A new study has
shown that liver transplant recipients with
less understanding of the treatment may be more likely to have problems
following the transplantation.
Over the past decade, advances in surgical techniques and
immunosuppressive drug therapies have resulted in improved survival rates
following solid organ transplants. Unfortunately, non-adherence to
post-transplantation treatment results in 15% of graft losses and about 50 % of
late acute rejections in adults.
published in the journal liver transplantion
included 105 post-liver
transplantation middle-aged males, who were each prescribed 11 drugs on an
average. Around 15% of the patients had limited literacy.
found that limited literacy and taking more medications were associated with
non-adherence to the treatment. The self-reported non-adherence was recorded as
14%; when the blood levels of tacrolimus, one of the medication used
post-transplantation was measured, this number jumped to 32%.
Serper from the Hospital of the University of Pennsylvania in Philadelphia,
says that, "It is important to understand how crucial self-care behaviors, such
as following treatment plans, could lead to re-hospitalization, graft
rejection, and infection if post-transplant regimens are not followed," added
concludes, "Higher scores for treatment knowledge and demonstrated regimen use
were independently associated with reduced post liver transplant
Also, we could
see an enhancement in long-term health of liver recipients involving existing
transplant center resources in cost-effective interventions that help patients
properly supervise their drug regimens."
that are effective in improving liver recipients' adherence to the medical
- Counseling on antirejection medication in the hospital.
- Educational intervention for paediatric patients.
- Increasing the frequency of clinical visits for nonadherent patients.
- Providing the liver recipients with a dedicated psychoeducational service.
After a liver transplant what are the
signs of organ rejection that transplant patients need to watch out for?
majority of rejection episodes are asymptomatic and detected on regular
screening labs. In advanced cases, symptoms of liver rejection include:
- Jaundice - yellow skin and yellowing of the whites of the eyes
- A high temperature of 38ºC (100.4ºF) or above
- Pale stools
- Dark urine
liver transplant patients is almost always successfully treated, emphasizing
the need for routine laboratory screening of liver function tests after
transplant and strict compliance with antirejection medication regimens.
taken to suppress the immune system after an organ
can be extremely powerful and have several side effects.
are three major immunosuppressive drugs commonly used in transplant, each with
its own set of potential side effects:
- Tacrolimus - Tacrolimus can cause kidney damage, high
blood pressure, diabetes and neurologic disturbances.
- Mycophenolate - Mycophenolate can cause stomach upset,
diarrhea and bone marrow suppression (low white blood cell count).
- Prednisone - Prednisone can cause diabetes, weight gain
and poor wound healing.
A year after
liver transplant, patients only need to be on a small dose of tacrolimus alone
to prevent rejection, but they must take this medicine for the rest of their
All of the immunosuppressive
drugs together increase the risk of infection and cancer. It is important to
have regular checkups with the transplant team to assess the new liver's
function, to look for any drug side effects and to examine for signs of
infection or cancer.
Brief overviews of drug interactions in liver transplant patients
Drug interactions with immunosuppressive medications can occur with certain antimicrobial
drugs particularly antifungal agents - certain seizure medications and certain
Also, antirejection drug levels need to be adjusted depending on the overall
functioning of the patient's liver and kidneys.
It is important that the Transplant Pharmacist
regularly review the patient's medication list to look for potential drug
interactions or drug dosage adjustments that might be