Multaq Warning
Multaq Warning :Organ transplants strike most people as exotic procedures, but the fact is that liver transplants have been around for about 40 years. The first successful transplant was performed in 1968, and since then this surgery has become almost routine. Even better, the success rate of this transplant has become increasingly predictable, with transplant patients surviving two decades or more after their surgeries. In the vast majority of cases, the patients lead normal lives, with no restriction on vigorous work and play.
About 5,000 liver transplants are performed in the United States each year, at more than 125 transplant centers. When a doctor estimates that the patient cannot live more than two years without a new liver, he or she will enter the patient’s name on the waiting list for a new organ. Indications of liver failure (such as worsening jaundice) or of advanced cirrhosis (such as ascites or encephalophathy) justify a referral, and patients whose chronic liver disease has progressed to liver cancer should also be evaluated for a transplant. Physicians may even order evaluations when the patients symptoms, such as pruritus or fatigue, are dramatically affecting the patient’s quality of life, even if the disease itself may not have progressed to the transplant stage.
Some patients, unfortunately, will not qualify for a transplant because they exhibit certain conditions, known as absolute contraindications, that would prevent the transplants success. Among the absolute contraindications are serious heart or lung disease, active uncontrolled infection, active alcohol or drug abuse, AIDS (but not HIV), metastatic liver cancer (liver cancer that has spread to other parts of the body), and cancer elsewhere that did not originate in the liver.
Borderline candidates for successful transplants are patients who display relative contraindications. These patients are not necessarily denied referrals for a new liver, but they are evaluated very carefully and may or may not be granted a transplant if they exhibit morbid obesity, failed kidneys, advanced age (older than 70 years, with disease of other organs), previous cancer in any organ, malnutrition, HIV, extensive portal vein thrombosis (a blood clot in the portal vein), or a failure thus far to adhere to physicians’ medication or wellness regimens.
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The doctors approval is a patient’s first step toward obtaining a new liver. The patients next step is a meeting with the transplant team-—-liver specialists (hepatologists), a transplant surgeon, an anesthesiologist, a social worker, a psychiatrist, and possibly other doctors, such as heart or lung specialists, depending on the patient’s condition—and an evaluation by the team. Additional MRIs and diagnostic tests such as a colonoscopy, blood tests, and upper endoscopy (to check for esophageal varices) are ordered, and if the medical team concludes that the patient is a suitable candidate for a transplant, he or she is added to a waiting list.
In 2002, the system for distributing new livers was revised. The old system had been widely criticized because of the public’s perception of inequalities based on fame and or financial status. The new system, the Model for End-Stage Liver Disease (MELD), is a mathematical score that does not recognize celebrity or favoritism. Instead, the MELD score calculates the severity of the patient’s liver disease on the basis of the mathematical probability (derived from the results of three blood tests) of the patients dying within three months without a transplant. Patients with liver cancer receive a different MELD score, which measures the status of the cancer. Simply put, the sickest patient gets the new liver.
During the waiting period, patients should be as active as possible because their strength and stamina will be a tremendous help to them in their recovery from the surgery.
Patients who are not hospitalized while waiting for a liver are asked to carry a beeper or a cellular phone so the transplant team can notify them immediately when a liver is located. The transplant center performing the surgery must accept the liver within one hour of it being offered, and if the hospital staff cannot contact the patient, they will call (or beep) the next patient on the list. If the transplant recipient is feeling well when the call comes, with no fever or signs of a developing illness, then he or she should proceed to the transplant center immediately. Considerations such as babysitters, pet care, transportation to the hospital, and a packed suitcase should be arranged in advance so the patient can leave at a moment’s notice.
In the case of complete transplants-—-that is, when the donor’s entire liver is transplanted into the recipient-—-the donor will be a newly deceased or a brain-dead person with a healthy heart and circulatory system. A family member of the donor will have signed a consent form for the donation. However, even if the donor had, in life, indicated a wish to donate his or her liver, several factors can prevent the donation: If the prospective donor has been diagnosed with cancer, AIDS, or active hepatitis B, or tests positive for HIV, then that person’s liver cannot be used. In addition, the donor’s liver function tests should typically be in the normal range, and the liver shouldn’t contain more than 30 percent fat, as fatty livers typically are rejected by the recipients body shortly after the transplant. The donor should be relatively young (under 60, if possible), and the body size and blood type should be similar to the recipient’s. Livers from donors up to age 70 have been successfully transplanted, as have those from donors who have been diagnosed with hepatitis C, if the recipient is also a hepatitis C patient.
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Liver transplantation cures the liver failure that led to the need for the transplant. However, some diseases, such as hepatitis C or fatty liver, may recur in the new liver and, in rare cases, may lead to failure of the new liver. If failure happens, it typically occurs 10 to 20 years after transplantation. Recurrence of liver disease is a particularly strong possibility for patients whose transplants were necessitated by chronic hepatitis C. This problem is receiving a great deal of research attention in transplant centers around the world. Recurrence of a few other diseases, including PSC and PBC, have been reported infrequently.
For most patients, life and a return to normal health can be expected after a transplant. Women of childbearing age can become pregnant a year after receiving their new livers, and most patients can return to their previous occupations. Quality of life can be high, especially for patients who commit to managing their health with diet and exercise and careful adherence to their prescribed medications. Regular follow-up by the transplant team also assures a life-preserving and -enhancing outcome.
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