Times of India
06 January 2011
By Shobha John

With news of West Bengal’s first kidney donor, Shibani Mahapatra, fighting to survive 16 years after she donated her kidney, it’s perhaps time to also look at transplant patients themselves and what they need to do to keep themselves fighting fit. While transplants, no doubt, give a new lease of life, over half of liver, heart and kidney transplant patients get endocrine problems and it’s only now that doctors are realizing the need to tackle these problems too. So while a kidney transplant patient will be rid of his earlier nausea, swollen feet and thrice-weekly dialysis, he’s at greater risk of diabetes, osteoporosis and cholesterol.

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.