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Gastroenterology (Expert Forum)
Brother just had liver transplant
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Brother just had liver transplant
by dona__0__0, Oct 16, 1998 12:00AM
My brother had a liver transplant on 10/2/98. The operation went smoothly, and he was sent home after only 6 days. ( He also has diabetes, which I understand will now be more difficult to control.) Prior to the transplant, he suffered sporadically from 'liver flaps'. Immediately after surgery, he showed what still looked like minor liver flaps, but we were told it was the effects of the cyclosporine, (this medicine I understand will cause minor trembling or tremors). His tremors have become so bad that he was readmitted into the hospital -- he cannot feed himself or walk without his body trembling out of control. He also has muscle weakness in his right arm (possible from all the IV"S), and the tremors are severely evident when he puts any pressure on his muscles, such as lifting a cup of coffee or a fork or when trying to lift himself out of bed or just holding his arm or leg out straight. The doctors do not seem to know what it is (we;ve had many different diagnoses, such as it's all in his head to they have no idea what is causing it). Neurology has reviewed all bloodwork and they find nothing. Also, his blood sugars range from the 60's to as high as 455, even with an Insulin drip in place. Could this actually be an effect of the cyclosporine or steroids? Or could his diabetes have anything to do with it? One doctor even mentioned that his symptoms mirror those of multiple sclerosis.
Any input would be greatly appreciated.
Any input would be greatly appreciated.
Doctor's Answer
by HFHSM.D.-D.M., Oct 16, 1998 12:00AM
_
Dear Donna:
I really appreciated your question and I can imagine how frustrated you are. Patients and their families are so relieved to actually get a liver transplant, it can be frustrating to realize that there can be significant problems after the transplant. The first year after transplant can be especially frustrating.
Diabetes is a common problem after transplant. It can be a new problem in someone who never had diabetes before or it can be harder to control in someone who already had this problem. The culprit is usually the steroids (prednisone or medrol) which makes an individual’s blood glucose levels rise. The problem is made even more challenging by the fact that the steroid doses are adjusted frequently after the transplant (hopefully down) and by the fact that patients have changing appetites after transplant (hopefully increasing). The problem with “sugar” control usually calms down over time. The most important thing in the meantime is for patients to try to eat in a consistent manner and for patients to accurately check their “sugars’ at least four times a day until you get things under control. Other thing such as infections can also make the “sugars” go haywire and obviously your physicians will know to look for that.
The nerve problems are more complicated and clearly I am limited in what I can say about that. It sounds like many tests have been done that I do not have answers to and it sounds as if your physicians have probably worked through a lot of the common causes. I will say problems such as weakness, tremors or focal weakness are often caused by a variety of factors and that often patients just need time to improve. As I mentioned before, patients are vulnerable to infections after their transplant because they are weak and because they are on immuno-suppressive medications. Transplant physicians know to look hard for this problem. Diabetes is certainly a cause of “neuropathy” and your brother may improve as this problem is controlled. Sometimes many symptoms after transplant are due to the powerful and exotic medications we use to prevent rejection. Over time we typically are able to lower these medications. Cyclosporine can cause a variety of side effects and we don’t even know all of them. Sometimes if a patient develops an unusual problem such as your brother’s, we consider switching the cyclosporine to a similar drug called prograf which has a somewhat different side effect profile. It has to be appreciated, however, that prograf also has side effects including an effect on nerves.
I hope this information is helpful to you in this difficult situation. Good luck. It sounds as if your brother was sick before his transplant and a lot of problems after transplant can improve with time. If you have any additional questions or concerns, you can post them through MEDHELP or contact us directly at Henry Ford. We have a very active liver transplant program. The direct number to our liver clinic is: (313) 916-8865.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question physician when you have a question pertaining to your health.
Dear Donna:
I really appreciated your question and I can imagine how frustrated you are. Patients and their families are so relieved to actually get a liver transplant, it can be frustrating to realize that there can be significant problems after the transplant. The first year after transplant can be especially frustrating.
Diabetes is a common problem after transplant. It can be a new problem in someone who never had diabetes before or it can be harder to control in someone who already had this problem. The culprit is usually the steroids (prednisone or medrol) which makes an individual’s blood glucose levels rise. The problem is made even more challenging by the fact that the steroid doses are adjusted frequently after the transplant (hopefully down) and by the fact that patients have changing appetites after transplant (hopefully increasing). The problem with “sugar” control usually calms down over time. The most important thing in the meantime is for patients to try to eat in a consistent manner and for patients to accurately check their “sugars’ at least four times a day until you get things under control. Other thing such as infections can also make the “sugars” go haywire and obviously your physicians will know to look for that.
The nerve problems are more complicated and clearly I am limited in what I can say about that. It sounds like many tests have been done that I do not have answers to and it sounds as if your physicians have probably worked through a lot of the common causes. I will say problems such as weakness, tremors or focal weakness are often caused by a variety of factors and that often patients just need time to improve. As I mentioned before, patients are vulnerable to infections after their transplant because they are weak and because they are on immuno-suppressive medications. Transplant physicians know to look hard for this problem. Diabetes is certainly a cause of “neuropathy” and your brother may improve as this problem is controlled. Sometimes many symptoms after transplant are due to the powerful and exotic medications we use to prevent rejection. Over time we typically are able to lower these medications. Cyclosporine can cause a variety of side effects and we don’t even know all of them. Sometimes if a patient develops an unusual problem such as your brother’s, we consider switching the cyclosporine to a similar drug called prograf which has a somewhat different side effect profile. It has to be appreciated, however, that prograf also has side effects including an effect on nerves.
I hope this information is helpful to you in this difficult situation. Good luck. It sounds as if your brother was sick before his transplant and a lot of problems after transplant can improve with time. If you have any additional questions or concerns, you can post them through MEDHELP or contact us directly at Henry Ford. We have a very active liver transplant program. The direct number to our liver clinic is: (313) 916-8865.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question physician when you have a question pertaining to your health.
