Author Affiliation: Dr Hanto is Chief, Division of Transplantation, Department of Surgery, Beth Israel Deaconess Medical Center, and the Lewis Thomas Professor of Surgery, Harvard Medical School, Boston, Mass.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR SHIP: Mr G is a 50-year-old man who has
had liver disease for about 12 years. He lives near Boston with his wife and
children and is a partner in a small industrial firm. He has managed care
During a routine life insurance evaluation in 1991, Mr G was found to
have abnormal liver function test results and was diagnosed with non-A, non-B
hepatitis. Liver biopsy showed mild periportal inflammation. In 1995, he was
found to have antibodies to hepatitis C. He was treated with interferon and
ribavirin but did not improve. A liver biopsy in 2001 revealed grade II to
III inflammation, stage IV fibrosis. He was subsequently treated with pegylated
interferon and ribavirin and again did not improve. In 2001, he developed
transient ascites and encephalopathy, with unsteady gait and forgetfulness.
In 2002, Mr G bled from esophageal varices and underwent a transjugular intrahepatic
portosystemic shunt (TIPS) procedure, requiring revision 1 week later. Since
that time, he has been on the liver transplant waiting list.
Hanto DW. A 50-Year-Old Man With Hepatitis C and Cirrhosis Needing Liver Transplantation. JAMA. 2003;290(24):3238-3246. doi:10.1001/jama.290.24.3238