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ASK A SURGICAL EXPERT: About Life after Transplant Surgery
QUESTION: Describe the post-surgical medical realities transplant recipients should expect to experience.
ANSWER: As with most other surgeries, recovery from a transplant operation involves additional medication and hospital visits to make sure that the incisions heal correctly. But while other surgery patients can typically move on from the experience, most transplant recipients must continue medical treatment for the rest of their lives. This is because of the immune system's reaction to the new organ.
QUESTION: How doe the immune system affect the transplant?
ANSWER: The immune system comprises all of the elements in the human body that keep bacteria, microbes, viruses, toxins and parasites from destroying organs and tissues. In other words, the immune system works to destroy any harmful foreign matter that ends up on the body. When the system is working correctly, it can distinguish most foreign cells from cells that are produced by the body. A transplanted organ is made entirely of foreign cells, of course, which means that the body will attack it if left to its own devices. To minimize the immune response, transplant teams make sure donors and recipients have matching blood and tissue types. But even with a good match, the body will see the new cells as foreign matter and will reject the organ (destroy it cell by cell).
QUESTION: What types of rejections might occur after a transplant?
ANSWER: There are three types of rejection that might occur following a transplant. The first of these is hyperacute rejection. Hyperacute rejections occur as soon as the donated organ is in the body. This only happens if there are already antibodies in the recipient's bloodstream that react to the new organ, which would occur if the blood types of the donor and recipient were incompatible for some reason. This almost never happens, since transplant teams always test for any incompatibility ahead of time. If it were to happen, the recipient would most likely die on the operating table.
The second type of rejection is acute rejection. Acute rejection occurs at least a few days after the transplant, after the body has had time to recognize the foreign material. This is the normal immune response to foreign matter.
The third type of rejection is chronic rejection. Chronic rejection is a very gradual rejection, lasting months or even years. It can be so subtle that the patient doesn't notice any ill effects for some time.
QUESTION: Which type of rejection poses the greatest obstacle?
ANSWER: The chief obstacle to living with a transplant is acute rejection. This sort of rejection would happen to nearly all recipients if it weren't for immunosuppressive drugs. As you might expect, immunosuppressive drugs generally suppress elements of the immune system so they do not attack the donor organ. The problem with this is that the drugs also suppress some f the beneficial things the immune system does. A person taking immunosuppressive drugs is more susceptible to infection and disease.
QUESTION: Are there any other ways of minimizing the likelihood of rejection that do not bring potential ill side effects?
ANSWER: A new approach may eventually change this course. In a few experimental cases, kidney transplant patients have also received bone marrow transplants from their donors. Bone marrow produces the white blood cells that play a crucial role in guarding the body against foreign matter. The theory behind this new approach is that the white cells from the donor marrow will merge with the recipient's natural cells, allowing the immune system to recognize the new organ as part of the body. The initial experimental results are encouraging. The first test subjects are doing well without taking any immunosuppressive drugs.
For now, however, immunosuppressive drugs are still a routine, and successful, course of action for transplant recipients. Transplant recipients must be vigilant about their medication, and must make regular doctor's visits for follow up tests. But doing so is worth it for most transplant recipients, many of whom have been sick for years and years due to disease or organ failure. For them, and organ transplant offers a miraculous second chance at life.
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