Changing immunosuppressant in Thailand

[Guderian]

This is a bit of a niche topic, I know, so not likely to be of much interest, but any experience or information would be gratefully received.

The consultant hepatologist I see once a year back in the UK (to monitor my liver transplant dating back to 1995) has been trying to get me to change immunosuppressant from mycophenolate to tacrolimus for several years. I’ve been on the current medication for 20 years now with no obvious problems so I was reluctant to make the change. However, on my most recent visit to see him he said that the immunosuppressant I currently take is causing minor skin cancer problems which will get worse with time and I really need to make the change. OK, I can see the driver now, but it will mean returning to stay in the UK for at least six months next year. I still have my own place there so financially it’s not an issue, it’s just that I get very bored (and more than a little bit cold!) when I spend an extended period there.

So I was wondering is there’s anywhere in Thailand that can safely manage the transition from one immunosuppressant to another? I’m no expert, but I gather they need to check your blood every month to test for levels of enzymes that are precursors to the rejection process if things start to go wrong. I’ve no idea what the name of this blood test is, but have been told that it’s a pretty complicated one. I gather that the main transplant centres in Thailand are Bumrungrad and Chula in Bangkok. In principle, I guess, either of them should be able to manage this process, but I wonder just how much experience they have with it? If they’re still on the steep part of the learning curve then I’m not interested.

If the Thai hospitals can safely do this, though, then I might make the whole change here, I don’t much care about the cost. Alternatively, I could return to the UK for a few months and get the process started there and then come back to Thailand for a month or six weeks before going back to the UK again to conclude the change. I’d just like to know what my options are realistically before trying to make a decision.

Thanks for any help.

[Sheryl]

Due to comparatively high incidence of primary liver cancer here there is a lot of Thai expetience with liver transplantation and if you are based in Bangkok I think this should be do-able though it will be very costly (the drug and the tests).  

 

The issue with tacrolimus is that it has a very narrow therapeutic range i.e. easy to under or over dose.

 

I will send you some specific doctor names in a bit. 

 

You would do well to price the drug and lab tests and also to consider the possibility if things go badly of an expensive hospitalization here.  Might be worth 6 months of boredom to get treated under NHS.

[Guderian]

15 minutes ago, Sheryl said:

Due to comparatively high incidence of primary luver cancer here thete is a lot og Thai expetience with liver trandplantation and if you are baded in Bangkok I think this should be do-snle though it will be very costly (the drug and the tests).  

 

The issue with tacrolimus is that it has a very narrow therapeutic range i.e. eady to under or over dose.

 

I will send you some specific doctor names in a bit. 

 

You would do well to price the drug and lab tests and also to consider the possibility if things go badly of an expensive hospitalization here.  Might be worth 6 months of boredom to get treated undet NHS.

Thanks. I'd heard that their liver transplantation programme wasn't having a great deal of success, but that was a few years ago. Have things improved now?

[Sheryl]

52 minutes ago, Guderian said:

Thanks. I'd heard that their liver transplantation programme wasn't having a great deal of success, but that was a few years ago. Have things improved now?

 

It depends on reason for the transplant in the first place, how far advanced the underlying condition was, and also whether the patient complies with the anti-rejection meds

 

Suggested doctors:

 

https://www.bumrungrad.com/doctors/Abhasnee-Sobhonslidsuk

also at  Ramtibodhi

https://med.mahidol.ac.th/qsmc/th/service/premium_clinic-th

 

https://www.samitivejhospitals.com/en/doctors/piyawat-komolmit/

also at Chula  longkorn – try their after hours clinic 13^th floor

detailed Cv here http://www.thasl.org/apld2016/wp-content/uploads/2014/11/Piyawat.pdf

 

https://www.bumrungrad.com/doctors/Siwaporn-Chainuvati

https://www.bnhhospital.com/medical-service/digestive-care-centre/

also at Siriraj  http://www.siphhospital.com/en/home

[Guderian]

Many thanks, Sheryl, I'll give them a call and see what they say.

 

Do you happen to know if tacrolimus is widely used in transplant patients here, in other words, do they have plenty of experience with it?

[Sheryl]

3 hours ago, Guderian said:

Many thanks, Sheryl, I'll give them a call and see what they say.

 

Do you happen to know if tacrolimus is widely used in transplant patients here, in other words, do they have plenty of experience with it?

 

It is definitely used here for kidney transplants and I would assume also liver. The doctors I listed all trained in the West as well. They will have experience with the drug.

 

 

[Guderian]

21 hours ago, Sheryl said:

 

It is definitely used here for kidney transplants and I would assume also liver. The doctors I listed all trained in the West as well. They will have experience with the drug.

 

 

Yes, thanks, I saw the Western training and it's a comfort as long as they can keep it to the fore once back working in Thailand.