Liver Transplantation Health Article

Risks

Early failure of the transplant occurs in every one in four surgeries and has to be repeated. Some transplants never work, some patients succumb to infection, and some suffer immune rejection. Primary failure is apparent within one or two days. Rejection usually starts at the end of the first week. There may be problems like bleeding of the bile duct after surgery, or blood vessels of the liver may become too narrow. The surgery itself may need revision because of narrowing, leaking, or blood clots at the connections. These issues may be solved with or without more surgery depending on the severity.

Infections are a constant risk while on immunosuppressive agents, because the immune system is supposed to prevent them. A method has not yet been devised to control rejection without hampering immune defenses against infections. Not only do ordinary infections pose a threat, but because of the impaired immunity, transplant patients are susceptible to the same opportunistic infections (OIs) that threaten acquired immune deficiency syndrome (AIDS) patients—pneumocystis pneumonia, herpes and cytomegalovirus (CMV) infections, fungi, and a host of bacteria.

Drug reactions are also a continuing threat. Every drug used to suppress the immune system has potential problems. As previously stated, hypertension, nephrotoxicity, and PTLD are some of the long-term adverse effects with immunosupressive drugs like cyclosporine. Immunosuppressants also hinder the body's ability to resist cancer. All drugs used to prevent rejection increase the risk of leukemias and lymphomas.

There is also a risk of the original disease returning. In the case of hepatitis C, reoccurrence is a risk factor for orthotropic liver transplants. Newer antiviral drugs hold out promise for dealing with hepatitis. In alcoholics, the urge to drink alcohol will still be a problem. Alcoholics Anonymous (AA) is the most effective treatment known for alcoholism.

Transplant recipients can get high blood pressure, diabetes, high cholesterol, thinning of the bones, and can become obese. Close medical care is needed to prevent these conditions.

Normal results

For a successful transplant, good medical care is important. Patients and families must stay in touch with their medical teams and drugs must be taken as advised to prevent infection and rejection of the new organ. However, sometimes because of the way it is preserved, the new liver doesn't function as it should, and a patient may have to go back on to the waiting list to receive a new liver.

Morbidity and mortality

Twenty-five million or one in 10 Americans are or have been afflicted with liver or biliary diseases. As of June 2003, there were 17,239 patients on the UNOS National Transplant Waiting List who were waiting for a liver transplantation. For the previous year (July 1, 2001 to June 30, 2002), there were a total of 5,261 liver transplants performed. Of those, 4,785 were cadaver donors (already deceased) and 476 living donors. For liver transplants performed from July 1, 1999 to June 30, 2001, the one-year survival rate was 86% for adults; 1,861 patients died while on the UNOS waiting list for the year ending June 30, 2002. More than 80% of children survive transplantation to adolescence and adulthood.

Since the introduction of cyclosporine and tacrolimus (drugs that suppress the immune response and keep it from attacking and damaging the new liver), success rates for liver transplantation have reached 80–90%.

Infections occur in about half of transplant patients and often appear during the first week. Biliary complications are apparent in about 22% of recipient patients (and 6% of donors), and vascular complications occur in 9.8% of recipient patients. Other complications in donors include re-operation (4.5%) and death (0.2%).

There are potential social, economic, and psychological problems, and a vast array of possible medical and surgical complications. Close medical surveillance must continue for the rest of the patient's life.

Alternatives

There is no treatment that can help the liver with all of its functions; thus, when a person reaches a certain stage of liver disease, a liver transplant may be the only way to save the patient's life.

BOOKS

Abhinav, Humar, M.D., I. Hertz Marshall, M.D., Laura J., Blakemore, M.D., eds. Manual of Liver Transplant Medical Care. Minneapolis, MN: Fairview Press, 2002.

Beauchamp, Daniel R., M.D., Mark B. Evers, M.D., Kenneth L. Mattox, M.D., Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th ed. London: W. B. Saunders Co., 2001.

Lawrence, Peter F., Richard M. Bell, and Merril T. Dayton, eds. Essentials of General Surgery, 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins, 2000.