At our last outpatient appointment, Lincoln’s liver labs looked very bad… everything was elevated and the team had us admitted to get a biopsy of the new liver to get an idea of what was going on. This is not a “surprise”. It sucks, but it’s part of the first year post-transplant, so we knew there was a good chance of ending up back in the hospital. We just didn’t think it would be so soon after we just got out.
Once admitted, we also saw that Lincoln’s anti-rejection medication levels were still low. The previous Thursday, they were sub therapeutic and we were told to increase his dose. This past Tuesday they were still sub therapeutic… so that’s at least 5 days of not getting enough anti-rejection medication. Therefore, there was a good chance he was rejecting just because he wasn’t getting enough medications, but they wanted to be sure since there are many types of rejection with a biopsy.
On Wednesday, the day of the biopsy, Lincoln had an ultrasound to make sure his vessels around the liver didn’t need a stent. If these vessels were stenosed, that could cause his elevated numbers and would mean a trip to the OR. Luckily, the ultrasound didn’t show that, but it showed some ascites. This is completely normal for a new liver transplant, but it made for a more difficult biopsy, so they postponed it to Friday, August 16.
Thursday labs didn’t show much improvement, so we still expected a biopsy today, but this morning’s labs were sooo much better! So no biopsy right now, just continue treating with steroids and increasing his anti-rejection medication to be therapeutic. We are so thankful he does not need to be intubated, sedated, and operated on right now, but also know this will forever be a concern in Lincoln’s life and a possibility further down the road.
On another note – Lincoln already got his first bone fracture in our last admission due to osteoporosis and excessive manipulation for an arterial line. We had another scare of a broken bone in his foot after discharge when it started to swell. He had had an IV in that leg so we were worried about a DVT or broken bone. After xray and ultrasound, we ruled out DVT but saw calcification of tissues in his foot and calf. Orthopedics was consulted and, like his wrist, there’s nothing to do at the moment but we will continue to see them outpatient. The likely culprit is tissue insult from the IV and then he received calcium gluconate which caused calcium to deposit in that foot and calf. As his body starts to normalize after transplant, the calcium may reabsorb into his body. He uses it great and doesn’t complain of pain though!
