We are still here in Utah, David has been admitted inpatient since surgery last week. He had another ERCP yesterday (Monday 4/22) and unfortuantely they were still unable to remove the infected stents in the bile ducts of his liver. With two failed attempts to remove the stents, the doctors feel that transplant is the next appropriate step. 

There were several factors considered before we came to this conclusion. We don't take transplant lightly. Also, David is already pretty exhausted from being in the hospital for a week recovering from a major surgery with the shunt. However, moving foward with transplant seems like the best option for long term outcomes. Maybe it is God's grace that they have been unable to remove the stents if removing them would cause life threatening bleeding. We may never know, but we feel two teams now have given an exceptional effort to take them out. It is abundantly clear that stenting is not a sustainable future for this disease given the complications that continually happen. 

Since last night, David is currently active on the transplant list here in Utah. David's MELD score is still very low because the system is not made for his disease and he doesn't really get any points for all these complications he has had. The transplant team is working on appealing to the board to get exception points and raise the chances of him getting an offer. He is currently the only patient on the B list for this team, but there are other B patients listed in the region with higher scores. 

Ideally, David will be discharged tomorrow with IV antibiotics that will hopefully keep the infection under control with the infected stents. The doctor wants us to stay in the area in anticipation of getting a call sooner rather than later for a liver. 

We feel extremely confident in the expertise of the surgeons here. They have experience from all over the country and some of them recently came from Mayo in Rochester. David's transplant is very technically challenging. The skill set of this team seems exceptional compared to the other teams we have worked with. They can also use the shunt they have just created in the previous surgery as blood flow to the new liver, which is a great option as that is a big challenge with his portal thrombus. 

Once he has transplant surgery, we will be here for a minimum of 4 weeks to complete regular lab and follow up appointments once he is discharged from the hospital. We are taking one day at a time right now to figure out logistics of being gone for this long, we will ask for help once we know what we need! Thank you to everyone for all the love and prayers. We are praying for renewed energy each day, smooth logistics for all the things, and a new healthy liver in God's timing.