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Friday, November 7, 2008

"A large number of diseases are potentially treatable by liver transplants."

1) What diseases are treated by liver transplantation?
A large number of diseases are capable of interfering with the liver's function sufficiently to threaten the life of the patient and most are potentially treatable by liver transplantation.

2) Which liver diseases are the most common?
In adults, cirrhosis, the death of liver cells due to a variety of causes, is one of the most common reasons for which liver transplantation is done. In children, the disease most often treated by liver transplantation is biliary atresia, a failure of the bile ducts to develop normally to drain bile from the liver.

3) What about alcohol-related liver disease?
Many people who develop cirrhosis of the liver due to excessive use of alcohol do need a liver transplant. Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.

4) And cancer of the liver?
Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers. Particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients.
However, cancers of the liver that begin somewhere else in the body and spread to the liver are not curable with a liver transplant.

5) Are there alternative treatments for liver disease?
There are effective medicines for some liver diseases, while for others only palliative treatment for complications is available. Treatment of complications may be all that is required if the liver is not failing. Frequently medical treatment delays, but does not eliminate, the need for transplantation.

6) Is liver transplantation a treatment of last resort, when everything else has failed?
Yes and no. If medical treatment is likely to allow prolonged survival with good quality of life, transplantation would be reserved for the future. However, ideally the surgery is undertaken before the terminal stage of the disease when the person is too ill to withstand major surgery. For patients with poor quality of life due to complications of liver cirrhosis liver transplantation should be undertaken at an optimal state of health in-order to avail good outcomes.

7) How is the decision made to transplant?
This is a decision made in consultation with all individuals involved in the patient's care, doctors as well as the patient’s family. The patient and family's input is vital and they must clearly understand the risks & benefits involved with proceeding to transplantation.

8) What are the major risks?
Before surgery, the risks are mainly the development of some acute complication of the liver disease, which might render the patient unacceptable for surgery. With transplantation there are risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver. One of the major risks for the patient is not having any liver function for a brief period. Immediately after surgery, bleeding, poor function of the grafted liver, and infections are major risks. The patient is carefully monitored for several weeks for signs of rejection of the liver.

9) What are the overall chances of surviving a liver transplant?
This depends on many factors but overall 85 - 90 percent of children & adults survive and are discharged from the hospital.

10) How long does it take to recover?
In part this depends on how ill the individual was prior to the surgery. Most patients should count on spending a few days in an intensive care unit and about four weeks in the hospital, as a minimum.

11) What happens during this recovery period?
Initially in the intensive care unit there is very careful monitoring of all body functions including the liver. Once the patient is transferred to the ward, the frequency of blood testing, etc. is decreased, eating is allowed and physiotherapy is used to regain muscle strength. The drug or drugs to prevent rejection are initially given by vein, but later by mouth. During the transplantation, frequent tests are done to monitor liver function and detect any evidence of rejection.

12) If a transplanted liver fails to function, or is rejected, what can be done?
There are varying degrees of failure of the liver, however, and even with imperfect function, the patient will remain quite well. Occasionally, when circumstances and time permit, a failing transplanted liver can be replaced by a second (or even third) transplant. Unfortunately, there is no dialysis treatment for livers as is possible with kidneys. Researchers are experimenting with devices to keep patients with failing livers alive while waiting for a new liver.

13) What side-effects do patients commonly experience from the drugs used to treat or prevent rejection?
All the drugs used for rejection increase the person's susceptibility to infections (and possibly to the development of tumors). Various medicines are used, and each has its own effects. Cortisone-like drugs produce some fluid retention and puffiness of the face, risk of worsening diabetes and osteoporosis (a loss of mineral from bone). Cyclosporine produces some tendency to develop high blood pressure and the growth of body hair. The dose of this medication must be very carefully regulated. Kidney damage can occur from cyclosporine but this can usually be avoided by monitoring the drug levels in the blood. Common side effects for FK-506 include headaches, tremor, diarrhea, increased tension, nausea, increased levels of potassium and glucose and kidney dysfunction.

14) Do recipients of liver transplant have to take these medicines for the rest of their lives?
Usually. However, as the body adjusts to the transplanted liver, the amount of medicine needed to control rejection is reduced. There are patients who have been successfully taken off these drugs. Researchers are attempting to determine why this has been successful in these cases.

15) How frequent is medical follow-up?
Routine follow-up consists of monthly blood tests, measuring of blood pressure by a local physician with annual or semi-annual checkups at the transplant center.

16) Are patients more susceptible to other infections?
Recipients should avoid exposure to infections as the immune system is depressed. Illness should be reported to the doctor immediately and medicines taken only under medical supervision.

17) What about physical activity after a liver transplant?
Most patients are able to return to a normal or near-normal existence and can participate in fairly vigorous physical exercise six to twelve months after a successful liver transplant.

18) What about sexual activity?
As with other physical activities, sexual activity may be resumed.

19) Is it safe for women to become pregnant after transplantation?
Studies have shown that women who undergo liver transplantation can conceive and give birth normally, although they have to be monitored carefully because of a higher incidence of premature births.
Mothers are advised against nursing babies because of the possibility of immunosuppressive drugs being ingested by the infants through breast milk.

20) What about diet?
Transplant patients have a tendency to gain weight because of their retention of water. They are advised to lower their intake of salt to reduce or eliminate this water retention. Otherwise patients should maintain a balanced diet.

21) Can there be a recurrence of the original disease in the transplanted liver?
If the disease was caused by hepatitis B or hepatitis C viruses then recurrence is likely. Other types of liver disease do not recur.

22) From the description, patients with successful liver transplants seem very healthy. How long can this good health last?
The newness of this procedure makes this question difficult to answer. There is every indication that those who are well after one year remain so indefinitely.

23) Where do the donor livers come from?
Livers are donated, with the consent of the next of kin, from individuals who have brain death, usually as a result of a head injury or brain hemorrhage. When such a donor is identified, transplant centers are contacted by a computer network and arrangements are made to retrieve whatever organs may be donated. Frequently this involves a team from a transplant center flying to the donor hospital to remove the organs, and returning with them for the transplant operation.

24) Do the donor and the recipient have to be matched by tissue type, sex, age, etc.?
No. For liver transplants, the only requirements are that the donor and recipient need to be approximately the same size, and of compatible blood types. No other matching is necessary.

25) What happens if there are two suitable recipients for a donated liver?
This is unusual in practice but the decision would be to transplant the patient with the more urgent need.
No. For liver transplants, the only requirements are that the donor and recipient need to be approximately the same size, and of compatible blood types. No other matching is necessary. This is unusual in practice but the decision would be to transplant the patient with the more urgent need.

26) How can I donate my organs?
If you wish to be an organ donor, carry an organ donor card and place an organ donor sticker on your medical identification card. It is important to discuss organ donation with family members since they will have to give consent. An organ donor card is available from the MOHAN Foundation and at SGRH (Sir Ganaga Ram Hospital) Delhi.

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