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After the Transplant | Liver
The steady improvement in success rates of liver transplantation means that there are a large number of patients with long-functioning liver grafts.
The overall 1-year survival rate of liver transplant recipients who receive an organ from deceased donor exceeds 86%, with 5-year survival rates almost 72%
Figure. Survival of living and deceased donor liver transplant recipients (1997-2004). Based on UNOS/OPTN data as of October 2, 2009
For recipients of living-donor livers, the survival rates are 90% and 78%, respectively.
Advances in medicine, including improvements in surgery and greater understanding in how to use anti-rejection drugs safely and effectively, have contributed to the success of liver transplantation.
There are many types of medications that are used to prevent rejection and there are different formulations of same anti-rejection drug.
The Table lists important information about anti-rejection medications such as dosages and formulations.
Figure. Anti-rejection medications
Your transplant team will adjust the dose depending upon your risk of rejection, your weight, and other medications that you might be taking.
TYPES OF REJECTION
A rejection episode can occur even with anti-rejection drugs especially during the first few months after surgery. The word "rejection" can be frightening. However, rejection does not mean that you will lose your new organ. Knowing what rejection is and how it can be prevented or reversed will help reduce your fears.
Three types of rejection can occur after receiving an organ transplant:
- Hyperacute rejection occurs as soon as the donated organ is transplanted. This rarely occurs because transplant doctors make sure to match blood types and check if you have antibodies against the donated organ
- Acute rejection occurs at least a few days after the transplant surgery when the body has had time to identify a foreign invader.
- Chronic rejection is a very gradual type of graft injury that can occur over months or even years.
DETECTING REJECTION
A rejection episode can usually be reversed if it is caught early. The transplant team can often detect the first signs of rejection. That is why it is important to keep all appointments with your transplant team.
You should also recognize the signs and symptoms of rejection. Contact your transplant team immediately if you think you might be having a rejection episode.
Symptoms of rejection of a liver graft are listed below:
| Liver |
- Yellow skin or eyes
- Itching
- Tea-colored urine or light-colored stool
- Weight gain or swelling of the legs or stomach
- Sudden tiredness
|
The following medical tests can be used to detect rejection of a liver transplant.
| Liver |
Albumin is a protein that is produced by the liver and released into the bloodstream |
Low albumin could indicate kidney disease, hepatitis, cirrhosis, or malnutrition |
| Alanine transaminase (ALT) and aspartate transaminase (AST) are blood tests to measure the amount of liver damage |
High ALT/AST could indicate that the liver is not working properly |
| Bilirubin is a waste product of hemoglobin that is found in bile |
High bilirubin could indicate liver damage or use of anti-clotting medication |
IMPAIRED FUNCTION AND LOSS OF THE TRANSPLANT
In addition to rejection, there are other reasons why a transplanted organ may not function as well as it should. If your liver is not working well but you are not experiencing rejection, your doctor will be able to explain what is happening and provide the appropriate treatment.
In the early days after liver transplantation, inadequate blood supply and reintroducing blood to the transplanted organ can cause liver graft dysfunction. Cytomegalovirus (CMV) infection is another cause of impaired liver graft function.
Diseases that damaged the recipient’s own liver may also recur. For example, hepatitis C virus (HCV) infection is the leading reason for liver transplantation and almost always recurs. The severity of liver damage from recurrent HCV is variable. Autoimmune diseases can recur despite the use of anti-rejection medications. Patients transplanted for alcohol-induced cirrhosis are also at risk if they drink heavily after liver transplantation. Patients transplanted due to hepatocellular carcinoma — a type of liver cancer — may experience recurrent cancer.
References
Desai. Transplant Proc. 2009;41:773-6
McCashland. Curr Opin Organ Transplant. 2009:221-4
United Network for Organ Sharing. http://optn.transplant.hrsa.gov/latestData/rptStrat.asp
Washington Adv Anat Pathol. 2005;12:221-6