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Post-transplant care of organ recipients fraught with risks; frequent infections and expensive therapies compound struggle
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Pune: Medical experts in the city have shed light on post-transplant risks and complications, highlighting that factors ranging from expensive immunosuppressants to lower immunity can contribute to rejection of an organ received by a patient.
Elaborating on the topic on World Organ Donation Day observed on Aug 13, doctors explained that after often-complex and prolonged transplant journeys, organ recipients still require lifelong monitoring post-procedure — including tissue biopsies to detect early signs of rejection.
And, despite such intense therapies, infections — even as common as respiratory viruses or urinary tract infections — can trigger immune responses that inadvertently attack the transplanted organ and render it failed.
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Doctors emphasised that recipients should try to honour the second chance that comes to them through the generosity and sacrifice of donors and their families.
Dr Shailesh Kakde, consultant nephrologist, Jupiter Hospital, told TOI that graft rejections are often reported after kidney transplants and not rare. He said, "A kidney transplant is a life-changing procedure, but it is not the end of the journey. Rather, it is the beginning of lifelong care.
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Rejection or transplant failure occurs when your immune system attempts to combat your new kidney. Immunosuppressant medications help prevent your body from fighting and rejecting your new kidney, which is why they must be taken every day, exactly as advised by your doctor.
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Lowered immunity risks exposure to infections, and sometimes a simple UTI could also lead to rejection owing to circulating antibodies. Dr Avinash Ignatius, nephrologist at Noble Hospitals and Research Centre, said, "In addition to immunosuppressive medications, regular blood tests, specialist consultations, and prompt treatment of infections or complications is important.
Though significant, these costs are lower than the cumulative expense of ongoing hemodialysis.
More importantly, a successful transplant restores freedom from the time-consuming, physically taxing dialysis. Improper care can lead to failure of the transplanted kidney, return to dialysis, re-listing for another transplant, and increased health risks."
The liver, a resilient organ, could also fail if not taken care of, said Dr Pavan Hanchanale, hepatologist and liver transplant physician at a city hospital.
"After transplant, recipients must ensure complete abstinence from alcohol as it can damage the new liver. Certain foods, like grapefruit and grapefruit juice, can interfere with immunosuppressant medications and should be avoided. It's also important to avoid raw or undercooked meats, eggs, and unpasteurised dairy products.
In addition, recipients should practice good hygiene, avoid close contact with sick people, and stay up to date on vaccinations.
Conditions like high blood pressure and high cholesterol must be managed with lifestyle changes and medication. Long-term immunosuppression can increase risk of certain cancers, particularly skin cancer, and so regular screenings are important," he told TOI.
Dr Vrishali Patil, head of the multi-transplant programme at DPU Super Specialty, said, "A patient's failure to adhere to the prescribed medication regimen, follow-up appointments, or other aspects of post-transplant care can lead to serious complications, including graft rejection, graft loss, and even death.
Noncompliance rates vary but can range from 20-50% in transplant recipients. A failed transplant can result in significant emotional distress, including depression, and places a heavy financial burden on patients, many of whom cannot afford a second transplant.
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She added, "Managing graft failure is both complex and costly, often requiring frequent hospitalisations, ICU admissions, and invasive procedures like biopsies. In severe cases, it can lead to multi-organ failure or even death. The price of neglecting proper care is extraordinarily high — both medically and personally."
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