Medical advances increasing the success of organ transplants

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Medical advances increasing the success of organ transplants

CGRMC News, Arizona City Independent February 21, 2007

About 350,000 Americans are living with an organ transplanted from

another person, and that number would be much higher if enough donor

organs were available.

The first successful human organ transplant was performed as recently

as 1954 - a kidney grafted from one identical twin to the other.

Considerable progress has been made since that time, and you may know

at least one person who has been the recipient of a vital organ such

as a kidney, heart, lung, liver or pancreas.

Marcia, a diabetic since age 12, had kidney failure and was on

dialysis for nearly two years. A kidney donated by her brother has

given her an improved quality of life for the past 21 years.

, age 46, had heart problems that put him at immediate risk of

death until he received a heart valve donated by the victim of an

automobile accident.

When taken from a living family member, as in Marcia's case, the

organ can be matched more closely genetically - lowering the risk of

rejection. The procedure can be scheduled to meet the needs of the

patient.

Some organs, of course, come from a person who has just died. Timing

is crucial, and a national computerized network matches organs

available with candidates who have been placed on a waiting list at a

transplant center. Each year about 60,000 persons waiting for organs

do not get them and many die while waiting.

For a person who has been on a waiting list for months or even years,

a transplant procedure is a major event. At the same time, early

enthusiasm must be tempered by the realization that keeping the new

organ healthy and functional is a lifelong challenge that involves:

-Taking powerful anti-rejection medications;

-Exercising extreme care to avoid disease-carrying organisms that

might sneak past the compromised immune system and;

-Controlling the disease process that caused the original organ to

fail.

Recognizing the new organ as an unnatural presence, the immune system

sets out immediately to destroy it. The risk of rejection is

particularly high in the first year and was a major problem for

grafts made in the early years. The emergence of cyclosporin as an

effective anti-rejection agent in 1978 made transplantation a safer

and more realistic option.

Anti-rejection medications, however, have side effects such as

nausea, vomiting, diarrhea, puffy face, weight gain and mood swings.

They work by suppressing the immune system, thereby leaving the

patient vulnerable to infections.

Right after surgery, when doses of anti-rejection medications are

high, the transplant recipient has to be extremely wary of germs -

washing hands frequently and avoiding large crowds and people who are

sick. Cuts and scratches must be treated promptly and monitored for

the first sign of infection. Pets, gardening and swimming pools are

all potential sources of disease-carrying organisms.

As time goes by, medication doses may not be as strong, and the

patient can ease up on some of these safety measures but still must

maintain a cautious attitude regarding hygiene and health.

Marcia was accustomed to monitoring her blood sugar, giving herself

insulin injections and taking medications to deal with complications

of diabetes. To this regimen, she added anti-rejection drugs,

antibiotics and antifungal medications plus anti-ulcer drugs to help

her deal with the side effects of her anti-rejection treatment.

Hypertension is a major cause of kidney damage so it was important

for her to keep her blood pressure and cholesterol under control with

diet, exercise and prescribed medications.

About a third of liver transplants are performed on patients who have

had alcoholic liver disease. Careful screening is done to make sure

that the recipient has gone through addiction treatment.

Studies show that as many as half of alcoholic recipients go against

professional advice and have at least one drink, but only 10 to 21

percent resume drinking heavily or in a sustained pattern - compared

to a relapse rate of greater than 60 percent for the whole population

of alcoholics.

Heavy drinking and psychiatric disorders are major causes of non-

compliance with anti-rejection medications. Counseling and social

support may be needed.

After recovery from surgery, the patient can expect to feel like a

new person and able to do things that weren't possible before. With a

good transplant team and compliance with treatment, about 80 percent

of transplanted organs are still functioning five years later.

This column was made available by Casa Grande Regional Medical

Center.