Q: My brother is suffering from HCV for the past 7 months and he had undergone kidney transplant 10 years back and was doing well. No bad habits. We are in a dilemma what to do next for him? He had already had around 8 ascitis tapping done and fluid removed. Enclosing a brief discharge summary below. Kindly advise what to next, please. ----------------------------------- Age: 33 years Sex: male Diagnosis: Cirrhosis - Decompensated & Hypoproteinaemia / HCV Brief History: Known case of renal transplant - cirrhosis decompensated - hepatitis-C positive H/o abdominal distension (+), breathlessness on exertion, yellowish discolouration of eyes, B/L swelling of the feet, Occ. dry cough On Ascitic tapping SOS Now Admitted for ascitic tapping No H/o Diabetes/Asthma Examination: P+ E+ (B/L Pitting Pedal oedema), Icterus ++, Afebrile, Pulse - 72/min, BP 170/110 mmHG, CVS - S1 S2 heard, RS - BL Basal crypts (+), P/A - Ascites ++ - Aseptic precautions, through 18G needle -> ascitic tapping done -> about 6.5 litres of straw coloured fluid was drained. Patient comfortable after the procedure. - I.V.F albumin 100 cc -> was given for 2 hours after the ascitic tapping. - Inj. Lasix 80mg IV after albumin transfusion. Advised on discharge - Tab Arkamin 0.1 mg 1-0-1 - Tab Pan 40 40mg 1-0-1 - Tab Aldactone 100mg 1-0-0 - Tab wysolone 7.5 mg 1-0.0 - Tab lax 40 mg 1/2 - 0-0 - Tab Folvite 0-1-0 - Tab Fefol 0-1-0

A:It looks like your brother has advanced liver disease secondary to HCV infection. The treatment options at this stage are limited. One possibility is liver transplantation, but you did not mention what other illnesses he has. Another possibility is to perform the TIPS procedure which may prevent the need for frequent taps for his ascites. However, your brother has a complex problem and it would be best to discuss treatment options with your hepatologist. It would not be correct for me to make recommendations without knowing the full details.