The silent dragon—hepatitis C - Home Study Program

AORN Journal, June, 2003 by Beverly Walker, Linda Howard

Other developments in the area of transplantation include donations from live donors and splitting liver segments between recipients. Use of living donors for liver transplantations in adults has been performed more than 100 times in the United States during the past two years. (54) Only a handful of medical centers in the country have performed the technically difficult procedure pioneered by surgeons in Japan and Hong Kong in the mid 1990s. During this procedure, a surgeon removes the right lobe of the donor's liver and transplants it into a recipient. The donor's left lobe regenerates to the liver's original size in about two weeks. This complicated surgery takes up to 12 hours for the recipient, and although it is controversial, physicians feel an ethical imperative to continue as the demand for organs rises. (55)

It is possible to split the liver into two segments that can be shared between two recipients because the liver regenerates. This procedure has excellent success rates, and in children, it has the same success rate as whole liver transplantation. Child recipients require only a small section of liver, so the larger section can be retained by the living donor. If a cadaver liver is available, it can be transplanted into an adult recipient. In all recipients, the partial liver segments regenerate within weeks of transplantation. (56)

CASE STUDY

Ms M is a 52-year-old RN with more than 30 years of experience in perioperative services. She also has HCV. Ms M began her career in the perioperative arena as an LPN, performing in the scrub role for several years before obtaining her nursing degree. As a circulating nurse, she cared for patients in all of the service lines in the busy 10-room OR of her hospital, but open heart surgery became her specialty.

Where and when she contracted HCV is not known, but she recalls being told in the early 1980s that she had non-A, non-B hepatitis and not to worry. For approximately the next 10 to 15 years, Ms M forgot about the hepatitis diagnosis. She did not recognize a connection between her symptoms and her "non" disease. Extreme fatigue, body aches, muscle cramps, and itchy skin were daily problems. They seemed vague enough that she learned to live with them at first.

When both her parents died in 1995, she realized she was depressed and sought treatment for her mood disorder. Her family physician prescribed an antidepressant, but she continued to have all the same symptoms and more. Chronic back pain and sciatica became daily problems. During a routine visit to her gynecologist, she discussed her symptoms with her physician who advised her to be tested for HCV. She tested positive for the HCV, and a liver biopsy in 1996 showed her to be in stage I liver disease. By 2000, she had progressed to stage IV with fibrosis and signs of early cirrhosis.

Treatment options in the beginning were minimal. She started with interferon injections three times per week for 48 weeks. The side effects from the interferon were quite unpleasant. Flu-like symptoms prevailed. Sometimes Ms M did not know what was worse, the symptoms from the disease or the side effects from the medication. The second 48 weeks combined ribavirin with the interferon. Side effects were just as disagreeable, but her viral counts began to drop during the treatment regimen.