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Clinical Crossroads
Clinician's Corner
December 24/31, 2003

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

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 insurance.

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.