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Ellis: Organ Transplant Rejection

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By Glenn Ellis

Everyone talks about the success rates of kidney transplants. Rarely do we talk about what happens when transplants fail. People will quote the official statistics that 97 percent of kidney transplants are working at the end of a month; 93 percent are working at the end of a year; and 83 percent are working at the end of three years.

We rarely talk about the 7 percent of people whose transplant failed within a year or the 17 percent of people who have lost their transplants within three years.

To understand how and why organ rejection after transplantation happens it is important to understand not only the organ transplant process, but also some essential information about the immune system, different types of organ donors, and how these two things can complicate organ transplantation.

A transplant is a medical procedure where a tissue or organ is removed from one body and implanted into another body to replace an organ or tissue that is not functioning well, is absent, or diseased.

Organ transplantation is only done for severe disease. This process is not done for mild or even moderate disease, it is done when an organ is so diseased that it will eventually lead to dialysis or death without a transplant.

The most common transplants are done by taking an organ from one human body, alive or deceased, and transplanted into another human body. Organs, tissues such as skin, ligaments, and tendons, and even the cornea from the eye can be recovered and given to a recipient to treat a wide variety of issues.

It is possible to transplant animal tissues as well, such as from a pig or a cow, and use it for a human recipient. One of the more common ways that this type of tissue can be used is for patients who need a heart valve replaced.

The majority of transplants done in the United States are actually tissue transplants. These transplants may be bone, ligaments, tendons, heart valves, or even skin grafts. For these recipients there is some very good news: they are far less likely to experience rejection of these tissues.

After an organ transplant, most patients quickly feel better. They go on to enjoy a significantly improved quality of life.

Big Health Challenges

But they are also likely to face big health challenges.

When it comes to transplant rejection, some organs are far trickier than others. Some transplantable organs, such as the liver, are readily accepted by the recipient’s immune system, rarely triggering an immune response and rejection. But the skin is a very different matter: Skin grafts have a high rate of rejection for unknown reasons.

For organ recipients, rejection of the new organ is an issue of such significance that it requires frequent monitoring through blood work, daily medication, and significant expense. Rejection means that the body rejects the new organ because it sees it as a foreign invader similar to an unwanted infection. The possibility of rejection is often a constant worry for transplant recipients because rejection could mean returning to dialysis treatments or even death due to organ failure.

The immune system is complex and very complicated, and in most cases does an amazing job of keeping the human body well. The immune system does many things, protecting the body from viruses, germs, and diseases as well as helping the healing process. To say that the immune system is complex is truly an understatement, as entire textbooks are written on the immune system and how it protects the body.

Without the immune system, we would not survive infancy as we would be unable to fight off the most minor bacteria—exposure to even a cold could lead to death. The immune system is able to identify what is “self” and belongs in the body and can also identify what is “other” and fight it off.

The immune system can also cause problems when it inaccurately sees “self” as “other.” This type of problem is referred to as “autoimmune disease” and is responsible for serious illnesses such as lupus, multiple sclerosis, ulcerative colitis, type I diabetes, and rheumatoid arthritis. These diseases are all caused by the immune system being triggered without good reason, and the results can be devastating.

In the case of organ transplants, the greatest challenge—after locating an organ that is appropriate for transplantation—is to keep the new organ healthy by preventing rejection. That is typically done with medication, or many medications, that help trick the body into recognizing “other” as “self.” Put simply, the immune system needs to think that the new organ is part of the body, rather than an organ that doesn’t belong.

Tricking the immune system is more challenging than it might seem because the body is very good at identifying invaders because it is essential to life. In most people, the immune system becomes more adept and stronger during the first decades of life and is better able to fight off infection with each passing year well into adulthood.

“Rejection” is a very scary word, but it doesn’t always mean you are losing your transplanted organ. At 10 years, 54 percent of transplant kidneys are still working. In fact, over 20 percent of kidney transplants every year are re-transplants.

Rejection is when the organ recipient’s immune system recognizes the donor organ as foreign and attempts to eliminate it. It often occurs when your immune system detects things like bacteria or a virus. Some degree of rejection occurs with every transplant, but how significant the rejection is will depend on the individual.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

Glenn Ellis is a health columnist and radio commentator who lectures, nationally and internationally on health related topics.

Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.