06 January 2011
By Shobha John
Dr Pankaj Shah, chairman of the transplant endocrinology group at Mayo Clinic in Rochester, where more than 1,100 transplants take place annually, said during a recent visit to Delhi that with greater life expectancy, transplant patients too were living longer. "In the US, 14% of those who had kidney transplants in 1987 died within five years. But in 2003, the mortality rate was reduced to 7%," says Shah.
The numbers too have gone up – in 1988, some 12,623 patients got organ transplants in the US; today, it’s over 21, 000, says Shah. In India, some 5,000 kidney transplants are performed annually, while 500 liver transplants were done in the last one year, says Dr Ambrish Mithal, chairman of division of endocrinology and diabetes at Medanta Medicity, Gurgaon.
This makes it all the more imperative to tackle the endocrine problems that crop up. In fact, says Mithal, diabetes may already exist in onefourth of patients before a transplant and another onefourth develop it after it. The reason is simple. Immunosuppressants are given to these patients so that the body doesn’t reject the foreign organ. But their side-effects invariably lead to these diseases. These medicines, which include steroids and drugs such as tacrolimus and cyclosporine, reduce the capacity of the body to make insulin, says Shah.
Osteoporosis is an added risk – lack of calcium and vitamin D can induce it. Activation of vitamin D happens in the liver and kidney and so chronic liver and kidney disease lead to low vitamin D, less calcium and greater risk of osteoporosis. Also, as the patient is so sick, he’s invariably less active, aggravating bone loss.