New stuff

I'm at the hospital with Nancy awaiting an ultrasound before the endoscopic procedure. Why another ultrasound, you ask, well during the night Nancy developed a strange, painful swelling on the right side of her incision. It's black and blue and very, very painful. In Nancy's words " it hurts like hell". Morphine didn't touch it and Dalaudin only made a dent. Nobody knows for sure what it is or how it came about. Some suggestions have included a hematoma ( the best guess), infection or dehiscence. All this is complicated by the fact that she will have to lay on this lump during the ercp procedure.

What is Rejection?

Liver Transplant Complications: Rejection

The most serious complication that may occur after transplant is rejection of the liver. The body's immune system fights against all foreign matter, such as bacteria. This defence system may recognize tissue transplanted from someone else as 'foreign' and act to combat this 'foreign invader.' In most cases, rejection can be controlled if treated promptly. That's why it's important to contact your transplant team or doctor immediately if you experience any rejection symptoms.

I found this on a really good site from Cincinnati University Hospital.... What Are The Symptoms Of Rejection? While you are in the hospital, the transplant team will be monitoring your liver function tests daily to watch for infection. If you reject your liver during this time, you may not have any noticeable symptoms because rejection was diagnosed early through your blood test results. After you leave the hospital, your blood tests will be monitored less frequently. If rejection occurs, you may experience some mild symptoms, although some patients may not notice any problems. Here is a list of signs and symptoms that may indicate liver rejection: - Fever greater than 101° - Fatigue or excess sleepiness - "Crankiness" - Headache - Abdominal swelling, tenderness, or pain - Decreased appetite - Jaundice (yellow skin or eyes) - Dark (brown) urine - Itching None of these symptoms are specific for rejection; but they are important enough that when they occur, you should call the liver transplant coordinator at 513-584-9999. How is Rejection Treated? Rejection does not mean you will lose your liver, but it is very important to begin treatment as soon as possible to avoid further complications. Rejections can usually be treated successfully with medication. Rejection is usually treated by increasing the doses of your anti-rejection medications or by adding or combining different anti-rejection medications. Your transplant team may want to perform a liver biopsy to confirm that your symptoms are caused by rejection before they make any changes to your medications. You may be prescribed an increased dose of prednisone/ prednisolone daily or given solumedrol, the IV form, or prednisone. Sometimes another anti-rejection medicine, such as mycophenolate mofetil, sirolimus, or azathioprine may be added. When your liver recovers, your doses of these additional anti-rejection medications may be decreased or discontinued. The level of your primary anti-rejection medication, usually tacrolimus or cyclosporine, may be reduced. Your transplant team's goal is to have the lowest amount of immunosupression possible so that you do not reject your liver, have good liver function, and have minimal risk of infection and other side effects. Will I Always Have To Be Concerned About Rejecting My Liver? The risk of rejection decreases over time, but can occur at any time. Taking good care of yourself, taking your medications as prescribed and having your blood tests done regularly will help decrease your risk of rejection. Good communication with your transplant team and following your care routine are key factors for a successful outcome after transplant. Rejection can be successfully treated due to advances in immunosuppression and combinations of anti-rejection medications.

How Do I Know I'm Rejecting My Liver? Any injury to the liver can cause the release of normal liver proteins, or enzymes, into the bloodstream. An injury could be caused by rejecting, infection, or drug toxicities. Measuring these enzymes, called the liver function tests (LFT's), regularly and watching the pattern of the results can help your doctor decide what is happening to your liver. What is a Liver Biopsy? Although liver function tests and your symptoms help diagnos rejection, a liver biopsy confirms that the liver is being rejected. A small piece of liver tissue is examined under a microscope for signs of rejection. Biopsies are usually done as outpatient procedures at the hospital. The actual biopsy only takes a few seconds. The piece of liver tissue looks like a small piece of string. It is placed into a special solution, and then taken to the pathology lab to be processed and viewed under the microscope. Your biopsy results may be ready later that day, or you may be asked to return to the clinic to discuss your biopsy results or any treatment that may be necessary. Following a liver biopsy, you will need to lay on your right side for at least one hour, and you must rest in bed for four to six hours. Your nurse will take your vital signs every 15-30 minutes during this time to watch for high heart rate or respatory rate and a low blood pressure.

Just as I was going to start the story......

I started not feeling so well. Not sick, really.....Just not well... A little nauseous, itchy, head aches, fatigue like before, loss of appetite.... I was peeing alot but worried about my liver and what the blood work would show on Friday. When I came in for my appt.......Good news first? My creatine....(kidney function #'s) were MUCH better! from an all time high of 6 something to 2.7 last week to 1.6 last friday.... .8-1.2 is normal..... BUT,

my ALT and AST had tripled since last week. Not a good sign. The wonderful Dr's held a pow wow and decided that I needed to stay and run some tests to find out exactly what was going on.

So far I have had an ultrasound of my liver to look at the arteries, portal veins, etc. and they are clear.... They have run all kinds of blood cultures, urinalysis, and stool. Today they did a biopsy of my liver. We will know the results tomorrow and I am having some kind of MRI type scan to look at my bilinary duct.

These are what the Dr's are looking for:

1. rejection.....see below

2. an infection

3. bile duct constriction

So, I wait...... We will know more tomorrow......