Percutaneous transhepatic biliary drainage (PTBD)

Ricki's new liver is having bile duct issues, which is more common in LDLT (living donor liver transplant) Statistics show about 10% of transplant patients that receive cadaver livers have biliary problems, but the number jumps to about 35% for LDLT patients. Since the drain has been placed, my bilirubin has dropped from the low 20's to 7 (normal is under 2) I am less itchy and already much less jaundiced. Since this drain is placed between the ribs and through the diaphragm it starts off pretty painful but after a while, just becomes uncomfortably bearable. Since stents had been unsuccessfully placed previously, this is my last option before surgery. I know for many of us liver patients, feeling a little sick is a daily feeling for us, but if you notice anything "un-normal" (I started feeling like I did just before my transplant) get yourself checked out... Following is more information on the PTBD.

Percutaneous transhepatic biliary drainage (PTBD) is a procedure that is done to open a blocked bile duct. Your bile duct is like a network of pipes that go from your liver to your gallbladder, pancreas, and small intestine (bowel). Your liver is an organ that makes fluid called bile, which is stored in your gallbladder and helps you digest food. Digestion is the process of the body breaking down food that is eaten. When bile reaches your small intestine, it helps break down the fat in your food. The pancreas is an organ that helps you digest food.

With PTBD, your body may digest food more easily. Abdominal pain and jaundice (yellowing of your skin and the whites of your eyes), may decrease. PTBD can help you get the nutrition that you need to feel better and be healthier.

  

Why may I need percutaneous transhepatic biliary drainage?

You may need PTBD if your bile duct is blocked. A disease called cholangitis causes swelling, which blocks your bile duct. Abnormal growths and small bile stones may block your bile duct. Trauma (an accident) or a scar from a past surgery also increase the risk of getting a blocked bile duct. Ask your caregiver to explain how your bile duct may have become blocked.

What tests may I need before or during percutaneous transhepatic biliary drainage?

Tests such as fluoroscopy, magnetic resonance imaging (MRI), and computed tomography (CT) may be needed before and during your procedure. These tests take pictures of your body organs and areas. Dye may be used to help caregivers see the pictures. Tell caregivers if you are allergic to dyes, iodine or seafood, as you may also be allergic to the dye used for these tests.

What happens during percutaneous transhepatic biliary drainage?

Your caregiver will put a needle through the right side of your abdomen and into your liver. A wire will be pushed through the needle into your liver. Your caregiver will use the wire to break up stones blocking your bile duct. Your caregiver will put a tube over the needle and then remove the needle and wire. A small part of the tube will come through your skin to the outside of your body. If the tube is capped closed, bile will drain into your intestines. If the tube is left open, bile will drain into a bag that is attached to the end of the tube outside of your body. You may need to have a PTBD tube for a short time, or it may be long-lasting.

What are the risks of percutaneous transhepatic biliary drainage?

• You may be allergic to the dye used for tests that are done before or during the procedure, and have an allergic reaction. Your gallbladder, bile duct, or blood vessels may be damaged. You may lose too much blood and need a blood transfusion. After the procedure, there may be swelling or bleeding around the tube, and it may be painful. The skin around the tube may get infected. The tube may move out of place or get blocked. Your gallbladder may become swollen or infected. You could get a blood clot in a blood vessel in your liver. You could get a lung infection, or your lungs could fill with blood or air, making it hard for you to breathe.
  
• If you do not have percutaneous transhepatic biliary drainage, you may not have enough bile in your intestines to digest food. Because of this, your body may not get the nutrition it needs. Bilirubin may build up in your liver and bile duct. You may get jaundice, causing your eyes and skin to turn yellow. Your gallbladder may burst. With or without PTBD, you may die from infection. Call your caregiver with questions about your condition, the PTBD procedure, or your care.

How do I care for the tube after percutaneous transhepatic biliary drainage?

Ask your caregiver how to care for your tube and the skin around it. If bile is draining out of your body into a bag, you will need to make sure there is bile in the bag. Ask caregivers how much bile should be in the bag and what color it should be. You will need to make sure the PTBD tube is not blocked. Ask caregivers when to flush (clear out) the inside of the tube, and to show you how to flush it.

When should I call my caregiver?

Call your caregiver if:

• You cannot make it to your procedure or your appointments.
  
• Your skin or the whites of your eyes look more yellow than usual.
  
• You have a fever (increased body temperature).
  
• You are nauseated (feeling sick to your stomach) or you are vomiting (throwing up).
  
• Your stool (bowel movements) have changed color, and are very dark or very light.

When should I seek immediate help?

Seek care immediately or call 911 after surgery if:

• There is little or no drainage from the tube into the bag.
  
• You have severe (very bad) pain in your abdomen, or your abdomen feels hard or is swollen.
  
• You are coughing or throwing up blood.
  
• You are dizzy, or you feel too weak to stand up.
  
• You have new trouble breathing.
  
• Your tube falls out.
  
• Your stools look red, or you see blood when you go to the bathroom.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
Copyright © 2011. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.


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Antiviral Cocktail Better than Single Drug for Children with Hepatitis C

 MEDIA CONTACT: Ekaterina Pesheva

EMAIL: epeshev1@jhmi.edu
PHONE: (410) 516-4996

November 10, 2010

-Combo therapy better than single drug at wiping out the virus

Children with hepatitis C fare decidedly better with a supercharged combination of two antiviral drugs than with the usual and standard single-drug regimen, according to research led by investigators at the Johns Hopkins Children Center.
“Our findings indicate that when it comes to getting rid of the hepatitis C virus, the combination therapy seriously outperforms the single-drug therapy and its effects appear to endure well after stopping the treatment,” says lead investigator Kathleen Schwarz, M.D., a gastroenterologist and director of the Pediatric Liver Center at Hopkins Children’s.
The results of the study, published online in the journal Gastroenterology, indicate that the combination is more than twice as effective in eliminating the liver-ravaging viral infection as the single-drug approach. Unlike its more stubborn cousin hepatitis B, the hepatitis C virus can be eradicated from the body with antiviral medications, stopping its harmful activity, a key factor in preventing liver damage.
HEAR Kathleen Schwarz discuss Hepatitis C treatment with Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine:
The research, which involved 112 children, ages 5 to 17 years, treated at 11 U.S. hospitals, is believed to be the first large-scale, head-to-head comparison of the dual vs. single-drug approach in pediatric patients. The findings are particularly important, the scientists say, because treatment protocols in children with hepatitis C have not been studied well.
Of the 112 children, 57 received standard medication — weekly injections with long-acting pegylated interferon, or PEG interferon — plus a placebo, while 55 got a combination of PEG interferon injections and daily pills containing the antiviral drug ribavirin (RV). After the year-long treatment, patients treated with the PEG-ribavirin cocktail cleared the infection at a rate two and a half times greater than children receiving PEG interferon injections alone (53 vs. 21 percent). Viral clearance occurs when a child’s blood is free of viral traces at the end of the treatment, and sustained viral clearance, or full eradication, occurs when the blood remains clear for at least six months after stopping treatment. Full viral eradication is the hallmark of effective therapy and was where the greatest differences between the two approaches emerged. Children on the combination therapy were less likely to relapse after stopping treatment — 17 percent of them did — than children on the single-drug regimen (45 percent). In all, 41 of the 112 patients achieved complete viral eradication, and all of them continued to do well without medication at the one- and two-year check-ups. The researchers will continue to monitor these children for five years after stopping therapy.
Twenty-eight of the children receiving the PEG-placebo combination who didn’t respond to treatment after six months were offered treatment with the PEG-ribavirin combination. Nearly half of them (13) responded well and had undetectable viral loads at the end of a six-month treatment, and 11 of the 13 remained clear of infection six months after stopping the treatment. Children who responded well to standard PEG therapy continued on the same treatment.
The investigators note that because past research has shown ribavirin’s harmful effects on the fetus, it should be avoided or used cautiously during pregnancy.
The blood-borne hepatitis C virus is a leading cause of liver cancer, second only to hepatitis B, and a top reason for liver transplantation. An estimated 132,000 U.S. children are infected with the hepatitis C virus, and nearly 42,300 of them have a chronic infection, the researchers say. 
Other Johns Hopkins investigators on the study: Alexandra Valsamakis, M.D.
Other institutions involved in the research include the University of Florida College of Medicine; Seattle Children’s Hospital; Indiana University School of Medicine; Children’s Hospital of Philadelphia; Children’s Hospital Boston; University of California San Francisco; Children’s National Medical Center, Washington, D.C., Cincinnati Children’s Hospital; University of Colorado; and Columbia University Medical Center.  
The study was funded by the National Institutes of Health and the Food and Drug Administration.  Manufacturer Hoffman-La Roche supplied the medications for the study and funded the lab costs and the data coordination for the study.
Conflict-of-interest disclosure: Schwarz receives research support from Roche, Bristol Myers, Squibb, Gilead and consulting fees from Novartis. Valsamakis receives research support from Roche. The terms of these arrangements are being managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.

Related Information:

Pediatric Liver Center
Managing Childhood Liver Disease
New Recommendations Issued for Children with Chronic Hepatitis B Infections

Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Hopkins Children’s is consistently ranked among the top children's hospitals in the nation. Hopkins Children’s is Maryland's largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. Hopkins Children's will celebrate its 100th anniversary and move to a new home in 2012. For more information, please visit www.hopkinschildrens.org

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Possible Trial for Telaprevir Post Transplant for Hep C Patients

Vertex and Tibotec also plan to conduct several additional clinical trials of telaprevir in 2011 that aim to expand the future patient population for telaprevir-based regimens.

Phase 2 Post-Transplant Study: Vertex recently completed a drug-drug interaction study of telaprevir with immunosuppressive agents commonly used following a liver transplant. Based on results from this study, Vertex and Tibotec plan to initiate in 2011 a Phase 2 study of telaprevir-based regimens in people with recurrent hepatitis C following a liver transplant.

Additional Trials of Telaprevir to Advance Leadership Position in Hepatitis C

Vertex and Tibotec also plan to conduct several additional clinical trials of telaprevir in 2011 that aim to expand the future patient population for telaprevir-based regimens.

These trials include:Phase 3 HCV/Human Immunodeficiency Virus Co-Infection Trial: Vertex recently completed enrollment in a Phase 2 clinical trial of telaprevir-based regimens in people who are infected with genotype 1 hepatitis C virus and the human immunodeficiency virus (HIV), also known as HCV-HIV co-infection. If positive, results from this trial could support the planned initiation of a Phase 3 study of telaprevir-based regimens in people co-infected with HCV and HIV in 2011.

The Phase 3 trial will be designed to generate data that, if positive, could support the submission of a supplemental NDA for this population.

Phase 2 Short-Duration Treatment Study: Also in 2011, Vertex and Tibotec plan to initiate a clinical trial to evaluate the role of telaprevir as part of hepatitis C treatment regimens involving less than six total months of therapy.

One part of the trial may evaluate a telaprevir-based treatment regimen as short as 12 total weeks in duration for certain subsets of patients.

Phase 2 Post-Transplant Study: Vertex recently completed a drug-drug interaction study of telaprevir with immunosuppressive agents commonly used following a liver transplant. Based on results from this study, Vertex and Tibotec plan to initiate in 2011 a Phase 2 study of telaprevir-based regimens in people with recurrent hepatitis C following a liver transplant

See Full Press Release (at HCV New Drug Research)

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DID YOU KNOW...

1 in 4 Americans has a fatty liver that
can lead to cirrhosis (scarring) of the liver

Check your numbers:

Further testing is needed if your
ALT liver enzyme levels are OVER
30 IU/L for men
19 IU/L for Women

A simple blood test can help you
take better care of your liver.

A HEALTHY LIVER IS UP TO YOU


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