Liver Transplants

When a person's liver is damaged to the point where liver failure is imminent and/or the symptoms cannot be otherwise treated, that person becomes a candidate for liver transplant. Thus it can be considered a treatment of last resort, although it should be undertaken before the terminal stage of disease when a patient could be too weak to survive the surgery or too far gone to survive the wait for a donor.

First performed in 1963, human liver transplantation did not become widespread until the 1980s, and the statistical results of the procedure are still improving. Drugs which suppress the immune system (such as cyclosporine and tacrolimus) and thus lower the chance of rejection of the new organ have done much to improve survival rates over the past several. An individual's chances of survival depend on many factors, but overall 60-75% of adult patients and 80-90% of children survive and are discharged from the hospital.

Most liver transplants in adults are performed due to cirrhosis brought about by a variety of causes. (In children, it is most often due to biliary atresia, the failure of the bile ducts to develop normally to drain bile form the liver.) Cancer of the liver is unfortunately not often successfully treated with transplantation due to the fact that the cancer has usually spread to or from other organs in the body by the time it has been detected.

Risks

The first risk is that the advancement of the disease will prevent the patient from surviving until the surgery can be performed or from surviving the surgery itself. Then the transplantation procedure carries all the risks inherent in major surgery, as well as particular technical difficulties in removing the diseased liver and implanting the donor liver. There is a danger to the weakened patient in not having any liver function at all for a brief period. As with many other surgical procedures, the post-operative risks include bleeding and infection, as well as the risk that the new liver will not function properly.

Rejection of a grafted organ by the body's immune system is always a great concern, although the requirements for matching are not as stringent as with some organs. It is sufficient for the donor and recipient to be the same blood type and roughly the same size. Immunosuppressive drugs will be administered and careful monitoring will take place for several weeks for signs of rejection of the new liver. A transplanted liver that functions imperfectly is still often a great improvement over the old liver and the patient can remain well, but in those cases where the new liver fails or is rejected it is sometimes possible to repeat the surgery with a second or even third new liver. The danger here again is surviving the wait for a donor.

All immunosuppressive drugs have the undesirable side effect of increasing susceptibility to infections (and possibly to the development of tumors). Other side effects of various anti-rejection medications can include:

fluid retention and puffiness of the face
risk of worsening diabetes
osteoporosis
high blood pressure
increased growth of body hair
kidney damage
headaches
tremors
diarrhea
increased tension
nausea
increased levels of potassium and glucose

Transplant recipients usually continue to receive immunosuppressive medications for the rest of their lives, although as the body adjusts to the new liver, the dosages can be reduced. Some patients have successfully been weaned from the anti-rejection drugs altogether.

Recovery

The length of recovery after surgery will depend greatly on the strength of the individual patient, but a minimum of a few days in intensive care and about four weeks in the hospital can be expected. Routine follow-up will include monthly blood tests and monitoring of blood pressure by a local physician with annual or semi-annual checkups at the transplant center. Any illness should be reported to the doctor immediately as the suppression of the immune system increases the danger from any infection.

Most patients are able to return to a normal or near-normal existence and can participate in fairly vigorous physical exercise (including sexual activity) six to twelve months after a successful liver transplant, although this greatly depends on the individual circumstances. It is even possible for female liver transplant recipients to conceive normally and bear children, although studies have shown a higher incidence of premature births so careful monitoring of such pregnancies is routine.

Prognosis

Typically a patient who is well a year after liver transplantation can expect to remain so indefinitely. Key to maintaining this health is a balanced diet (low in salt to control water retention and thus weight gain) and avoidance of the risk factors that caused the damage in the first place. Most liver disease does not recur in a successfully transplanted liver (although hepatitis B or C infections are notable exceptions).



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