Piedmont Transplant

1) How long can a liver stay out of a body?

Less  than 18hrs; However, we  try to get livers transplanted in under 12hrs.

2) How long can kidneys stay out of the body?

Less than 24hrs – sometimes up to 30hrs if on a pump; however, we  try to get kidneys transplanted in under  20hrs.

3) How much time do we have to get into hospital if we get called in for a transplant?

Usually several hours, plenty of time to drive in safely.

4) If I reject my liver (kidney) will I lose it?

Not necessarily, but it does mean we need to treat you more aggressively.

5) When can I drive again after transplant surgery?

When you are no longer taking pain medication and you can jam on the breaks fast for an emergency (uses belly muscles that we cut during surgery).

6) Do I need to avoid places or people after transplant surgery?

No.  Our goal is to get you back to living a normal life and enjoying it.  You need to use common sense e early after transplantation (avoid people with colds/illnesses), and avoid foodstuff that does not look fresh or clean.  However, you can go to church, stores, public places and visit family and friends.

7) Will my new liver (kidney) last forever?

Not necessarily.  Kidneys on average last about 10 years (some longer, some less).  Livers tend to last forever unless hurt by recurrent diseases (alcohol, hepatitis C or B, autoimmune) or non-compliance with medications.

1. Q: Will the hospital pay for and provide me with my first month of medications on discharge?

A: The transplant case managers will assist you in setting up how/where to get your first month of medications filled on discharge. You will be responsible for your portion of payment per your insurance coverage. The hospital pharmacy does not dispense outpatient medications, nor is the cost of medications built into your copay for transplant surgery.

2. Q: Will I be on all these antirejection medications for the rest of my life?

A: After transplantation, the body will need continued immunosuppression with medications to prevent rejection episodes from occurring. The number of drugs and doses may change over time, but your transplant will always require some amount of medication for the life of the organ.

3. Q: Why can’t I drink/eat grapefruit, pomegranate and green tea?

A: These food products are known to interact with the transplant medications, specifically tacrolimus (Prograf), cyclosporine (Neoral) and sirolimus (Rapamune), lowering their drug levels in the body that can potentially lead to a rejection episode.

4. Q: Why do I need to stay on 5mg of prednisone for the rest of my life after having a kidney transplant? Won’t it cause me to become fat?

A: Kidney transplants generally require more immunosuppression to prevent rejection episodes. Although there are other centers that do not maintain some patients on steroids long-term, the benefits of lower rejection rates outweigh the minimal side effects we see with such a low dose of prednisone. Most weight gain after transplant can be attributed to less food restrictions, increased intake of food and/or lack of adequate exercise to maintain a healthy weight.

5. What medications will I be on after transplant, when will I get my medicines, how will I take them, what do I need to know about them?

Prior to discharge, you and/or your significant other/family member will go through an education class that will answer all of these questions in detail.  The transplant pharmacist will also spend some one on one time with you before discharge to make sure you have and know your medications. The Social Worker will help  arrange for the insurance to take care of these meds and let you know if you are financially responsible for anything. You will receive a medication plan with the names of the meds, pictures of the pills, and a schedule with exact times to take each medication prior to discharge.

6. How long will I be here in the hospital following kidney transplant?

The usual stay for a living related kidney transplant is 4 to 5 days.  The usual stay for a deceased donor kidney transplant is 5 to 8 days.

7. What can I use at home to help have a bowel movement while on pain medication?

It’s not usual for patients to experience some constipation after surgery – especially while taking narcotic pain medicines. We recommend using Miralax  1-2 times daily and / or  Colace (or equivalent) 1-2 times daily.  You can also use Dulcolax suppositories if needed. Any and or all  of these regimens are good choices. Obviously stop taking these medications if you have diarrhea.

1. Who should be evaluated  for pancreas transplantation?

Type I diabetics with kidney failure,  Type I diabetics with normal kidneys with life threatening hypoglycemia,  and some (non-obese, less than 50 years old) type II diabetics who have kidney failure and are currently using insulin.

2. How long will a pancreas transplant last?

One year after transplant about 85% of pancreas transplant recipients are insulin free. At 5 years, 60-69% remain free of insulin.

1. Will opening me up and letting air get in there make my cancer spread?

No.  It is a myth that “letting air in” will make cancer spread.

2. Will my liver regrow/regenerate after a liver resection?

Yes –  it will regrow to the size your body needs; However,  if the liver is cirrhotic,  it might not regenerate

3. How long will it take for my liver to regrow?

It depends  – if the liver is normal, it can regrow in  a few weeks to a couple months; if the liver is fatty and/or cirrhotic, it will take longer;  if the liver is  cirrhotic, might not regrow.

4. What can I eat to help my liver?

The usually recommended healthy diet; nothing special for the liver; it’s more an issue of what to avoid than it is what to consume

Depending on the transplant that you receive, the disease process that caused your own organ to fail, and other factors like your age and other medical problems, different patients have different combinations that are needed to protect their organ from rejection.  Your medicines are a careful balance, and that is why they are always reviewed meticulously.

Kidney donors are screened very carefully, and many subjects will be declined if there are any conditions found that could cause elevated risk for kidney donation.  If the donor passes through our extensive workup, the risks of kidney failure and major perioperative complications are low (but not zero).  We will carefully discuss all these risks with donors so they can make an informed decision.

Approximately 1 month after the donation/transplant occurs the donor family will receive an information packet and letter with some general information about all the people that they helped.  This info will not contain names but will have the tools needed to continue communication. On some occasions, after time has passed and if both parties are wiling, the recipient and donor family can meet with the help of LifeLink of Georgia.

Once approved for transplantation by the transplant center’s transplantation committee from a medical and psychosocial perspective, your name is listed with United Network of Organ Sharing (UNOS), who distributes organs impartially based on the Model for End Stage Liver Disease  (MELD)  score within your blood group and region. The MELD score is a numerical scale which is a reflection of the liver health; the higher the MELD score, the more  severe the liver disease, and higher the mortality.

The duration on the UNOS transplant list is not the criteria for seniority but the Model for End stage Liver Disease [MELD] score is. A person with the highest MELD score in the region may get transplanted within a short time versus another with a low score who had been waiting for a long time. MELD score reflects the severity of the liver disease and predicts mortality if not transplanted.

Liver transplantation is not just about replacing the liver. It involves assessing your health as a whole. The surgery is complex and post transplant anti-rejection medicines require that you have a healthy heart, lung, kidney functions. Rarely, undiagnosed health problems may surface after transplantation and lead to catastrophic complications jeopardizing the liver graft and your health as a whole. Hence potential liver transplant recipients are subjected to a rigorous testing by a multi disciplinary team during liver transplantation evaluation. This process is time consuming and requires that you are in a decent health to participate. Hence, you should consider this evaluation when your are relatively healthy and not wait till the last minute.

Once you are diagnosed with cirrhosis it is prudent to establish care with a hepatologist, and specifically a transplant hepatologist at a transplant center. Although you may not need transplantation right away, end stage liver disease can often deteriorate rapidly. Also, there are certain under appreciated yet common features like liver cancer and liver-heart-lung associated changes that require specific and time sensitive attention from a transplant candidacy perspective.

How can I help the team stay in touch with me in case I am offered an organ?

• Keep your contact information up to date
• Answer phone calls from blocked numbers – esp at night, weekends, holidays
• Verify with your phone provider that all call blocks are removed from your number
• Keep cell phones on  and answer unknown numbers
• Make certain your additional contacts are aware of the above