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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.
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. 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. Most people who develop cirrhosis of the liver due
to excessive use of alcohol do not need a liver transplant. Abstinence
from alcohol and treatment of complications will usually allow them
to live for prolonged periods without a transplant. For patients with
advanced liver disease, where prolonged abstinence and medical treatment
fails to restore health, transplantation is a consideration. Most cancers of the liver
begin somewhere else in the body and spread to the liver. These are
not curable with a liver transplant. Likewise the tumors which start
in the liver have usually spread to other organs by the time they are
detected and are rarely cured by liver transplantation. Transplantation
at an early stage of liver cancer may result in long-term survival for
some patients. There are effective medicines for some liver diseases,
while for others only 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. 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
and will not survive until a suitable donor is available. This is a decision made in consultation with all individuals
involved in the patient's care, including the patient and/or family.
The patient and family's input is vital and they must clearly understand
the risks involved with proceeding to transplantation. Before surgery, the risks are mainly the development
of some acute complication of the 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. 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. 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. 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. 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. 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. 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. 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. 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.
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.
The American Liver Foundation is the only national voluntary health organization dedicated to preventing, treating, and curing hepatitis and all other liver and gallbladder diseases through research and education.
Copyright
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