethi,
I am so sorry to hear about your Mother-in-law's condition.
Before answering your question, I would like a couple of clarifications. You said "possible" autoimmune hepatitis (AIH). How was it diagnosed? Were there any blood tests done to confirm it? and was a liver biopsy ever done?. I ask this because if the cirrhosis is not due to auto-immune hepatitis, then steroids will not be of any benefit.
Provided the diagnosis is confirmed to be AIH, then she has already reached the cirrhotic stage with portal hypertension (fluid in belly). At this juncture you should start thinking about a liver transplant for your mother-in-law, provided her physical status is good. The transplant will not only get rid of the old diseased liver and replace it with a new one, but also the immune-suppressive medications prescribed after transplant will keep the AIH at bay.
I am sure there is a good reason why your hepatologist has not already suggested this to you. In case she is not a transplant candidate, then in addition to steroids there are other medications which can control AIH. Drugs like azathioprine, cyclophosphamide and tacrolimus have been used for treating steroid resistant AIH. But these drugs have the potential to cause severe side effects and hence have to be used only under close supervision.

Hope this helps and please do not hesitate to contact me for further clarifications especially regarding centers which offer liver transplant - rxsuresh@gmail.com
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Suggest Treatment For Autoimmune Hepatitis Patient

Hi Preethi, I am so sorry to hear about your Mother-in-law s condition. Before answering your question, I would like a couple of clarifications. You said possible autoimmune hepatitis (AIH). How was it diagnosed? Were there any blood tests done to confirm it? and was a liver biopsy ever done?. I ask this because if the cirrhosis is not due to auto-immune hepatitis, then steroids will not be of any benefit. Provided the diagnosis is confirmed to be AIH, then she has already reached the cirrhotic stage with portal hypertension (fluid in belly). At this juncture you should start thinking about a liver transplant for your mother-in-law, provided her physical status is good. The transplant will not only get rid of the old diseased liver and replace it with a new one, but also the immune-suppressive medications prescribed after transplant will keep the AIH at bay. I am sure there is a good reason why your hepatologist has not already suggested this to you. In case she is not a transplant candidate, then in addition to steroids there are other medications which can control AIH. Drugs like azathioprine, cyclophosphamide and tacrolimus have been used for treating steroid resistant AIH. But these drugs have the potential to cause severe side effects and hence have to be used only under close supervision. Hope this helps and please do not hesitate to contact me for further clarifications especially regarding centers which offer liver transplant - rxsuresh@gmail.com