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Monday, January 28, 2008

Life After Transplant

Q: How long will my liver transplant last?

A: Liver transplant can have excellent outcomes. Recipients have been known to a normal life over 30 years after the operation. According to the most recent year computed international average one-year graft survival at 83%, and patient survival at 87% for patients receiving a deceased donor liver and 92% for those transplanted with an organ from a living donor. Five-year graft and patient survivals are 67% (deceased/2000) 62% (living/2000) and 76% (deceased/2000) 81% (living/2000), respectively. During 2006 at one-year graft and patient survival rates are 82% and 88%.

It is important to remember that many factors come into play with these statistics. They represent ALL patients transplanted, including the very old and the very young, those who were critically ill and those with less severe liver problems at the time of transplant.

Transplant recipients directly contribute to the success of their transplant. Failure to comply with the immunosuppression medical regimen is the number one cause of organ failure. Close follow-up with your transplant team and primary-care physician can help ensure a good outcome. Careful attention to medication schedules, lifestyle changes, infection-avoidance techniques are all important ways to prolong one's life after transplantation.Q: What can I expect my quality of life to be after liver transplantation?A: The first three months following transplantation are the most difficult. The body is adjusting to the "new" liver and all the medications needed to maintain its health. By the time of discharge from the hospital patients are able to care for themselves, with some minor restrictions. The transplant team carefully prepares each patient for discharge. Most patients can return to work within 3 to 6 months after a transplant. Playing sports and getting healthy exercise, socializing, and traveling for business and pleasure are all possible. The Center's expectation is that people who undergo liver transplantation can and do go on to lead "normal" lives.
Q: Will my liver disease come back after a transplant?
A: Certain liver diseases can reappear in the new liver. One example is hepatitis C. The transplant team can advise you on the incidence of recurrence of specific liver ailments. In cases where there is a risk of recurrence the transplant team will monitor you very closely to help prevent recurrence.

Q: How much pain is typical after the surgery?
A: There is pain after liver transplant surgery, however it is generally not as severe as with other abdominal surgeries. This is because nerves are severed during the initial abdominal incision causing numbness of the skin around the abdomen. These nerves regenerate over the following six months and sensation returns. More common post-transplant discomfort is back pain associated with the length of time on the operating table. The team prescribes the appropriate pain medicine for each patient.
Q: How large is the scar?
A: The standard incision used for the liver transplant is called a "chevron incision." It starts at the right side of the midsection just under the ribs and extends to the left edge of the abdomen. There is also a short incision starting under the sternum (breastbone) which extends to meet the horizontal incision.
Q: How long is the recuperation period?
A: Most patients are hospitalized for 2-3 weeks after liver transplant. Afterwards, they generally recuperate at home and typically return to work or school after about 3 months.
Q: Will I need to take medications after my liver transplant?
A: Patients must take many medications after a liver transplant: some to prevent rejection (immunosuppressants), some to fight infection, and others to treat the side effects of the immunosuppressants. Patients returning home after transplantation will be taking approximately 7 to 10 different type of medicines. As the patient heals and recovers health with the help of their new liver, dosages and number of medications are reduced over time. By six months, it is common to be down to 1 or 2 medications. However, patients will be taking immunosuppression medications for the rest of their lives in virtually all cases. It is vital that these medications are taken as prescribed, in the proper amounts and at the specified times. Missing medication doses or discontinuing them on one's own can lead to rejection and organ failure.
Q: What side effects can be expected from the medications prescribed after transplant?
A: Is usually not granted for more than six months after a liver transplant, because the disabling disease has been treated. From the start of the transplant process, patients should consider their long-term employment goals so that they can rejoin the workforce in a timely manner and avoid lapses.
Q: Can I drink alcoholic beverages after my transplant?
A: No. Not only is alcohol toxic to the liver, it can also interfere with the metabolization of certain medications. Be aware that many "non-alcoholic" beers do contain some alcohol.
Q: Can I have sex after my liver transplant?
A: Yes. Sexual activity can resume early after discharge from the hospital. Because of illness, many patients experience impotence or lack of desire prior to the transplant. This usually reverses itself after transplant, but a patient's libido tends to return slowly. Immunosuppressed individuals are at greater risk of contracting sexually transmitted diseases, therefore protective barriers such as condoms should be used (unless in a long-term monogamous relationship).
Because of their chronic illness, many people are unable to conceive prior to transplant, but this may not be the case afterwards. Birth-control methods should be discussed with your transplant team and implemented when sexual activity resumes.
Q: Will I be able to have children after my transplant?
A: Many couples are able to have children after liver transplantation with minimal risk to the mother and baby. Women are advised to wait at least one year following transplantation before trying to conceive. It is important to discuss such plans with the transplant team. They will need to carefully evaluate the health and medication regimen of women seeking to become pregnant. Often, changes in medications are recommended. Women becoming pregnant will need to be closely followed by their obstetrician and the transplant team. It is common to require monthly lab testing for pregnant transplant recipients. Babies born to immunosuppressed mothers tend to have lower birth weights than average, but are generally healthy. Planning the pregnancy and receiving close follow-up care throughout are key.
Q: How can I get in touch with the family of my donor? (Relevant in case you received a cadaver organ)
A: Transplant recipients often want to thank the donor's family for the liver they received. This can only be done anonymously through the organ procurement agency. To communicate with the donor's family, write a letter without signing it and give it to the team's social worker at the Liver center. They send it to the organ procurement agency who in turn forwards it to the donor's family. Often the donor's family will respond via another anonymous letter. However, not everyone receives a response, but this does not mean your gratitude wasn't appreciated by the donor's family.

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