24 June 2009

Why a liver transplant?

Liver transplantation entails surgery to remove a diseased liver, and replace it with a healthy liver from an organ donor.

Liver transplantation entails surgery to remove a diseased liver and replace it with a healthy liver from an organ donor.

A liver transplant is done when other medical treatment cannot keep a damaged liver functioning. About 80 to 90 percent of people survive liver transplantation. Survival rates have improved over the past few years, because of newer and more effective medication, which has the ability to suppress the immune system and keep it from attacking and damaging the new (donor) liver.

Auto-immune hepatitis
Most liver transplant recipients have chronic liver diseases that have led irreversible scarring of the liver. Auto-immune hepatitis is among the most common causes. Generally people with cancer, or people with alcohol or drug problems do not make it onto the transplant lists.

Auto-immune hepatitis is a disease in which the body's own immune system attacks liver cells. This causes the liver to become severely inflamed (hepatitis).

Researchers think a genetic factor may predispose some people to auto-immune diseases. About 70% of those with auto-immune hepatitis are women, mostly between the ages of 15 and 40.

The disease is usually quite serious and, if not treated, gets worse over time. It's usually chronic, meaning it can last for years, and can lead to cirrhosis (scarring and hardening) of the liver and eventually liver failure.

Auto-immune hepatitis is classified as either type I or II. About half of those with type I have other auto-immune disorders, such as type 1 diabetes, proliferative glomerulonephritis, thyroiditis, Graves' disease, Sjögren's syndrome, auto-immune anaemia, and ulcerative colitis. Type II auto-immune hepatitis is less common, typically affecting girls aged 2 to 14, although adults can have it too.

Fatigue is probably the most common symptom of auto-immune hepatitis. Other symptoms include:

  • an enlarged liver with subsequent abdominal discomfort
  • nausea and vomiting
  • jaundice
  • itching
  • skin rashes

People in advanced stages of the disease are more likely to have symptoms such as fluid in the abdomen (ascites) or mental confusion. Women may stop having menstrual periods. Symptoms of auto-immune hepatitis range from mild to severe.

A diagosis is confirmed by means of a liver biopsy.

Treatment of auto-immune hepatitis
Treatment works best when auto-immune hepatitis is diagnosed early. With proper treatment, auto-immune hepatitis can usually be controlled. In fact, recent studies show that sustained response to treatment not only stops the disease from getting worse, but also may actually reverse some of the damage. The primary treatment consists of medicine to suppress (slow down) an overactive immune system.

In about seven out of 10 people, the disease goes into remission, with a lessening of severity of symptoms, within two years of starting treatment. A portion of persons with a remission will see the disease return within three years, so treatment may be necessary on and off for years, if not for life.

(Updated June 2009)



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