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Learn About Transplants

Alchoholic Liver Disease

Definition

Alcoholic liver disease involves an acute or chronic inflammation of the liver induced by alcohol abuse. See also cirrhosis.

Alternative Names

Liver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Laennec's cirrhosis

Causes

Alcoholic liver disease usually occurs after years of excessive drinking. The longer the duration of alcohol use and the greater the consumption of alcohol, the greater the probability of developing liver disease. Acute alcoholic hepatitis can result from binge drinking, and may be life-threatening if severe.

Malnutrition develops as a result of empty calories from alcohol, reduced appetite, and malabsorption (inadequate absorption of nutrients from the intestinal tract). Malnutrition contributes to liver disease.

The toxicity of ethanol to the liver, individual susceptibility to alcohol-induced liver disease, and genetic factors also contribute to the development of alcoholic liver disease.

Alcoholic liver disease does not affect all heavy drinkers, and women may be more susceptible than men. Drunkenness is not essential for the development of the disease.

Changes start within the liver as inflammation (hepatitis) and progress to fatty liver and cirrhosis. Cirrhosis is the final phase of alcoholic liver disease. Symptoms may not be present until the disease is relatively advanced.

Serious complications are associated with advanced disease such as alcoholic encephalopathy (damage to brain tissue) and portal hypertension (high blood pressure within the liver).

Symptoms

· Loss of appetite
· Nausea
· Jaundice
· Abdominal pain and tenderness
· Fever
· Ascites (fluid collection in the abdomen)
· Unintentional weight gain (because of fluid collection)
· Mental confusion
· Excessive thirst
· Dry mouth
· Fatigue

Additional symptoms that may be associated with this disease:

· Vomiting blood or material that looks like coffee grounds
· Bloody or dark black or tarry bowel movements (melena)
· Abnormally dark or light skin
· Redness on feet or hands
· Paleness
· Light-headedness or fainting, especially with upright posture
· Rapid heart rate (tachycardia) when rising to standing position
· Slow, sluggish, lethargic movement
· Breast development in males
· Impaired ability to concentrate
· Agitation
· Fluctuating mood
· Difficulty paying attention (attention deficit)
· Impaired judgment
· Confusion (encephalopathy)
· Altered level of consciousness
· Impaired short- or long-term memory
· Hallucinations

Symptoms vary with the severity of the disease and are usually worse after a recent period of heavy drinking.

Exams and Tests

· A CBC may show anemia and other abnormalities.
· Liver function tests such as ALP are abnormal.
· Liver biopsy shows alcoholic liver disease.

Tests to rule out other diseases include:

· Ultrasound of the abdomen
· CT scan – abdominal
· Blood tests for other causes of liver disease

This disease may also alter the results of the following tests:

· Reticulocyte count
· Ferritin
· Alpha fetoprotein

Treatment

The objective of treatment is to discontinue alcohol, and to provide a high-carbohydrates, high-calorie diet to reduce protein breakdown in the body. Vitamins, especially B1 and folic acid, are associated with improvement. An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Management of the complications of chronic liver disease may be needed. If cirrhosis develops, liver transplant may be necessary.

Support Groups

The stress of illness can often be eased by joining a support group whose members share common experiences and problems. See alcoholism - support group and liver disease - support group.

Outlook (Prognosis)

Continued excessive drinking is associated with a shorter life expectancy. The probable outcome is poor if drinking continues.

Possible Complications

· Bleeding esophageal varices
· Portal hypertension
· Hepatic encephalopathy
· Cirrhosis

When to Contact a Medical Professional

· Call your health care provider if symptoms of alcoholic liver disease develop.
· Call your provider if symptoms develop after prolonged or heavy drinking, or if you are concerned that drinking may be damaging your health.

Prevention

Discuss your alcohol intake with your doctor, who can counsel you about safe amounts of alcohol intake for your situation.

Review Date: 5/4/2006
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Lung Transplant

Lung transplant

Definition

Lung transplant is surgery to replace one or both diseased lungs with healthy lungs from a human donor.

Description

A lung transplant is usually the last resort treatment for lung failure. The new lung or lungs are donated by someone who has been declared brain-dead but remains on life-support. The donor tissue must be matched as closely as possible to that of the recipient to reduce the odds that the transplanted tissue will be rejected.

While the recipient is unconscious and pain-free (under general anesthesia), an incision is made in the chest. Tubes are used to reroute blood to a heart-lung bypass machine to provide oxygen and move blood through the body during the surgery.

One or both of the patient's lungs are removed, and the donor lung or lungs are stitched (sutured) into place. Chest tubes are inserted to drain air, fluid, and blood out of the chest for several days to allow the lungs to fully re-expand.

Sometimes heart and lung transplants are done at the same time (heart-lung transplant) if the patient's heart is also diseased.

Why the Procedure is Performed

Lung transplants may be recommended for patients with any severe lung disease. Some examples of disease that may require lung transplant are:

Lung transplant is not recommended for:

  • Patients who are too sick to go through the procedure
  • Patients whose lung disease will likely affect the new lung
  • Patients who have severe disease of other organs

Risks

Risks for any anesthesia are:

  • Breathing problems
  • Reactions to the medications
Risks for any surgery are:
  • Bleeding
  • Infection
Other risks of transplant include:

Outlook (Prognosis)

Lung transplant is an extreme measure for patients with life-threatening lung disease or damage. Survival rates are high at 1 year following the transplant but are somewhat lower at 4 years.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ as an invader (much like an infection) and may attack it.

To prevent rejection, organ transplant patients must take anti-rejection (immunosuppression) drugs (such as cyclosporine and corticosteroids) that suppress the body's immune response and reduce the chance of rejection. As a result, however, these drugs also reduce the body's natural ability to fight off infections.

Recovery

Patients should expect to stay in the hospital for an extended period of time. The recovery period is about 6 months. Patients will need to have regular check-ups with blood tests and x-rays for many years.


Review Date: 1/18/2008
Reviewed By: Andrew Schriber, MD, FCCP, Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Bone Marrow Transplant

Definition

A bone marrow transplant is a procedure that transplant healthy bone marrow into a patient whose bone marrow is not working properly. A bone marrow transplant may be done for several conditions including hereditary blood diseases, hereditary metabolic diseases, hereditary immune deficiencies, and various forms of cancer.

The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).

Alternative Names

Transplant - bone marrow

Description

Bone marrow is a soft, fatty tissue inside the bones. This is where blood cells (red blood cells, platelets, and white blood cells) are produced, and where they develop. In a disease of the blood cells -- especially cancers such as leukemia -- high doses of chemotherapy may be required to destroy the cancer. However, this also destroys normal blood cells.

In other cases in which hereditary or acquired disorders cause abnormal blood cell production, transplantation of healthy bone marrow may correct these problems. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

Bone marrow transplant patients are usually treated in specialized centers. The patient stays in a special nursing unit -- a bone marrow transplant unit, or BMT -- to limit exposure to infections.

Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor (found through the national marrow donor program). Donors are matched through special blood tests called HLA tissue typing. (See HLA antigens.)

Bone marrow is taken from the donor in the operating room while the donor is unconscious and pain-free (under general anesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Transplant marrow is transfused into the patient through a vein (IV) and is naturally carried into the bone cavities where it grows to replace the old bone marrow.

Alternatively, blood cell precursors, called stem cells, can be made to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis.

The patient is prepared for transplant by administering high doses of chemotherapy or radiation (conditioning). This serves 2 purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it slows the patient's immune response against the donor bone marrow (graft rejection).

Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 - 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.

Why the Procedure is Performed

Bone marrow transplant may be recommended for:
• Bone marrow deficiency disease caused by:
• Abnormal red blood cell production, such as thalassemia or sickle cell disease
• Aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukemia or lymphoma
• Lack of normal blood cell production (aplastic anemia)
• Immune system disorders (immunodeficiencies) such as:
• Congenital neutropenia
• Severe combined immunodeficiency syndrome
• Specific forms of cancer:
• Leukemias
• Lymphomas
• Myeloma

Bone marrow transplant is not recommended for:
• Patients with heart, kidney, lungs, or liver disorders
• Patients with other diseases that may limit survival

Risks

The risks for any anesthesia are:
• Reactions to medications
• Problems breathing

Chemotherapy given prior to bone marrow transplant (conditioning) may cause significant toxicity, such as mouth sores, diarrhea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection.

The major problem with bone marrow transplants -- when the marrow comes from a donor, not the patient -- is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections.

Outlook (Prognosis)

Ideally, bone marrow transplant lengthens the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough, and after consulting with the doctor.

Other significant problems with a bone marrow transplant are those of all major organ transplants -- the finding of a donor, and the cost. The donor is frequently a sibling with matching tissue. The more siblings the patient has, the more chances there are of finding a matching donor.

Recovery

The hospitalization period is from 4 - 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection. The patient will require attentive follow-up care for 2 - 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.

Review Date: 10/30/2006
Reviewed By: William Matsui, MD, Assistant Professor of Oncology, Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Stem Cell Transplant

Stem cell research

Definition

A stem cell is a "generic" cell that can make exact copies of itself indefinitely. In addition, a stem cell has the ability to produce specialized cells for various tissues in the body -- such as heart muscle, brain tissue, and liver tissue. Scientists are able to maintain stem cells forever, developing them into specialized cells as needed.

There are two basic types:

  • Embryonic stem cells - these are obtained from either aborted fetuses or fertilized eggs that are left over from in vitro fertilization (IVF). They are useful for medical and research purposes because they can produce cells for almost every tissue in the body.
  • Adult stem cells - these are not as versatile for research purposes because they are specific to certain cell types, such as blood, intestines, skin, and muscle. The term "adult stem cell" may be misleading because both children and adults have them.

Information

Potential uses for stem cells

There are many areas in medicine where stem cell research could have a significant impact. For example, there are a variety of diseases and injuries in which a patient's cells or tissues are destroyed and must be replaced by tissue or organ transplants. Stem cells may be able to generate brand new tissue in these cases, and even cure diseases for which currently there is no adequate therapy. Diseases that could see revolutionary advances include Alzheimer's and Parkinson's disease, diabetes, spinal cord injury, heart disease, stroke, arthritis, cancer, and burns.

Stem cells could also be used to gain a better understanding of how genetics work in the early stages of cell development. This can help scientists understand why some cells develop abnormally and lead to medical problems such as birth defects and cancer. By understanding the genetic basis for cell development, scientists may learn how to prevent some of these diseases.

Finally, stem cells may be useful in the testing and development of drugs. Because stem cells can be used to create unlimited amounts of specialized tissue, such as heart tissue, it may be possible to test how drugs react on these specialized tissues before trying the drugs on animals and human subjects. Drugs could be tested for effectiveness and side effects more rapidly.

Controversy about stem cell research

In August 2001, President George W. Bush approved limited federal funding for stem cell research. While stem cell research has the potential to provide major medical advances, including cures for many diseases, stem cell research is controversial.

The stem cell controversy is based on the belief by opponents that a fertilized egg is fundamentally a human being with rights and interests that need to be protected. Those who oppose stem cell research do not want fetuses and fertilized eggs used for research purposes. However, a team of scientists have developed a technique that was successful in generating mouse stem cells without destroying the mouse embryo. This technique has not yet been attempted on human embryonic tissue. Many other scientists are attempting to create more universally accepted forms of human embryonic stem cells, as well as other types of adult stem cells.

Supporters of stem cell research argue that the fertilized eggs are donated with consent from each couple and would be discarded anyway. Therefore, there is no potential for those fertilized eggs to become human beings. Fertilized eggs are not (at this time) being created specifically for stem cell research.

As with any moral and ethical issue, the controversy surrounding stem cell research will likely continue for quite some time.

In the United States, supporters believe that an aggressive federal program is needed before the potential of stem cell research can be realized. At this time, federal funding is limited to stem cell lines that already exist. The funding does not support creating new stem cell lines from existing fertilized eggs. This is based on the idea that a decision on the existing stem cell lines has already been made, prior to the policy’s implementation, by the egg donors themselves. The current U.S. policy is an attempt at a compromise -- one that supports medical research, and at the same time eases the ethical concerns of those opposing embryonic stem cell research.

References

Okie S. Stem-cell research--signposts and roadblocks. N Engl J Med.2005 Jul 7;353(1):1-5.

Lindvall O, Kokaia Z. Stem cell therapy for human brain disorders. Kidney Int. 2005 Nov;68(5):1937-9.

Fukuda H, Takahashi J. Embryonic stem cells as a cell source for treating Parkinson's disease. Expert Opin Biol Ther. 2005 Oct;5(10):1273-80.

Green R. Can we develop ethically universal embryonic stem-cell lines? Nature Genet Rev. June 2007;8:480-485.

Lougheed T. New US guidelines for research on human embryos. CMAJ.2005 Jun 21;172(13):1672.

Zwillich T. Guidelines set ethical bar for US stem cell research. Lancet. 2005 May 7-13;365(9471):1612.


Review Date: 7/25/2007
Reviewed By: Chad Haldeman-Englert, MD, Division of Human Genetics, Children's Hospitalof Philadelphia, Philadelphia, PA. Review provided by VeriMed HealthcareNetwork.
2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Heart Transplant

Definition

Heart transplantation is a surgical procedure to remove a damaged or diseased heart and replace it with a healthy donor heart.

Alternative Names

Cardiac transplant; Transplant - heart

Description

Heart transplant is one of the most common transplant operations performed in the United States. A healthy heart is obtained from a donor who is brain dead but on life support. The healthy heart is put into a special solution that preserves the organ.

The patient is put into a deep sleep with general anesthesia, and a cut is made through the breast bone. The patient's blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich. The patient's diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart.

Why the Procedure is Performed

A heart transplant may be recommended forheart failure caused by:
• Coronary artery disease
• Cardiomyopathy (disease of the heart muscle)
• Heart valve disease with congestive heart failure
• Severe heart disease present at birth
• Life-threatening abnormal heart beats that do not respond to other therapy

Heart transplant surgery is not recommended for patients who have:
• Kidney, lung, or liver disease
• Insulin-dependent diabetes with poor function of other organs
• Other types of blood vessel disease of the neck and leg
• Other life-threatening diseases

Risks

Risks for any anesthesia are:
• Reactions to medications
• Problems breathing

Risks for any surgery are:
• Bleeding
• Infection

Heart transplants carry major risks. There is a greater risk of infection because of the drugs that must be taken to prevent transplant rejection. Call your doctor if there are signs of infection (redness, drainage, fever) or if there is a general worsening of health.

Outlook (Prognosis)

Heart transplant prolongs the life of a patient who would otherwise die. About 80% of heart transplants are alive 2 years after the operation. The main problem, as with other transplants, is graft rejection. If rejection can be controlled, the patient's survival can be increased to over 10 years.

Drugs that prevent transplant rejection must be taken for the rest of the patient's life. Normal activities can resume as soon as the patient feels well enough and after consulting with the doctor. However, vigorous physical activities should be avoided.

The major problems are the same for all major organ transplants:
• Finding a donor
• Fighting the rejection effect
• The cost of the surgery
• Avoiding infection
• Avoiding blocked blood vessels in the transplanted organ

Finding a donor can be difficult. In heart transplantation, the healthy heart must come from a person who recently died or is on life-support and is brain dead. This is different than a kidney transplant, because a kidney may be donated by a living person.

Timing is very important because there is no good way to keep a donor heart alive for long periods of time. A person in need of a heart transplant may be kept alive on artificial heart devices for longer and longer periods of time. However, artificial hearts also have major risks. While some of these devices are fully approved, others are still considered experimental.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs such as cyclosporine and corticosteroids that suppress the body's immune response. The downside of these drugs is that they weaken the body's natural defense against infection.

Recovery

The recovery period is about 6 weeks. The patient must move the legs often to reduce the risk of deep venous thrombosis. The stitches or clips are removed about 1 week after surgery.

References

Lee DK. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult Summary for MD Consult Cardiology. MDC Cardiology Guideline Summaries. 2002 Mar;1.

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo; WB Saunders; 2005: 641-651.

Review Date: 7/25/2007
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Kidney Transplant

Definition

A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.

Alternative Names

Renal transplant; Transplant - kidney

Description

Kidney transplants are one of the most common transplant operations in the United States.

A donated kidney is needed to perform a kidney transplant.

The donated kidney may be from:
• Living related donor -- related to the recipient, such as a parent, sibling, or child
• Living unrelated donor -- such as a friend or spouse
• Deceased donor -- a person who has recently died and who has no known chronic kidney disease

Persons with chronic kidney disease can receive lifesaving dialysis until a donated kidney becomes available. The healthy kidney is transported in cool salt water (saline) that preserves the organ for up to 48 hours. This gives the health care providers time to perform tests that match the donor's and recipient's blood and tissue before the operation.

PROCEDURE FOR A LIVING KIDNEY DONOR

If you are donating a kidney, you will be placed under general anesthesia before surgery. This means you will be asleep and pain-free. The surgeon makes a cut in the side of your abdomen, removes the proper kidney, and then closes the wound. The procedure used to require a long surgical cut. However, today surgeons can use a short surgical cut (mini-nephrectomy) or laparoscopic techniques.

PROCEDURE FOR THE KIDNEY RECIPIENT

Persons receiving a kidney transplant are given general anesthesia before surgery. The surgeon makes a cut in the lower belly area and stitches the new kidney into place. The wound is then closed.

Why the Procedure is Performed

A kidney transplant may be recommended if you have kidney failure caused by:
• Diabetes
• Glomerulonephritis
• Severe, uncontrollable high blood pressure
• Certain infections

A kidney transplant alone may NOT be recommended if you have:
• Certain infections, such as TB or osteomyelitis
• Difficulty taking medications several times each day for the rest of your life
• Heart, lung, or liver disease
• Other life-threatening diseases

Risks

The risks for any anesthesia are:
• Problems breathing
• Reactions to medications

The risks for any surgery are:
• Bleeding
• Infection

Other risks include:
• Infection due to medications that suppress the immune response that must be taken to prevent transplant rejections

Outlook (Prognosis)

Kidney transplants generally offer the best outlook for patients with end-stage kidney disease. Kidneys from living related donors do better than from donors who have died. (If you donate a kidney, you can usually live safely without complications with your one remaining kidney.)

Persons who receive a transplanted kidney may reject the new organ. This means that their immune system sees the new kidney as a foreign substance and tries to destroy it.

In order to avoid rejection, almost all kidney transplant recipients must have take medicines that suppress their immune response for the rest of their life. This is called immunosuppressive therapy. While the treatment helps prevent organ rejection, it also puts patients at a higher risk of infection and cancer. If you take this medicine, you need to be regularly screened for cancer. The medicines may also cause high blood pressure and high cholesterol and increase the risk of diabetes.

A successful kidney transplant requires close follow-up with your doctor and always taking your medicine as directed.

Recovery

The recovery period is 4-6 weeks for persons who donate a kidney. If you've done so, you should avoid heavy activity during this time. Your doctor removes the stitches after a week or so.

If you received a donated kidney, you will need to stay in the hospital for about a week. Afterwards, you will need close follow-up by a doctor and regular blood tests.

Review Date: 2/7/2008
Reviewed By: Parul Patel, MD, Private Practice specializing in Nephrology and Kidney and Pancreas Transplantation, Affiliated with California Pacific Medical Center, Department of Transplantation, San Francisco, CA. Review provided by VeriMed Healthcare Network.Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Liver Transplant

Definition

Liver transplant is surgery to replace a diseased liver with a healthy liver.

Alternative Names

Hepatic transplant; Transplant - liver

Description

Liver transplants have become common operations worldwide.

A healthy liver is usually obtained from a donor who has recently died, but has not suffered liver injury. The donor liver is transported in a cooled saline solution that preserves the organ for up to 8 hours, thus permitting the necessary tests for donor-recipient matching.

The diseased liver is removed through an incision in the upper abdomen. The donor liver is put in place and attached to the patient's blood vessels and bile ducts. The operation may take up to 12 hours and requires a large amount of transfused blood.

In some cases, a living donor may donate a section of liver for transplant to someone else, often a family member or friend. This poses some risk to the donor because of the nature of the operation, but since the liver can regenerate itself to some extent, both parties usually end up with fully functioning livers after a successful transplant.

Why the Procedure is Performed

A liver transplant may be recommended for:
• Liver damage (such as cirrhosis or primary biliary cirrhosis)
• Long-term active infection (hepatitis)
• Hepatic vein clot (thrombosis)
• Birth defects of the liver or bile ducts (such as biliary atresia)
• Metabolic disorders associated with liver failure (such as Wilson's disease)

Liver transplant surgery is not recommended for patients who have:
• Heart, lung, or kidney disease
• Type 1 diabetes
• Other life-threatening diseases

Risks

Risks for any anesthesia are:
• Reactions to medications
• Problems breathing

Risks for any surgery are:
• Bleeding
• Infection

Liver transplants carry major risks. There is an increased risk of infection because of the immunosuppressive medications that must be taken to prevent transplant rejection. Call your doctor if there are signs of infection (redness, drainage, fever, swelling, tenderness, jaundice, diarrhea) or if the condition worsens.

Outlook (Prognosis)

Liver transplants can save the lives of people who might otherwise die. Approximately 75% of patients survive 3 years or more after the transplant. Major problems with any transplant include:
• Finding a healthy organ
• Transplant rejection
• Life-long need for immunosuppressive drugs, which weaken the body's ability to fight infections
• Cost

The patient is encouraged to resume normal activities as soon as possible.

Recovery

The recovery period averages 12 weeks. Move legs often to reduce the risk of deep vein thrombosis. Resume normal activity as soon as possible. Consult your doctor before returning to normal activities.

Review Date: 5/8/2006
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Pancreas Transplant

Definition

A pancreas transplant is surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to become independent of insulin injections.

Alternative Names

Transplant - pancreas

Description

The healthy pancreas is obtained from a donor who has suffered brain-death, but remains on life-support. The donor pancreas must meet numerous criteria to make sure it is suitable.

In addition to insulin, the pancreas produces other secretions, such as digestive enzymes, which drain through the pancreatic duct into the duodenum. Therefore, a portion of the duodenum is removed with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.

The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually inserted in the right lower portion of the patient's abdomen and attachments are made to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder to drain pancreatic secretions.

The operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease.

Why the Procedure is Performed

A pancreas transplant may be recommended for people with pancreatic disease, especially if they have type 1 diabetes and poor kidney function.

Pancreas transplant surgery is not recommended for patients who have:
• Heart or lung disease
• Other life-threatening diseases

Solitary pancreas transplant for diabetes, without simultaneous kidney transplant, remains controversial.

Risks

The risks for any anesthesia are:
• Heart attack
• Reactions to medications
• Problems breathing

The risks for any surgery are:
• Bleeding
• Infection
• Scar formation

The body's immune system considers the transplanted organ foreign, and fights it accordingly. Thus, to prevent rejection, organ transplant patients must take drugs (such as cyclosporine and corticosteroids) that suppress the immune response of the body. The disadvantage of these drugs is that they weaken the body's natural defense against various infections.

Outlook (Prognosis)

The main problem, as with other transplants, is graft rejection. Immunosuppressive drugs, which weaken your body's ability to fight infections, must be taken indefinitely. Normal activities can resume as soon as you are strong enough, and after consulting with the doctor. It is possible to have children after a transplant.

The major problems with all organ transplants are:
• Finding a donor
• Preventing rejection
• Long-term immunosuppression

Recovery

It usually takes about 3 weeks to recover. Move your legs often to reduce the risk of blood clots or deep vein thrombosis. The sutures or clips are removed about two to three weeks after surgery. Resume normal activity as soon as possible, after consulting with the physician. A diet will be prescribed.

References

Robertson RP. Pancreas and islet transplantation in type 1 diabetes.Diabetes Care. Apr 2006; 29(4): 935.

Larson-Wadd K. Pancrease and islet cell transplantation. Anesthesiol Clin North America. Dec 2004; 22(4): 663-74.

Review Date: 7/25/2007
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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