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Yes. Sexual activity can resume early after discharge from the hospital. Because of illness, many patients experience impotence or lack of desire prior to the transplant. This usually reverses itself after transplant, but a patient’s libido tends to return slowly. Immunosuppressed individuals are at greater risk of contracting sexually transmitted diseases, therefore protective barriers such as condoms should be used (unless in a long-term monogamous relationship). Because of their chronic illness, many people are unable to conceive prior to transplant, but this may not be the case afterwards. Birth-control methods should be discussed with your transplant team and implemented when sexual activity resumes. Facebook Twitter

Liver transplantation is very successful. Most people are able to return to their daily routine within three months after the transplant, and many of them even earlier. Recipients have been known to live a normal life 30 years after the operation. Transplant success depends on a number of variables, including health status at the time of transplant, age and recurrent disease. Transplant recipients also directly contribute to the success of their transplant. The number one cause of organ failure following a transplant is due to patients not following the prescribed immunosuppression medication regimen. Careful attention to medication schedules, lifestyle changes, infection-avoidance techniques and close follow-up with with your transplant team and primary care physician can help ensure a good outcome.

How do you become a living donor? The following comes from m the mother of all things Transplant – https://unos.org/transplant/living-donation/ an excellent place for info and resources: 1. Contact a transplant hospital If you know a person you would like to help through living directed donation, talk to him or her and contact the transplant program where the person is listed. If you would like to be a living non-directed donor, contact a transplant hospital of your choice to find out if they have this type of donation program. Visit the OPTN Member Directory for a complete list of transplant hospitals. When you contact transplant hospital staff, they will typically ask for your consent to begin a basic medical screening. With your consent, the transplant hospital staff will ask you questions about your medical history to find out if you have any conditions that would keep you from being a donor. 2. Have an initial screening This initial screening is typically followed by a blood test to see if you are compatible with the intended transplant candidate. If you are not compatible with that person, you may have other options to donate. These options include paired exchange, blood type incompatible donation or positive crossmatch donation. 3. Get an independent donor advocate Transplant hospitals are required to provide an independent donor advocate (IDA) or IDA team for all potential donors. Your IDA should not be part of the potential transplant recipient’s medical team. The IDA will assist you during the donation process.

Category: Liver transplants Primary liver cancer, or hepatocellular carcinoma (also called hepatoma or HCC) is one of the major reasons for liver transplantation in the United States. Patients with HCC that is detected early enough for transplant are evaluated for liver transplantation similar to other patients, with additional careful evaluation of the extent of tumor. Transplant candidates with HCC are then placed on the liver transplant waiting list. Additional treatments are often needed while the patients wait on transplant. A major advantage of transplantation for HCC is that it results in complete removal of the cirrhotic liver that could harbor additional HCC tumors or develop new tumors in the future. For this reason, the chance of cancer recurrence after treatment is lower in patients who receive a liver transplant compared to patients who receive surgical resection as the curative treatment for HCC.

The best way to find willing donors is to share your story. Begin with family and friends, co-workers and church members. People in your social groups. A member of our transplant team can help you with tips and information you can share with people about living donor transplant for children.

Noncholestatic cirrhosis, including post-necrotic cirrhosis from hepatitis B or C or non-alcoholic steatohepatitis (NASH) Cholestatic liver diseases (ie, primary biliary cirrhosis, secondary biliary cirrhosis, primary sclerosing cholangitis) Biliary atresia Acute hepatic failure, including acutely decompensated Wilson disease Metabolic diseases (ie, alpha-1-antitrypsin deficiency, Wilson disease, tyrosinemia, glycogen storage disorder type I or type IV) Malignant neoplasms or benign tumors (ie, HCC, cholangiocarcinoma, hepatoblastoma, polycystic liver disease, hepatic adenoma) Less common additional diagnoses include the following [1] : Cystic fibrosis Budd-Chiari syndome Total parenteral nutrition/hyperalimentation Neonatal hepatitis Congenital hepatic fibrosis Byler disease Trauma Graft versus host disease

Research into the possibility of liver transplantation (LT) started before the 1960s with the pivotal baseline work of Thomas Starzl in Chicago and Boston, where the initial LT techniques were researched in dogs. Starzl attempted the first human LT in 1963 in Denver, but a successful LT was not achieved until 1967. In 1970, with an immunosuppressive regimen largely based on steroids and azathioprine, survival rates were dismal—approximately 15% at 1-year follow-up. LT did not become a clinical reality until the early 1980s, after the discovery of cyclosporine, which led to improvements in rejection rates. In 1983, the US National Institutes of Health established, by consensus, that LT was to be considered out of the experimental realm and was to be clinically accepted as definitive therapy for end-stage liver disease (ESLD). Additional improvements in immunosuppression that were instrumental in advancing the science included the discovery of monoclonal antibodies (ie, muromonab-CD3 [OKT3]) in 1986. The combination of improvements in rejection rates and in surgical technique led to an enormous growth of the field during the 1980s, with expansion from 3 centers in 1982 to more than 120 centers today. In 2017, over 8,000 procedures were performed, up from approximately 100 in 1982. Of great importance in this expansion was the development of the University of Wisconsin (UW) solution in 1988, which increased preservation time and allowed for a smoother surgical procedure, avoiding a rushed tour de force in the operating room. Finally, the development of newer immunosuppressants, such as tacrolimus and interleukin-2 (IL-2) receptor blockers, has paved the way for further growth in this field. All those advances have produced excellent results, with current 1-year patient survival rates of 91-93% and 5-year survival rates of 75-84%. [1] Future advances may include the development of xenotransplantation, which was pioneered by Starzl in 1992, and the development of cloning techniques and their impact on organ availability. Organ allocation has also evolved over time, with the current system based on the Model for End-Stage Liver Disease (MELD; see the MELD Score calculator), with a focus on maximizing transplant benefit. [7, 8] Further refinements of the model are always ongoing and aim to improve fairness in allocation and survival results. Hepatitis C virus, hepatocellular carcinoma (HCC), chronic kidney disease, and alcohol abuse relapse continue to be major challenges, and continued research in these areas will undoubtedly lead to better outcomes for transplant recipients.

Contraindications The following conditions are currently considered absolute contraindications to liver transplantation (LT) by most programs: Untreated spontaneous bacterial peritonitis (SBP) or other active infection Severely advanced cardiopulmonary disease, unless already addressed successfully (eg, with coronary artery bypass grafting [CABG]) Extrahepatic malignancy that does not meet cure criteria Active alcohol or substance abuse, with exceptions on a case-by-case basis Inability to comply with immunosuppression protocols because of psychosocial situations SBP, which is sometimes protean in its manifestations (eg, malaise, abdominal discomfort), can be devastating and can cause decompensation in an otherwise stable patient with cirrhosis. The development of SBP in a patient with cirrhosis is an indicator of a very poor prognosis. SBP may present as encephalopathy, hypotension, fever, leukocytosis, and an elevated white blood cell count in the peritoneal fluid. The absolute criteria for a diagnosis of SBP are one or more of the following: Peritoneal fluid polymorphonuclear leukocyte count > 250 cells/μL Identification of bacteria in peritoneal fluid by light microscopy Subsequent positive bacterial culture results in the appropriate clinical setting If pneumonia or other active infections are present, mortality rates after transplantation are greatly increased. This emphasizes the need to have a high index of suspicion for infection. If any doubt exists about the presence of infection, abdominal paracentesis, chest radiograph, urinalysis, and/or pan cultures may be indicated. In patients with a prior history of drug use, examine arms and legs for evidence of new track marks. Patients with a history of alcohol abuse should have an alcohol level test performed as part of the preoperative workup through contract arrangements and upon admission for transplantation. Secondary liver malignancies are contraindications to LT because of the universal recurrence of the tumors under immunosuppression. Exceptions to this rule include metastatic neuroendocrine malignancies such as carcinoid tumors. An elicited history of previous malignancy in a transplant candidate should prompt an extensive workup for metastatic disease, staging before and after surgery or therapy, and consultation with an oncologist. Relative contraindications to LT are multiple, and each should be weighed when considering the prospective recipient’s severity of illness. While no single relative contraindication alone may prevent a given patient from receiving a liver transplant, these are red flags, which, if multiple or if manifesting in an otherwise high-risk recipient, may proscribe LT. Most commonly, these red flags include the following: Chronic renal failure (in which combined liver-kidney transplantation may be required) Advanced cachexia and frailty Large HCCs (more advanced than stage II (ie, Milan criteria, as described by the UNOS–modified American Joint Committee on Cancer [AJCC] classification) Medication-resistant hepatitis B virus (HBV) cirrhosis Portal and mesenteric vein thrombosis History of prior cancer not meeting full AJCC cure criteria Active infection Multisystem organ failure

The workup of a potential candidate for liver transplantation (LT) determines the patient’s degree of illness and overall suitability for LT. This ensures better allocation of resources and optimizes survival. The first step is to establish a diagnosis of end-stage liver disease (ESLD) by clinical evaluation; the second is to exclude any absolute or relative contraindication to LT. Mandatory consultations and clearances are as follows: Cardiopulmonary clearance Psychiatrist and social worker consultations Financial clearance Nephrologist, infectious diseases specialist, or dentist, as needed The liver allocation system implemented by the Organ Procurement Transplantation Network in February 2002 is based primarily on the severity of liver disease as assessed by the Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD) survival models for all patients with chronic liver disease. The MELD score, which is based on biochemical variables (see below; also see the MELD Score calculator), has been shown in retrospective and prospective studies to be highly predictive of 3-month mortality in patients with chronic liver disease. The PELD model for pediatric patients, which incorporates both clinical and biochemical variables (see below; also see the PELD Score calculator) was developed through analysis of data from the Study of Pediatric Liver Transplantation database and has been shown retrospectively to be predictive of waiting list mortality in pediatric patients. Model for End-Stage Liver Disease (MELD) scoring system The MELD score is calculated on the basis of the following variables: Serum creatinine Serum bilirubin International normalized ratio (INR) Pediatric End-Stage Liver Disease (PELD) scoring system The PELD score is calculated on the basis of the following variables: Age Weight Height Albumin Total bilirubin INR

A nurse coordinator will remain in close contact with you throughout the waiting period. You will also continue to follow up with your regular gastroenterologist. Your position on the list, also known as your MELD score, will be updated regularly, based on blood work and testing. We will periodically check for liver tumors by having you complete imaging studies, such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI). As your MELD score rises over time, the likelihood of receiving a liver becomes greater. Our team is available at all times to guide you through this stressful waiting period.

A typical liver transplant lasts about five hours or more.

Your length of stay in the hospital is determined by your health status before the transplant and the course of your recovery. Typically, transplant patients remain in the hospital for 10 to 14 days.

Patients are typically admitted to the Surgical ICU after surgery until the physicians feel that you can be transferred to a regular room. You will be monitored closely by the medical team and given transplant medications. We will provide you with extensive education about these medications and about how to care for your new liver.

Some of your medications will be discontinued over time, but you will need to take anti-rejection medication for the rest of your life. This is why you will need to maintain your insurance benefits or have arranged a way to pay for your post transplant medications. If you do not take your anti-rejection medication, you will reject your liver. Without a functioning liver, you could die.

Your MELD (Model for End Stage Liver Disease) score is obtained from measuring four factors in your blood: sodium (an electrolyte that can be low in points with liver disease) bilirubin (how the liver gets rid of bile) prothombin time (ability to make blood clotting factors) creatinine (kidney function)

In very rare occasions, transplant surgeons can perform a domino liver transplant. A first recipient receives a liver from a deceased donor. This first recipient is then able to donate his or her liver to a second recipient, who is not likely to experience the same type or extent of liver disease. For example, some people require a liver transplant because they have a disease called familial amyloidosis. After a person with familial amyloidosis receives a new liver, however, he or she can donate the removed liver to another who is waiting for a liver transplant. This donation is possible because the patient’s liver is not actually diseased and should function normally in another individual. Although familial amyloidosis prevents the liver from processing certain proteins properly, which eventually causes damage to arms, legs and internal organs, its effects generally are not noticeable for 40 to 60 years. Because this process takes place so slowly over the course of a lifetime, the person who receives this liver likely will never experience any of the problems associated with familial amyloidosis. Though rare, there are other liver diseases that make domino liver transplants possible. While domino liver transplants can help expand organ availability, they are still considered experimental protocols and require special patient consent.

Rejection is a signal that your immune system has identified the new liver as foreign tissue and is trying to get rid of it. Preventing rejection with immune-suppressing medication is the first priority. Most rejection episodes cause no symptoms and are identified as increased liver function tests on routine blood work check-ups. This is why you need frequent blood testing in the first three months after transplantation, and regular testing after that. If the rejection episode is verified through liver biopsy, then the transplant team will increase the amount of anti-rejection medication or prescribe a different combination of anti-rejection drug therapy. Using medicine, we can successfully reverse most rejection episodes, if we detect it early enough. However, if the episode is severe, it may shorten the overall life span of the new liver.

Immunosuppressants are a class of drugs that suppress the immune response through various mechanisms. In organ transplantation, immunosuppressants are used to prevent the body from either recognition or attacking the foreign organ via various immune responses. They should only be used under the supervision of appropriately trained and experienced staff. The types of drugs that use for immunosuppression in organ transplant are: Calcineurin inhibitors (cyclosporin, tacrolimus) Corticosteroids (eg methylprednisolone, dexamethasone, prednisolone) Cytotoxic immunosuppressants (azathioprine, chlorambucil, cyclophosphamide, mercaptopurine, methotrexate) Immunosuppressant antibodies (eg antithymocyte globulins, basiliximab, infliximab) Sirolimus derivatives (everolimus, sirolimus) Other immunosuppressants (mycophenolate)

Calcineurin inhibitors Calcineurin inhibitors react in the body to block the acitivity of calcineurin. This results in controlling the body’s immune response and reducing the body recognising and attacking the foreign organ. Neoral (cyclosporin) is available as a microemulsion, which has greatly enhanced its oral bioavailability, with much less variation in absorption within and between patients. Evidence suggests that Prograf (tacrolimus) may be slightly more efficacious than Neoral (cyclosporin) and they are now used in equal numbers of patients worldwide. Absorption is hindered by food, so usually it needs to be taken on an empty stomach. Sirolimus Rapamune (sirolimus) is a recently developed immunosuppressant, which is very similar to Prograf (tacrolimus). It has many adverse effects, but has much less renal toxicity than calcineurin inhibitors, and is currently mainly used in lung transplantation to ‘rescue’ patients from chronic renal failure, by substituting it for Neoral or Cicloral (cyclosporin). Cell cycle inhibitors Imuran (azathioprine) is used in 60% of patients and mycophenolate mofetil in 40%. These drugs stop the production of cells called B and T cell that cause the immune response. Corticosteroids Corticosteroids are thought to reduce the synthesis and secretion of a variety of inflammatory mediators.

The side effects for each type of medication vary but the most common side effects that occur to less than 10% of patients are: Alopecia Dyspepsia Increased susceptibility to infections (eg oral, vaginal and intertriginous candidiasis) Masking of signs of infection Increased appetite Delayed wound healing Some of the rare serious side effects that can occur in less than 1% are: Muscle weakness and wasting (particularly symptomatic on drug withdrawal) Amenorrhoea Psychosis Euphoria Depression Hirsutism Gingival hyperplasia These side effects may not occur but if you have any concerns, see your doctor about it.

After an organ transplant, you will need to take immunosuppressant (anti-rejection) drugs. These drugs help prevent your immune system from attacking (“rejecting”) the donor organ. Typically, they must be taken for the lifetime of your transplanted organ. You will take other medications to help the anti-rejection drugs do their job or control their side effects. And you may need to take medications for other health conditions. Organ rejection is a constant threat. Keeping the immune system from attacking your transplanted organ requires constant vigilance. So, it’s likely that your transplant team will make adjustments to your anti-rejection drug regimen. After your transplant, it’s vital that you: Keep all your doctor appointments Undergo every recommended lab test Take all your prescription drugs It’s also important to find a good pharmacist who can help you: Understand your medications Manage your medication schedule Understand how the medicine works Learn about side effects and interactions Although rejection is a scary word, it doesn’t necessarily mean that you will lose your donor organ. Most of the time, a rejection can be reversed if your doctor detects its early signs. The symptoms of rejection — and the medical tests used to detect rejection — vary by the type of your organ transplant. So, it’s important to familiarize yourself with the early symptoms of rejection that are specific to your transplant. If your doctor identifies a rejection, they will first try to reverse it by adjusting your medications. For example, you may need to: Switch to a new drug Add another drug Take a larger or smaller dose of your medications During the first few months after an organ transplant, your transplant team will see you frequently to assess the function of your donor organ. Your doctor will help you develop good health habits to keep your body as healthy as possible. The transplant team also will urge you to: Keep all wellness checkups Monitor your blood pressure, weight, and cholesterol Get all recommended health screenings on schedule

After an organ transplant, you may experience short-term medication side effects such as: Hair growth or hair loss Acne Mood swings Round face Enlarged gums Weight gain These side effects may let up as your initial high dose of medication is tapered down. You also may experience other side effects such as: Diarrhea High blood pressure High cholesterol Elevated blood sugars Infection If you notice any side effects, don’t stop taking the drugs on your own. First, let your doctor know. They can adjust your prescriptions to minimize side effects without increasing your risk of organ rejection. Self-Monitoring at Home In addition to the tests that you undergo at regular follow-up visits, you will need to do some self-monitoring at home. Among the things you’ll need to monitor are: Weight. Weigh yourself daily at the same time, preferably in the morning. Call your doctor if you gain 2 pounds in a day or more than 5 pounds total. Temperature. Take your temperature daily. Call your doctor if your temperature is too high. Blood pressure. Check your blood pressure as recommended by your doctor. Pulse. Check your pulse daily. Call your doctor if it’s higher than the normal resting heart rate of 60 to 100 beats per minute. (If you’ve had a heart transplant, your resting heart rate may be as high as 110 to 120 beats per minute.) Blood sugar. Monitor your blood sugar if you have high blood sugar or diabetes. Anti-rejection drugs can interact with many other medications or supplements. So check with your doctor or pharmacist about safe over-the-counter products you can take. Anti-rejection drugs increase your risk of dental problems. These include: Dry mouth Mouth ulcers Enlarged gums Tumors Thrush (a yeast infection) Brush and floss your teeth each day. Also look inside your mouth and under your tongue each day. Call your dentist if you notice any changes or problems. Adopting a Healthy Lifestyle A healthy lifestyle is important for everyone. But it’s especially important after an organ transplant. Poor lifestyle habits can increase the risk of organ rejection. Be sure to avoid unhealthy behaviors such as smoking and excessive drinking. Embrace healthy behaviors such as: A nutritious diet Exercise Stress management Your transplant dietitian will give you tips for following a healthy diet. These may include: Eat high-fiber foods such as raw fruits and vegetables. Increase calcium by eating low-fat dairy products, eating green leafy vegetables, or taking calcium supplements (if directed by your doctor). Eat less salt, processed food, and snacks. Drink plenty of water (unless you are told to limit fluids). Eat high-protein foods such as lean meat, chicken (without the skin), fish, eggs, unsalted nuts, and beans. Instead of frying your food, try baking, broiling, grilling, boiling, or steaming. After an organ transplant, most patients are advised to start their exercise program with a low-impact activity such as walking. You can then gradually increase your workout intensity with aerobic activities such as: Bicycling Jogging Swimming Resistance exercise with weights can increase strength and help prevent bone loss. Stretching exercises can increase muscle tone and flexibility. The type and amount of exercise you can do after an organ transplant will depend on your age and overall physical condition. So, it’s important to follow the recommendations of your transplant team. Transplant patients face a wide range of health concerns after the transplant. It’s not uncommon for these health challenges to lead to stress. Getting proper rest and exercise can help.