My landmark liver transplant

I had a liver transplant owing to several tumours in the liver which could not be taken out individually causing excruciating pain due to frequent haemorrhages in 2008. The largest lesion caused splaying of the portal vein around the lesion. Hepatic veins were compressed and displaced by the segment 4&8 mass lesion. I had two episodes of bleeding in the hemangioblastomas and required hospitalisation.

A non-fdg avid lung nodule was found in the right lower lobe.

           The necessity of immunosuppressants.

The transplanted liver needs the immune system to be suppressed so that it isn’t rejected like any pathogen. Immunosuppressants are expensive life-saving medicines. I am on immunosuppressive medicines for life.

The essence behind continuing an immunosuppressive regimen is that the transplanted organ into the body of the host is not similar in genetic structure(DNA) of the recipient.

We have been endowed with a wonderfully complex structure called the immune system to protect us from viruses which are essentially nucleic acid DNA or RNA.

Hence, the immune system not having the capacity to distinguish between a new organ transplanted to save life destroys it instead which results in rejection.

Immunosuppressive treatment begins during the surgery and continues throughout the patient's life. Regular blood tests and other maintenance strategies by which medicines at specific doses are adjusted periodically by constant monitoring to prolong the transplant recipient's life and prevent acute or chronic rejections of the graft.

All immunosuppressants leave the patient more susceptible to infections and less able to fight them off.

Soon after discharge I got viral infection varicella and was treated with Zovirax.

I am an MDR- TB survivor with pulmonary, lymph and bone involvement.

Two years after liver transplant a lymph nodes biopsy showed TB infection(AFB+). More than 4 months of being on anti-Tb-treatment showed lung condition worsening. HAIN test confirmed that the bacteria is resistant to Rifampicin, Isonazid and ethambutol hence a change was implemented but it didn't work and I stopped walking due to immense pain pelvis onwards. Dr.Randeep Guleria of AIIMS changed the medicines to highest degree antibiotics and the expensive drugs cured MDR-Tb but till this day I need a walking stick to walk and can't do most of the daily jobs for which I have to depend on her 69 years old mother.

Such unforeseen infections haunted throughout my life increasing the cost of health maintenance.

The trigeminal nerve is also involved with the teeth and often sets in tooth pain so under the advice of my transplant hepatologist I visited the dentist under antibiotic coverage last year. But after returning I felt feverish and fever rose to 105 degrees and three lymph nodes in the neck stood out.

Head and Neck surgeon who removed the TB bacteria-infected lymph node advised an ice bath to bring the temperature immediately down and then he treated it. This way I have suffered many unknown fevers, and infection dealt with doctors who know her low immune system and the disease.

Immunosuppression strategy during the COVID19 pandemic 

Although there is a concern that organ transplant patients may be at a higher risk of COVID-19 infection, there is no evidence as of now to modify the immunosuppression protocol. Standard immunosuppression should be followed in the post-transplant period until further data is available.

Follow up post-transplant.

Patients should follow up with their respective centres as usual. It is strongly encouraged that the patient should avoid hospital visits for routine follow up and consult online via telemedicine.

There is a concern that immunocompromised patients are at a greater risk of morbidity and mortality due to COVID-19 infection, although data on liver transplant patients is limited at present.

Thus, I assume imprisonment in your own home isn't just a wise idea but a sensible one until it's safe outside.