Your Questions Answered (Part Two)
by Joseph S. Galati, M.D.
Visit Liver Q&A on our website for answers
to other frequently asked questions.
Which types of liver disease are the leading causes
of transplantation?
JSG: Currently, hepatitis C is the leading cause of cirrhosis and
liver failure leading to transplant. Keep in mind that this occurs
in an absolute fraction of all those with hepatitis C. Hepatitis
B can lead to cirrhosis and the need for transplant, too. Ongoing
infection with type B or C hepatitis following transplant can lead
to problems later on relating to re-infection in the newly transplanted
liver. In these cases, antiviral therapy before and after transplantation
can significantly reduce the complications seen following successful
transplant surgery. Hepatitis A rarely leads to liver transplantation.
When it does, it is usually seen in older individuals with underlying
liver or other chronic illnesses.
I recently read where there has been some success with partial-liver
transplants. Who is most likely to be considered for this procedure?
JSG: In this procedure, a portion of the liver is used. It may come
from a cadaveric or a "living-related" donor. In the case
of the cadaveric donor, the donated liver is split into halves and
can potentially treat two patients waiting for a transplant. Who
would be suitable for this type of surgery depends on the anatomy
of the recipient as well as that of the donor. In the living-related
situation, there is an associated risk to the living donor.
How long will it take for the liver to regenerate under these circumstances?
JSG: Under most circumstances, the liver regenerates within one year.
The current anti-rejection medication is taken for life. Are there
other medicines that a transplant patient will need?
JSG: The amount of other medication needed after transplant will
vary from patient to patient. Hypertension is one of the more common
problems encountered after transplant. In certain cases, this may
require up to two or three additional medications. In addition, infection
can occur after surgery. This is successfully treated with antibiotics.
We are always concerned about bone loss, both pre- and post-liver
transplant. This may require additional vitamins and minerals to
be taken daily. While we are always trying to reduce the number of
pills our patients are taking, some are required for proper health,
and this is the trade-off for improved survival.
What is the most common cause for organ (liver) rejection?
JSG: Organ rejection is a very complex problem. It is due to overstimulation
of the immune system, which in turn sets off a chain reaction of
events within the liver, which ultimately leads to liver damage.
What are the odds of rejecting a transplanted liver?
JSG: Seventy-five percent of all patients coming to liver transplantation
survive the first year after transplantation. Most centers report
that over 95% of their patients who survive the first year survive
each year after the first. However, rejection occurs in as many
as 50-to-80 percent of all those undergoing liver transplantation,
and must be managed. The early cases of rejection can be easily
treated with appropriate medications. The loss of the liver due
to severe damage will occur in 5 to 10 percent of the cases.
How long is the typical recuperation time following liver transplant
surgery?
JSG: The patient's condition prior to surgery dictates the recovery
time. Patients who are not as sick can expect one to three days in
the intensive care unit with another several days on the regular
hospital floor before discharge home. Rehabilitation continues at
home with close monitoring of nutritional, physical and emotional
recovery. Patients can be back to work within 12 weeks. Unfortunately,
if organ availability becomes scarcer, transplant centers around
the country may have to transplant sicker patients, which could lead
to longer recovery times.
Are there any new drugs besides combo therapy?
JSG: Yes, there are a couple of new "extended" release
interferons being developed that are currently in clinical trial.
I had to stop combo therapy because I developed anemia. Can I resume
therapy once my red blood count returns to normal?
JSG: The anemia that is encountered is usually due to the Ribavirin.
A lower dose can be tried and the hemoglobin should be monitored.
In many cases, this works.
When will we find out if combo therapy can be a total success?
JSG: There is still a lot of clinical research to analyze. With the
current therapies, we have significantly increased the number of
sustained responders. It may be a long time before "everyone" experiences
a positive response, but more good stuff is on the horizon - hang
in there!
I was taking the combo treatment but had to discontinue it because
of an adverse reaction. Now my viral count is on the increase. What
are my treatment options?
JSG: It depends on the type of reaction you experienced. There is
the possibility a lower dose may be better tolerated. Of course,
some individuals may never tolerate the therapy. How aggressive you
should get with the therapy depends on the extent of activity and
amount of damage the liver has experienced. In these situations,
a risk-benefit decision regarding treatment should be discussed with
your physician.
