Adult Blood Cancer & Stem Cell Transplant

Absolute Neutrophil Count (ANC) - A calculation of the white blood cells that counts not only the mature white blood cells but also the less mature white blood cells; also called "absolute granulocyte count."

Acyclovir - a type of medicine that fights viral infection.

Allogeneic Transplant - Transplant of stem cells donated from another person. Genetic matching, called HLA matching, is done from blood samples prior to transplant. The donor may be a family member, unrelated donor, or umbilical cord blood.

Anemia - A condition in which there is a decreased number of red cells, resulting in weakness and fatigue.

Antibiotics - A group of medicines used to treat infections.

Antibody - A protein that helps the body fight foreign substances (antigens) in the body, such as bacteria, fungi and viruses.

Apheresis - A procedure where blood is withdrawn from the body and circulated through a machine that removes certain components and returns the remaining components to the body. This procedure is used to collect blood stem cells for transplant. It may also be used to collect platelets or other components of the blood.

Aplasia - Period of time when the bone marrow space inside the bone is empty. In bone marrow/stem cell transplant process, this occurs after chemotherapy with or without radiation in preparation for transplant.

Aplastic Anemia - A blood disorder in which the bone marrow is deficient in producing red blood cells, white blood cells and platelets.

Aseptic - A condition of being free from germs and infection.

Aspiration (of marrow) - The removal of marrow from the cavities in large bones by suction through a needle.

Autologous Transplant - A transplant in which a patient's own stem cells are collected, stored and then returned to the patient at a later date.

Biopsy - A small piece of tissue removed for microscopic examination.

Blood Cells - Cells formed in the bone marrow that makes up blood.

Blood Stem Cell Harvest - A procedure in which stem cells are collected from the circulating blood for use in a transplant.

Bone Marrow - The spongy tissue found inside large bones; also the home to the immune system. It is responsible for making blood cells including red blood cells, white blood cells and platelets.

Bone Marrow Stem Cell Harvest - A procedure in which bone marrow is taken from the pelvic bone (hip area) for use in a transplant.

Bone Marrow Transplant - A process in which a patient's bone marrow is destroyed by chemotherapy and/or radiation therapy and then replaced by previously harvested bone marrow stem cells from a donor or the patient.

Central Venous Catheter - A small tube that is inserted into a large vein through which drugs and blood products can be given and blood samples withdrawn.

Chemotherapy - Treatment that destroys cancer cells with drugs.

Clinical Trial - A very structured study to determine the effectiveness of a drug or treatment.

Colony Stimulating Factor - Proteins that stimulate the production and growth of certain types of blood cells.

Complete Blood Count - A blood test that determines the number of red blood cells, white blood cells and platelets in the blood.

Conditioning - A combination of chemotherapy drugs, and sometimes radiation, given a few days prior to transplant to eliminate cancer cells and destroy the immune system.

Cyclophosphamide - A drug used for immunosuppression and destruction of cancer cells. A commonly used brand name is Cytoxan.

Cyclosporine - An immunosuppressive drug used to treat and prevent graft versus host disease.

Cytomegalovirus (CMV) - A virus that can lie dormant in a person but may cause an infection after a transplant when the immune system has been compromised.

DMSO - A preservative used in the freezing of bone marrow and blood stem cells.

Electrolytes - Minerals found in the blood such as sodium and potassium and magnesium that must be maintained in a certain range to prevent complications.

Engraftment - The successful implantation and function of stem cells in the patient's bone marrow cavities.

Febrile - Having a fever.

Fungus - A mold or yeast infection in the body, especially after a transplant when the immune system has been compromised.

Gastrointestinal (GI) - Refers to that part of the body that includes the stomach and intestines.

Graft Rejection - When donated bone marrow/stem cells infused during transplant is rejected by the patient's body and does not grow and develop.

Graft vs. Host Disease - A condition that can occur following an allogeneic bone marrow/stem cell transplant in which some of the donor's bone marrow cells attack the patient's tissues and organs.

Granulocyte - One of the major groups of white blood cells. Includes three types of cells: neutrophils (segs and bands), eosinophils, and basophils.

Granulocyte Colony Stimulating Factor (GCSF) - A natural substance that stimulates white blood cell growth.

Growth Factor (Colony Stimulating Factor) - An injectable drug used to stimulate the development of blood cells (Neupogen, Filigrastin).

Harvesting - Term used for the collection of stem cells from the bone marrow or peripheral blood.

Hematology - The study and treatment of diseases of the blood and blood forming tissues.

Hematopoietic stem cells - Immature cells from which all blood cells develop. The "parent" or "seed" cells found in the bone marrow or peripheral blood produce several different types of blood cells. Blood cells grow in the same way as other human cells. The stem cells begin to divide and mature until they are fully developed, forming all the different types of blood cells white blood cells, platelets and red blood cells.

Hemoglobin - The part of a red blood cell that carries oxygen to tissue.

Hemorrhage - A general term for a large loss of blood brought about by injury to blood vessels or by a lack of necessary cells (platelets) to clot blood.

Herpes Simplex - A virus that can produce small, painful, fluid-filled blisters on the skin and mucous membranes.

Herpes Zoster - A virus that can produce shingles (painful skin eruptions that follow the underlying nerve routes inflamed by the virus).

Histocompatibility - Referring to the similarity of tissue between different individuals. The level of histocompatibility describes how well the patient and donor are matched. The major histocompatibility determinants are the Human Leukocyte Antigens (HLA). HLA typing is performed between the potential marrow donor and the potential transplant recipient to determine how closely their HLAs match. The closer the match, the less the donated marrow and the patient's body will react against each other. (See "GVHD.")

Human Leukocyte Antigens (HLA) - The genetic "fingerprint" present on the surface of white blood cells, platelets, and most other cells of the human body, which allow the body to recognize self versus non-self. Made up of proteins, it plays a critical role in activating the body's immune system to respond to foreign organisms.

HLA Typing - The identification of an individual's specific HLA type.

Host - The patient's body.

Hypertension - High blood pressure.

Hypotension - Low blood pressure.

Iliac Crest - The "hip bone" where large quantities of bone marrow is found.

Immune System - The body's defense network against infection and foreign particles.

Immunoglobulin - Proteins made by the body that attach to infections and tend to decrease their action. They can be given intravenously or orally.

Immunosuppression - A state of decreased immunity or a lowering of the body's immune response to prevent a reaction against donor marrow or stem cells and to prevent GVHD. This can also occur after receiving chemotherapy.

Intravenous (IV) - Within or into a vein.

Irradiation - High energy rays used to kill diseased cells before or during transplant.

Laminar Air Flow (LAF) Room - A room that is specially designed to create a germ-free atmosphere through airflow and filtration.

Leukocytes - A general term for all the types of white blood cells.

Lymph Node - A gland in the body that produces lymph (the clear fluid that circulates through the body and contains white blood cells and antibodies).

Lymphocyte - One major group of white blood cells. B lymphocytes make antibodies against bacteria. T lymphocytes attack virus infected cells directly.

Lymphoma - Cancer of the lymph nodes.

Malignant - Cancerous; abnormal growth of cells.

Match - In marrow transplantation, the word "match" relates to similarity in HLA typing between the donor and the recipient.

Matched Unrelated Transplant - Another type of allogeneic transplant, but the stem cells are donated by someone other than a family member.

Microbe (or microbial) - Minute forms of life such as bacteria, fungi or viruses.

Morbidity - Sickness, side effects and symptoms of a treatment or disease.

Magnetic Resonance Imaging (MRI) - A method of taking pictures of the body tissue using magnetic fields and radio waves.

Mucositis - Inflammation of the mucous membranes, which include tissues lining the mouth and throat.

Neutropenia - Low counts of neutrophils, a type of white blood cells.

Neutrophil - The most common type of white blood cell in the bloodstream. It helps defend against bacterial (also called segs and bands) infections.

Oncology - The study and treatment of cancer.

Packed Red Blood Cells - Red blood cells collected from one individual that are "packed" into a small volume for a transfusion into a patient.

Petechiae - Small red spots under the skin caused by a low platelet count.

Platelets - Blood cells that promote blood clotting.

Prednisone - A steroid drug used to treat and prevent GVHD.

Preparative regimen - The chemotherapy with or without radiation therapy given to a patient prior to a bone marrow/stem cell transplant.

Protocol - The plan of treatment.

Purging - Process by which certain types of cells are removed from bone marrow prior to transplant to kill diseased cells and/or make space for healthy new marrow and/or suppress the immune system so graft rejection does not occur.

Red Blood Cells (Erythrocytes; RBC) - Cells that carry oxygen from the lungs to tissues throughout the body (measured by the hematocrit or HCT).

Relapse - Recurrence of the disease following a period of remission.

Remission (complete or partial) - No cancer cells can be detected by a microscope and the patient appears to be disease free. Partial indicates that there has been at least a 50% regression of the disease following treatment.

Sepsis - The presence of infection in the blood.

Steroid - A drug commonly used in bone marrow/stem cell transplant to prevent or treat graft verses host disease.

Stomatitis - Mouth sores.

Syngeneic Transplant - Transplant in which the donor is an identical twin.

T Cell (Lymphocyte) - A type of white blood cell that can distinguish which cells belong in a person's body and which do not.

Titer - A blood test that assesses levels of antibodies against such things as viruses.

Total Body Irradiation (TBI) - A form of radiation therapy where virtually the entire body is exposed to the radiation.

Total Parenteral Nutrition (TPN; also called Hyperalimentation) - Intravenous feedings consisting of fluids high in calories and essential nutrients.

Transfusion - The transfer of any product derived from blood cells from one individual to another.

Urinary Catheter - A catheter inserted into the urinary bladder to allow continuous bladder irrigation and drainage during the conditioning phase.

Veno Occlusive Disease (VOD) - A disease that sometimes occurs following high dose chemotherapy and/or radiation therapy in which the blood vessels that carry blood through the liver become swollen and clogged.

Virus - A specific type of organism that invades cells and alters their genetic machinery, turning them into "factories" for production of more of the virus.

White Blood Cells (leukocytes) - Blood cells that fight infection in the body; neutrophils are the most important type.

What is bone marrow?

Bone marrow, found inside bones, is a spongy material where blood cells are made.


What are stem cells?

These are the “mother” cells in the bone marrow space which produce white blood cells, red blood cells, and platelets.


Why a transplant?

Bone marrow/stem cell transplants are performed for individuals who have diseased marrow or who will be receiving high doses of cancer therapy which will damage their marrow. Among the most common types of cancer treated with a transplant are testicular, lymphoma, myeloma, leukemias, and aplastic anemia. While transplants do not provide 100% assurance that the disease will not recur, it can increase the likelihood of a cure or may prolong the period of remission in many patients.


Are there different types of transplants?

Yes. Autologous transplants occur when the patient’s own stem cells are harvested and stored for re infusion after high-dose chemotherapy and/or radiation treatments.


Allogeneic transplants occur when stem cells are harvested from a sibling with matching marrow, an unrelated donor with matching marrow, a donor with mismatched marrow or umbilical cord blood, and are stored for transfusion following high-dose chemotherapy and/or radiation treatments.


What is a harvest?

Stem cells are collected by one of two methods: bone marrow harvest and aphaeresis. The highest concentration of stem cells is in the bone marrow. A bone marrow harvest is performed in the operating room under general anesthesia. Marrow with stem cells is collected from the back of the hips and, occasionally, the breast bone (sternum), or from the front of the hip bones. The collected marrow is then processed, frozen, and stored. To collect peripheral stem cells, a growth factor (such as Neupogen®) is given for four days in order to move the stem cells into the bloodstream. A special cell-separating machine is then used to collect the stem cells from the patient. This process is done on an outpatient basis over several days.


What if I can not have an autologous transplant and do not have a matching donor?

If a patient does not have a matched donor from their family, the transplant center will search for potential donors through the National Marrow Donor Program and other national and international marrow registries.


What are the risks associated with a blood or marrow transplant?

When your white blood cell count is low, your risk for infection is high. Most of the infections in transplant patients are caused by bacteria and viruses which are normally present in your body. When you receive chemotherapy, your body’s normal protective mechanisms (such as mucous membranes in your mouth and gut, and the healthy white blood cells that make up your immune system) are temporarily destroyed. When this happens, you become more likely to develop an infection. Anyone who comes into your hospital room is required to wash their hands. Person who are sick or who have been exposed to anything contagious are not allowed to visit during that time. You will shower daily with a special soap that is provided to keep your skin from germs. There are special filter systems in some room s to keep the air clean for patients at high risk of infection. While your blood cell count is low, antibiotics are given to prevent and treat any infections that might occur. Bleeding precautions are another important aspect of your care. Because your platelet count will be low, you ill bruise and bleed more easily. You will be provided a special sponge-like toothbrush to use, you be asked not to floss your teeth. You will also be asked not to use razors and/or nail clippers. These precautions are for your protection.


Why are cell and blood bone counts so important?

All mature blood cells begin as stem cells. White blood cells fight infection, while red blood cells deliver oxygen. Platelets prevent bleeding. Following high doses of chemotherapy and/or radiation, the bone marrow is damaged causing a decrease in the white and red blood cells and platelets. Blood counts are monitored daily.


What if someone wants to donate blood for my use?

Some patients have family or fiends who would like to donate blood products for their use. The contact number for South Texas Blood and Tissue Center is (210) 731-5555.


Why is chemotherapy given before the transplant?

Chemotherapy drugs are given for two reasons (1) to destroy diseased cells and (2) to suppress the immune system. The immune system is the body’s mechanism for fighting off anything foreign that enters it. In an allogeneic bone marrow transplant, the immune system is suppressed so that the body will not reject the new bone marrow or stem cells. While it is undesirable to suppress the immune system in an autotologous transplant, that is a side effect of chemotherapy. Patients may have been treated with chemotherapy before and maybe familiar with its side effects. However, the chemotherapy received as part of the transplant process is given in much higher doses.


How is the transplant performed?

The frozen marrow and/or peripheral stem cells are thawed in a warm water bath at the bed side. It looks like blood as it is injected into the patient’s central venous catheter. The cells find their way back into the bone marrow and in approximately seven to ten days begin to grow.


Why is there so much emphasis on nutrition?

Good nutrition will be especially important for the patient throughout the transplant process. A high-calorie, high-protein diet is encouraged. This diet will help withstand the side effects from treatments, help maintain strength, and prevent muscle and other body tissues from breaking down while rebuilding normal tissue affected by the treatment.


What kind of support can I expect from the transplant team?

Our approach is a team approach. During the transplant process the patient will have abundant access to the following resources: professional individual and/or family support counseling, volunteer peer counseling from other transplant recipients, support groups, resource books, video and audio tapes.


How do I know if I am a candidate for transplant?

Whether or not you are a transplant candidate requires a process involving very detailed information about your disease, what therapies you have received and how your disease has responded to previous treatments. The patient’s personal physician is required to play an important role in their care before and after transplantation. Their doctor will discuss your disease history with the transplant doctor before the patient’s initial visit.


Will my insurance pay for a bone marrow or stem cell transplant?

At the time that the patient is referred to the transplant program, a financial coordinator will verify the patient’s transplant benefits with their insurance company. Confirmation of the patient’s insurance is essential and must be completed prior to beginning the transplant process. Insurance coverage for the transplant and related services is dependent on the patient’s individual insurance policy. The financial coordinator will work closely with the patient to ensure that all transplant benefits are maximized. The insurance clearance process typically happens quickly upon referral, but in some instances could take a couple of weeks depending on the responsiveness of the insurance company to the requests for information. Do not assume that the insurance company will pay for a transplant. Also, if the insurance company initially denies coverage for any reason, there may be an appeal process available to overrule the initial decision.


What kinds of insurance does Methodist accept?

The transplant program is a Medicare and Medicaid provider. In addition, it is contracted for transplant services with almost every major insurance carrier. If Methodist is not contracted with a particular insurance company, they will work quickly to try and put an arrangement together in order for the patient to be treated in the clinic.


What types of charges should I expect?

You will incur separate bills for hospital and physician services. All of the doctors who treat you are independent contractors who bill for their services separately from the hospital. The transplant clinic is a hospital-based clinic; therefore you will receive a hospital outpatient bill for each time you are seen in the clinic. The financial coordinator and social worker will help the patient and their family becomes aware of what charges to expect and at what time during the process.


What is a clinical trial?

A clinical trial is a research study which involves cancer patients. Each study is specially designed to answer specific questions or to find new and better ways to help cancer patients. Advances in the treatment of cancer are the result of the new ideas developed from research. Many of the standard treatments used today are the result of clinical trials conducted years ago.


Are clinical trials safe?

Extensive testing is completed before a drug is used in a clinical trial. This testing happens in laboratories and in animal studies. The best results from this testing are then tried in patients before these drugs are available for use outside the clinical trial setting. Each clinical trial is carefully supervised, monitored and documented by both physicians and nurses involved in the trial. Each clinical trial is also supervised by the Institutional Review Board whose membership consists of clinical experts and laypersons.


Are there risks associated with clinical trials?

Yes. There are risks and potential side effects. Cancer treatment is particularly powerful because it is designed to destroy cancer cells. A clinical trial is a tool used to investigate new areas of cancer treatment. The risks and side effects are not always known ahead of time. Researchers are continually trying to develop treatments that destroy cancer cells but do not harm healthy cells and which may have few side effects. Although every effort has been made to identify the potential risks and side effects prior to a patient’s participation, the possibility of unknown danger, side effects and still remain.


Who is eligible to participate in a clinical trial?

Each study has its own guidelines for who can participate. Generally, participants are alike in key ways such as the type and stage of cancer. The patient’s physician will determine whether or not they are a candidate for a research trial.

Heart Failure and Transplant

ACE (angiotensin converting enzyme) inhibitors - A type of heart failure medication that works by preventing the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure. In large-scale studies, ACE inhibitors have been proven to slow the progression of heart failure.

Advance Directive - A written document that states a person's healthcare choices and names someone to make those choices, should the person become unable to make their own decisions about medical care. The most common types of Advance Directives are a living will and a durable power of attorney for healthcare.

Anemia - A reduction in the amount of oxygen-carrying red blood cells. Anemia can have many causes, but the most common is a lack of iron in the body. Also known as iron-poor blood.

Angiography - An X-ray test used to detect diseases of the blood vessels, such as weakening of the vessel walls and the narrowing or blocking of vessels. The X-ray is taken after the vessels have been injected with a substance that allows them to be seen on film.

Angioplasty - A procedure that reopens blocked blood vessels to the heart. A physician inserts a hollow needle (catheter) into the diseased artery and pushes a small deflated balloon into the blocked section. Then the physician inflates the balloon to widen the artery.

Angiotensin II receptor blocker - A medication that blocks the action of a special chemical called angiotensin, which normally raises the heart rate and blood pressure.

Arrhythmia - An abnormal rhythm or rate of the heartbeat caused by disturbances in the movement of electrical impulses through the heart.

Atrial fibrillation - Rapid, uneven contractions in the upper heart chambers (atria), which cause the lower chambers (ventricles) to beat irregularly.

Atrium - One of the two upper chambers of the heart.

Beta blockers - Medications that reduce the heart's tendency to beat faster by blocking specific receptors ("beta receptors") on the cells that make up the heart.

Blood thinners - Medications, such as warfarin and heparin, used to prevent blood clotting. Some people with heart failure are prescribed blood thinners to reduce the risk of stroke.

Calcium channel blocker - A drug that prevents calcium from entering the heart's muscle cells. This causes the muscles to relax, lowering the heart rate.

Cardiac rehabilitation - A supervised program of increasing exercise, mental support and training to allow a person with a heart condition to resume normal activities.

Cardiologist - A doctor who diagnoses and treats heart problems.

Cardiomyopathy - Any weakening or deformity of the heart muscle that causes decreased pumping force. This leads to less-efficient circulation of blood through the lungs and the rest of the body.

Cardiomyoplasty - An investigational surgical treatment for heart failure that involves taking muscles from the person's back or abdomen and wrapping them around the heart. Its goal is to increase the heart's pumping power.

Caregiver - Anyone who helps a chronically ill patient cope with an illness. Caregivers can be home healthcare workers, family members or friends. They assist in many ways, from making sure patients take their medications properly to helping out with day-to-day activities.

Chronic illness - An illness or condition that develops slowly and persists for a long time. Heart failure is almost always a chronic illness.

Congenital heart disease - Any heart condition or abnormality that a person was born with.

Congestive heart failure - A common form of heart failure that results in a patient retaining excessive fluid, often leading to swelling of the legs and ankles and congestion in the lungs.

Coronary artery bypass - A procedure used to reroute the blood supply around a blocked section of a coronary artery. Surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. Then they surgically attach the vessels to the diseased artery to let the blood flow around the blocked section.

Coronary artery disease - A condition caused by thickening of the walls of the arteries that supply blood to the heart muscle. When these arteries become blocked, the heart is deprived of oxygen and can become damaged. Severe cases can result in heart attack.

Defibrillator - A device that delivers pacing or an electric counter shock to the heart when an abnormal rhythm is detected. A surgically implantable version is called a pacemaker.

Diabetes - A condition in which the body doesn't produce the right amount of insulin, the hormone that allows cells to absorb glucose (sugar) from the bloodstream. Some people with diabetes must inject themselves with insulin every day to maintain a healthy glucose level. Others are able to control the condition with pills or a special diet.

Diastolic pressure - The pressure of blood inside arteries when the heart is at rest. This is the bottom number in a blood pressure reading.

Digoxin (or digitalis) - A medication that increases the force of the heart's contractions and slows certain types of irregular heartbeats (arrhythmia).

Diuretic - A medication that promotes the formation and release of urine. It helps to reduce fluid overload in people with heart failure. Also called a water pill.

Drug interaction - A change in the effect of a drug when taken with a certain other drug or food. Its effect may increase or decrease, or a side effect may occur.

Dyspnea - Difficult or labored breathing, often caused by heart conditions.

Dysrhythmia - A disturbance in heart rhythm, sometimes used as an alternative to the term "arrhythmia."

Echocardiography - A test that obtains an image of the structure and motion of the heart using ultrasound (inaudible, high-frequency sound waves). Used to detect cardiomyopathy and other abnormalities of the heart wall, valves and large blood vessels.

Edema - An abnormal accumulation of fluid in body tissues. Edema is common in the legs, ankles and lungs of people with heart failure.

Ejection fraction - The amount of blood released during each contraction of the lower ventricle of the heart. It's usually expressed as a percentage: an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is expelled with each heartbeat.

Electrocardiogram (EKG or ECG) - A record of the electrical activity of the heart, allowing diagnosis of abnormal heart conditions.

Endocarditis - Inflammation of the lining of the heart and the heart valves, usually due to bacterial infection.

Heart attack - Sudden death of a portion of the heart muscle caused by a sudden decrease in blood supply to that area. Also known as myocardial infarction or MI.

Heart disease, ischemic - The most prevalent form of heart disease, in which narrowed or blocked coronary arteries result in decreased blood supply.

Heart failure - The inability of the heart to keep up with its workload. When someone has this condition, their heart can't pump enough blood to the lungs and the rest of the body. Heart failure is often a chronic condition that can be treated with medications, diet and other lifestyle changes, and in some cases, surgery.

Heart transplant - Surgery that replaces a damaged heart with a healthy heart taken from a donor who has been declared brain dead.

Heart valve - One of the four structures in the heart that control the flow of blood by opening and closing with each heartbeat. The valves permit blood to flow in only one direction.

Hypertension - The medical term for abnormally high blood pressure.

Hyperthyroidism - Over activity of the thyroid gland, leading to overproduction of thyroid hormones. It can make the body's metabolism overactive, leading to symptoms such as weight loss and rapid heart rate.

Hypotension - Abnormally low blood pressure.

Left-ventricular assist device - A mechanical pump used to aid the natural pumping action of the heart's left ventricle.

Left-ventricular heart failure - Heart failure in which the left side of the heart must work harder to pump the same amount of blood. This type of heart failure usually causes breathing difficulties.

MUGA (Multigated Acquisition) - A test in which a radioactive tracer is injected into the bloodstream and scanned as it passes through the heart. A computer then calculates the size and shape of a patient's ventricles based on the amount and distribution of radiation they emit.

Myocardial infarction - Sudden death of a portion of the heart muscle caused by a sudden decrease in blood supply to that area. (see Heart attack)

Myocarditis - Inflammation of the heart muscle.

Potassium - A mineral that, together with sodium and calcium, regulates the body's water balance, maintains normal heart rhythm, and is responsible for nerve impulse conduction and muscle contraction.

Primary care doctor - A general internist or family physician who provides patients with routine preventive healthcare and is their first contact when medical problems arise.

Pulmonary edema - Fluid in lung tissues, often caused by congestive heart failure.

Right-ventricular heart failure - Heart failure caused by damage to the right-side chambers of the heart, leading to decreased blood flow, and swelling in the hands, legs and abdomen.

Side effect - Any reaction that results from a medication or therapy. Heart failure medications can cause side effects such as headaches, nausea, dizziness, kidney complications and low blood pressure.

Sodium - A mineral that, together with potassium and calcium, regulates the body's water balance, maintains normal heart rhythm, and is responsible for nerve impulse conduction and muscle contraction. Excessive intake of sodium from food contributes to high blood pressure in some people. In people who already have high blood pressure, too much sodium may increase the risk of stroke, heart disease and kidney damage.

Stress test - An exercise test that examines how well the heart works. Patients are asked to walk on a treadmill to increase their heart rate. During the test, a doctor monitors electrocardiogram (ECG or EKG) readings from the heart to check for any heart rhythm irregularities.

Systolic pressure - The pressure of blood inside arteries when the heart contracts. This is the top number in a blood pressure reading.

Vaccine - Weakened or dead germs, given by injection, that protect against infectious disease. People with heart failure should receive a yearly influenza vaccine and a one-time pneumococcal vaccine (to guard against pneumonia).

Valve replacement - Surgery to replace a defective or diseased heart valve.

Vasoconstriction - A narrowing of a blood vessel, causing decreased blood flow to a part of the body.

Vasodilator - A medication that causes widening or relaxation of blood vessel walls. Examples include ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, natriuretic peptides and nitrates.

Ventricle - One of the two lower chambers of the heart that receive blood from the atria (upper chambers). The right ventricle pumps blood to the lungs and the left ventricle pumps blood to the rest of the body.

What is transplantation?

Transplantation is the act of surgically removing an organ from one person and placing it into another person. Transplantation becomes necessary when the recipient's organ has failed or has been damaged through illness or injury.


Which organs can be transplanted?

  • Liver
  • Kidney
  • Pancreas
  • Kidney/Pancreas (can be transplanted at the same time)
  • Heart
  • Lung
  • Heart/Lung (can be transplanted at the same time)
  • Intestine

What questions should I ask about the cost of transplantation?

  • What part of the transplant cost is covered by my insurance?
  • How much will I have to pay?
  • What happens if my financial coverage runs out?
  • Who are the members of the transplant team and what are their jobs?
  • Who will tell me about the transplant process?
  • Is there a special nursing unit for transplant patients?
  • Can I tour the transplant center?
  • Will I be asked to take part in research studies?
  • Does the hospital do living donor transplants?
  • If a living donor transplant is a choice in my case, where will the living donor evaluation be done?

Do transplant hospitals in the U.S. only perform transplants on U.S. citizens?

No. Patients from other countries may travel here to receive transplants. Once accepted by a UNOS transplant center, international patients receive organs based on the same policies as U.S. citizens.


What factors are considered in organ matching and allocation?

Many different medical and logistical characteristics are considered for an organ to be distributed to the best-matched potential recipient. While the specific criteria differ for various organs, matching criteria generally include:

  • Blood type and size of the organ(s) needed
  • Time spent awaiting a transplant
  • The distance between donor and recipient

For certain organs other factors are vital, including:

  • The medical urgency of the recipient
  • The degree of immune-system match between donor and recipient
  • Whether the recipient is a child or an adult

How does the matching process work?

  • An organ is donated. When the organ becomes available, the Organ Procurement Organization (OPO) managing the donor sends information to the (United Network for Organ Sharing (UNOS). The OPO procurement team reports medical and genetic information, including organ size, and condition, blood type and tissue type.
  • UNOS generates a list of potential recipients. The UNOS computer generates a list of potential transplant candidates who have medical and biologic profiles compatible with the donor. The computer ranks candidates by this biologic information, as well as clinical characteristics and time spent on the waiting list.
  • The Transplant Center is notified of an available organ. Organ placement specialists at the OPO or the UNOS Organ Center contact the centers whose patients appear on the local list.
  • The Transplant Team considers the organ for the patient. When the team is offered an organ, it bases its acceptance or refusal of the organ upon established medical criteria, organ condition, candidate condition, patient availability, and organ transportation. By policy, the transplant team has only one hour to make its decision.
  • The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

How do I get on the waiting list?

To get on the national waiting list, the following must take place:

  • Receive a referral for transplant evaluation from your physician.
  • Contact a transplant hospital.
  • Schedule an appointment for evaluation to determine if you are a good candidate for transplant.
  • During the evaluation, ask questions to learn as much as possible about that hospital and its transplant team.
  • The hospital's transplant team will decide whether you are a good transplant candidate. If after evaluation, the transplant team determines that you are a good transplant candidate, they will add you to the national waiting list.

How long will I have to wait?

There is no set amount of time, and there is no way to know how long, a patient must wait to receive a donor organ. Factors that affect waiting times are patient medical status, and the level of match between the donor and recipient.


How are organs distributed?

The organs are distributed locally first, and if no match is found they are then offered regionally, and then nationally, until a recipient is found. Every attempt is made to place donor organs.

Kidney Transplant

Absorption - the degree and pace at which a drug enters the bloodstream from the small intestine

Acute Tubular Necrosis (ATN) - reversible kidney damage resulting in delayed kidney function

Allocation - The process of determining how organs are distributed. Allocation includes the system of policies and guidelines, which ensure that organs are distributed in an equitable, ethical and medically sound manner.

Allograft - a graft between two individuals who are of the same species (i.e. human) but have genetic differences

Anemic - low red blood cell count

Antacid - a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort

Antibody - a protein produced by the body to eliminate foreign substances, such as bacteria

Anti-rejection Drugs - see immunosuppressants

Antigen - a substance that triggers an immune response. This response may be the production of antibodies which try to inactivate or destroy the antigen of a transplanted organ

Arteriogram (angiogram) - an x-ray of the arteries taken with the aid of a dye

Atherosclerosis - a build up of fats in the lining of the arteries that may interfere with the flow of blood

Bacteria - small germs that can cause disease

Biopsy - the removal and examination of tissue sampling for diagnosis

Bladder - the part of the urinary tract that receives urine from the kidneys and stores it until urination

BUN (blood urea nitrogen) - a waste product normally excreted by the kidney. BUN values represent how well the kidneys function

Cadaveric Donor - an individual who has recently died of causes that do not affect the function of an organ to be transplanted

Cardiac Catheterization - a procedure in which a small tube is guided through a vein or an artery into the right or left side of the heart to check the function of the heart and the coronary arteries

Cardiologist - doctor who studies and treats diseases of the heart

Catheter - a tube, generally small and flexible, inserted into the body, to infuse medications, monitor organ function and drain fluid

Cellcept® - an immunosuppressive drug used to prevent the rejection of the transplanted organ. Also known by its chemical name myophenolate mofetil

Cholesterol - fat substance found in animal meats, dairy products and produced by the liver. A high level of cholesterol in the blood is a risk factor for developing heart disease.

Coagulation - blood clotting

Corticosteroids - a category of immunosuppressive medications that includes prednisone and prednisolone

Creatinine - a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function

Crossmatch - a test in which donor and recipient blood samples are mixed together. A "positive" crossmatch shows the donor and recipient are incompatible. A "negative" crossmatch shows there is no reaction between the donor and the recipient which means that the donor and recipient are compatible and the transplant may proceed.

Cyclosporine - drug that helps keep the body from rejecting a transplanted organ. Brand names include Neoral® and Gengraf®

Detoxify - to change a harmful substance into a safer form

Diabetes - a disease in which patients have high levels of sugar in their blood

Dialysis - the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed.

Diastolic - the bottom of two blood pressure numbers which measures blood pressure in the arteries when the heart is at rest

Donor - person who gives an organ to be transplanted in another person

Echocardiogram - a diagnostic test that uses reflected sound wave (ultrasound) to see images of the heart, and provides information regarding the heart’s structure and function

Edema - excess fluid in body tissues caused by fluid leaking from blood vessels

Electrocardiogram - a recording of the electrical activity of the heart

Electrolyte - refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc.

Enzyme - a protein made in the body and capable of changing a substance from one form to another

Fluid Retention - condition in which the body stores excess fluid

Gastroenterologist - a physician who specializes in the care of the digestive tract

Glucose - a type of sugar found in the blood

Graft - a transplanted organ or tissue

Hemodialysis - a method of dialysis in which blood is purified by circulating through an machine outside the body

Histocompatibility - the examination of antigens in a patient often referred to as "tissue typing" or "genetic matching". Tissue typing is routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients in an effort to decrease rejection of the transplanted organ.

High Blood Pressure or Hypertension - Occurs when the force of the blood pushing against the walls of the blood vessels is higher than normal because the blood vessels have either become less elastic or have gotten smaller. Hypertension causes the heart to pump harder to move blood through the body. It can cause kidney failure and heart disease if not treated.

Immune Response - any defensive reaction to foreign material by the immune system

Immune System - the body’s natural defense system against foreign substances such as viruses, bacteria, some types of cancers, and transplanted organs or tissue

Immunosuppressive agents - drugs that help treat or prevent the immune system from rejecting an organ or tissue transplant

Imuran® - an immunosuppressive drug used to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine

Incompatible - no match or similarity between donor or recipient blood type or organs

Insulin - substance produced by the pancreas that helps the body absorb blood sugar from the blood into cells to produce energy

IV (Intravenous) - refers to giving medicines or fluids directly through a vein

IV Catheter - a small needle with a hollow tube inserted into a vein and used to give medicines or fluids

Kidney - one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. Their function is to remove the body’s waste materials and maintain fluid balance through the production of urine

Lab Draw - process of taking blood or urine for laboratory analysis

Living Related Donor (LRD) - a blood relative who donates an organ

Match - the compatibility between recipient and donor; the closer the match between the donor and recipient, the greater potential for a successful transplant

Nephrologist - a physician who studies the kidney and treats kidney disease

Non-compliance - failure of patients to follow the instructions and recommendations of their medical team, such as not taking medicine as prescribed or not showing up for clinic visits

Organ Preservation - methods used to preserve organs while they are out of a donor’s body and to be transplanted to a recipient.

Organ Procurement and Transplantation Network (OPTN) - The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. Administered by UNOS (United Network Organ Sharing), it provides a unique public-private partnership that links all of the professionals involved in the donation and transplantation system.

Organ Procurement Organization (OPO) - An organization designated by the Centers for Medicare and Medicaid Services (CMS) that is responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation

Organ Rejection - an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence

Panel Reactive Antibody (PRA) - a way of measuring the immune system activity within the body; PRA is higher when more antibodies are being made

Potassium - a mineral essential for body function

Prednisone - medication used to limit rejection; taken by recipients of a transplanted organ or tissue

Prograf® - See tacrolimus

Psychiatrist - physician who diagnoses and treats mental disorders

Rapamycin (Rapamune®) - medicine that belongs to a group of medicines known as immunosuppressive agents used to lower the body's natural immunity and prevent organ rejection in patients who receive kidney transplants

Rejection - an immune response against grafted tissue in which a recipient’s body rejects tissue or organ transferred from a donor

Shingles - a herpes virus infection that usually affects a nerve, causing pain in one area of the body

Sodium - a component of table salt (sodium chloride); an electrolyte that is the main salt in blood

Status - indicates the degree of medical urgency for patients awaiting heart or liver transplants

Survival Rates - indicate how many patients or grafts (transplanted organs) are alive or functioning at a set time post transplant

Systolic - the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers

Tacrolimus - a drug the helps keep the body from rejecting a transplanted organ. Brand name is Prograf®

Thrush - a fungus infection in the mouth

Triglycerides - a form of fat that the body makes from sugar, alcohol, and excess calories

Tissue Typing - a blood test performed prior to transplantation to evaluate the closeness of tissue match between the donor and recipient

Ultrasound - device that uses ultrasonic waves to outline the shape of various tissues and organs of the body

UNOS (United Network for Organ Sharing) a national agency that maintains a national computerized transplant waiting list and helps locate donor organs

Urethra - a tube that drains urine from the bladder to the outside

Ureters - tubes that drain urine from the kidneys to the bladder

Urinary Tract Infection (UTI) - an infection of one or more parts of the urinary tract

Virus - a germ that causes infection

Waiting List - After a patient has concluded evaluation by the transplant physician, he/she is added by the transplant center to a national waiting list. Lists are specific to both geographic area and organ type. Each time a donor organ becomes available, UNOS generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency, and time a patient has been on the waiting list

What are the advantages of a kidney transplant compared to dialysis?

The most important advantages are that your overall quality of life improves significantly after a kidney transplant and typically you will live a longer and healthier life following a transplant. Taking transplant medications are much less time consuming than being on dialysis three times week or even doing peritoneal dialysis at home or doing at-home hemodialysis. All of those are very time consuming.

Generally, we find patients have better energy and a better appetite when they have a kidney transplant. There are very few dietary restrictions when you have a kidney transplant versus dialysis. You have more time available for your family. It’s easier to maintain a job and you have more time available for travel. Patients on dialysis and with kidney transplant are at higher risk of heart disease. But that risk goes down significantly with a kidney transplant.

Presented by Dr. Melissa Isbell, nephrologist with Renal Associates and a former Chief of Staff at Methodist Specialty and Transplant Hospital.


How do I qualify for a kidney transplant?

To receive a kidney transplant there are several requirements that need to be met. And these are requirements that are established nationally and by our program. At the Texas Transplant Institute, we help patients through every step of the process to ensure they are a good candidate for kidney transplantation and have great results.

Presented by Dr. Melissa Isbell, nephrologist with Renal Associates and a former Chief of Staff at Methodist Specialty and Transplant Hospital.


What are the advantages of live donor transplantation?

There is little doubt that transplantation is the preferred method for treatment for failing kidneys. Dialysis helps patients survive, however, people get sick very quickly on dialysis. With a kidney transplant people can live longer and healthier.

Presented by Matt Kapturczak, M.D., physician with the San Antonio Kidney Disease Center, medical director of the kidney and pancreas transplant program at the Texas Transplant Institute and vice chief of staff at Methodist Specialty and Transplant Hospital.


How do I approach someone about being a kidney transplant donor?

Approaching a friend or family member about donating a kidney can be very difficult. A living kidney donation is a precious gift that only the donor can decide in their heart of hearts to help somebody and to improve and prolong their life.

Presented by Matt Kapturczak, M.D., physician with the San Antonio Kidney Disease Center, medical director of the kidney and pancreas transplant program at Texas Transplant Institute and vice chief of staff at Methodist Specialty and Transplant Hospital.


How does the kidney waitlist work?

The patient needs to work very closely with their nephrologist and primary care providers. They need to make sure they are up to date on their age-appropriate cancer screening tests including colonoscopy, PSA, mammogram, chest X-rays, etc. If there is any change in the patient’s health status, it’s important to notify the folks at the Texas Transplant Institute immediately.

Presented by Irfan Agha, M.D., transplant nephrologist at the Texas Transplant Institute.


What do you recommend for patients who are waiting for a transplant off the list?

We encourage patients to identify a living donor from among their family, friends and social circle. If you have a live donor, a transplant can sometimes happen very quickly. If an appropriate live donor is not available, then the patient will have to wait for an appropriate deceased donor to become available.

Presented by Irfan Agha, M.D., transplant nephrologist at the Texas Transplant Institute.


Is it safe to donate a kidney to someone?

We have complete processes in place to ensure the safety of each donor. The donor evaluation includes a thorough work up that includes medical, surgical and psychological evaluations. Because of this comprehensive work up, we are able to eliminate high risk donors and include the only donors who meet the requirements.

Presented by Fadi Abouzahr, M.D., nephrologist at the Texas Transplant Institute.


What is the evaluation process to qualify to donate a kidney?

A potential kidney donor must be 18 years old or older and able to consent for themselves. They should be free of any active medical disease.

Presented by Fadi Abouzahr, M.D., nephrologist at the Texas Transplant Institute.


What types of medication are needed after a kidney transplant?

Medications after your transplant can be summed up fairly simply: two medications, twice a day is what most of our patients end up on.

Presented by Francis Wright, M.D., transplant surgeon at Texas Transplant Institute.


What is the usual follow-up after a kidney transplant?

Your follow-up after a kidney transplant is a team effort. You’re part of the team. We depend on you to let us know if there are any problems and to be part of your follow-up care. The other members of the team are the entire transplant team here.

Presented by Francis Wright, M.D., transplant surgeon at Texas Transplant Institute.


What function does a kidney serve?

The function of a kidney is to filter the blood in our body. What this kidney does, it filters the toxins that our body creates from the byproducts of our metabolism and so forth.

Presented by Luke Shen, M.D., transplant surgeon at Texas Transplant Institute.


What happens during a kidney donor’s surgery?

The kidney donor surgery is a safe operation. We do it through a laparoscopic technique using a small incision to take the kidney out safely.

Presented by Luke Shen, M.D., transplant surgeon at Texas Transplant Institute.


What is the recovery process for a kidney donor?

The recovery period for a living donor surgery is rather short. Most patients stay in the hospital one to two nights. The pain level is usually described as being comparable to doing a lot of stomach sit ups.

Presented by Luke Shen, M.D., transplant surgeon at Texas Transplant Institute.


What follow up is required for a kidney donor?

We like to see donors back in the clinic about two to three weeks after surgery. After that we would like for them to come back to the clinic at six months, 12 months and two years for follow-up visits. These follow-up visits require us to examine the incisions that we made as well as get laboratory studies to ensure their kidney function remains stable and within normal limits.

Presented by Luke Shen, M.D., transplant surgeon at Texas Transplant Institute.


What is the history of Methodist Specialty and Transplant Hospital’s transplant program?

The history of the program dates back more than 30 years. It was set up by nephrologists and urologists who performed the kidney transplants. Up to 2014, the program has now done nearly 4,000 kidney transplants including nearly 2,000 live donor kidney transplants. The program has really taken off over the years. It’s always been set up as a regional program. About half of our patients come from San Antonio and the other half come from outside San Antonio.

Presented by Adam Bingaman, M.D., Ph.D., transplant surgeon and director of the abdominal transplant program at Texas Transplant Institute.


What sets Methodist Specialty and Transplant Hospital’s kidney transplant program apart from other programs?

In the United States there are about 250 kidney transplant programs. The biggest live donor kidney program is right here at Methodist Specialty and Transplant Hospital in San Antonio. We have developed a program built on four pillars and that is the key to our success. The first pillar is our people.

Presented by Adam Bingaman, M.D., Ph.D., transplant surgeon and director of the abdominal transplant program at Texas Transplant Institute.


What if a kidney donor and recipient are not a match?

Unfortunately, statistically, there’s at least a one in three chance that two random people will not be a match… We formed a dedicated team to address this exact issue. We meet once a week to work on finding matches for patients with willing donors. This team has grown to become the biggest single center program in the United States doing these exchange transplants. In other words, finding a situation where you’re not a match with your donor so maybe somebody else’s donor can match you and your donor can match somebody else.

Presented by Adam Bingaman, M.D., Ph.D., transplant surgeon and director of the abdominal transplant program at Texas Transplant Institute.


What is the most gratifying part of your profession?

Everybody working at the Texas Transplant Institute at Methodist Specialty and Transplant Hospital has a true passion for transplant. We’re here because we want to be here. We’re here because transplant gets us up in the morning… It’s rewarding to be part of a field that can give people their lives back.

Presented by Adam Bingaman, M.D., Ph.D., transplant surgeon and director of the abdominal transplant program at Texas Transplant Institute.


Will I feel better after a kidney transplant?

Undergoing kidney transplantation will help restore kidney function thus eliminating the need for dialysis. Most patients recover strength, and energy, and are expected to be able to live twice as long, as compared to remaining on dialysis.


How will I be evaluated as a kidney transplant recipient?

The process begins with a referral from your physician. Our transplant specialists review your medical records, and contact you and your physician to inform you of expectations and schedule a half-day appointment for a pre-transplant evaluation.


What is the process to find a donated kidney?

After you have completed the evaluation process by the transplant team, and a decision has been made that you are a good candidate for transplantation, your name is added to the UNOS national donor waiting list. There are two options for obtaining a kidney: from deceased donors or from a live donor. The average wait for a deceased donor kidney is 4 to 6 years. A living donor is the ideal choice as it expedites the waiting period. A living donor can be related or non-related and must undergo compatibility tests to ensure there is a match.


What is the length of a hospital stay after a kidney transplant?

The average hospital stay for a kidney transplant is seven days, but it varies for each patient.


Will I have to go back to the hospital after transplant?

Organ rejection is a concern after transplant. Transplant patients have a schedule of necessary follow-up visits with the transplant team which will include clinic and hospital visits.


How safe is the donor operation?

Our experience with living donors is greater than any other Texas program. Most donor operations are now done with laparoscopic techniques which speed recovery of the donor. Typically, donors return to normal activities within a few weeks.


Will I be on medications for a long time after the transplant?

Transplant patients generally start out with six to eight medications in addition to their anti-rejection medications. By six months, they generally take two to three per day. Eventually, patients are required to take only their anti-rejection medication for the rest of their life.


Will insurance pay for the transplant surgery and medications?

If a kidney transplant is medically necessary, the patient’s health insurance covers the majority of the costs.


What organization oversees transplant centers?

The United Network for Organ Sharing (UNOS) is contracted by the federal government to administer the deceased donor organ waiting list, as well as collect data regarding patient outcomes for transplant centers.

Liver Disease and Transplant

Absorption - the degree and pace at which a drug enters the bloodstream from the small intestine

Acute Tubular Necrosis (ATN) - reversible kidney damage resulting in delayed kidney function

Alkaline Phosphatase - an enzyme produced by liver cells; elevated blood levels of this substance may indicate abnormal function of the liver or other organs

Allograft - a graft between two individuals who are of the same species (ie. human) but have genetic differences

Antacid - a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort

Antibody - a protein produced by the body to eliminate foreign substances, such as bacteria

Anesthetic - medication that reduces pain by reducing sensation

Arteriogram - an x-ray of the arteries taken with the aid of a dye

Ascites - excess fluid in the abdomen

Atherosclerosis - a build up of fats in the lining of the arteries that may interfere with the flow of blood

B Cell - a specialized white blood cell responsible for the body's immunity

Bacteria - small germs that can cause disease

Biliary Stenosis - narrowing or constriction of a bile duct

Biliary Tree - all passageways inside and outside the liver that carry bile to the intestines

Bile - a fluid produced by the liver, stored in the gallbladder, and released into the small intestine to help absorb dietary fats

Bile Ducts - the tubes through which bile flows

Bile Leak - a hole in the bile-duct system that causes bile to spill into the abdominal cavity

Bilirubin - a substance in bile, orange in color, produced by the breakdown of red blood cells

Bio Availability - a measure of how much of an administered drug is absorbed into the bloodstream, actually reaching the intended site of action in the body

Biopsy - the removal and examination of tissue sampling for diagnosis

Bladder - the part of the urinary tract that receives urine from the kidneys and stores it until urination

Blood Urea Nitrogen (BUN) - a waste product normally excreted by the kidney. BUN values represent how well the kidneys function

Brain Death - when the brain has permanently stopped working, as determined by a neurological surgeon, artificial support systems may maintain functions such as heartbeat and respiration for a few days

Bun - see Blood Urea Nitrogen (BUN)

Cadaveric Donor - an individual who has recently died of causes that do not affect the function of an organ to be transplanted

Cellcept® - an immunosuppressive drug used with other immunosuppressants to prevent the rejection of the transplanted organ.

Cholesterol - a form of fat that performs necessary functions in the body but can also cause heart disease; cholesterol is found in animal foods such as meat, fish, poultry, eggs, and dairy products

Cirrhosis - a disease causing irreversible scarring of the liver

Cyclosporine - drug that helps keep the body from rejecting a transplanted organ. Brand names include Neoral® and Gengraf®

CMV (Cytomegalo Virus) - a virus infection that is very common in transplant recipients; it can affect the lungs and other organs as well; a member of the family of herpes viruses

Coagulation - blood clotting

Corticosteroids - a category of immunosuppressive medications that includes prednisone and prednislone

Creatinine - a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function

Detoxify - to change a harmful substance into a safer form

Diabetes - a disease in which patients have high levels of sugar in their blood

Dialysis - the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed

Diastolic - the bottom of two blood pressure numbers which measures blood pressure when the heart is at rest

Diuretic - a drug that removes water from the body by promoting urine formation and the loss if salt

Edema - excess fluid in body tissues; Example: swelling of the ankles

Electrocardiogram - a recording of the electrical activity of the heart

Electrolyte - refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc.

Encephalopathy - changes in mental function that develops when the liver cannot filter poisons from the bloodstream

Enzyme - a protein made in the body and capable of changing a substance from one form to another

Fibrosis - formation of excess fibrous connective tissue in an organ; fibrosis of the liver can lead to cirrhosis

Gallbladder - a muscular sac attached to the liver; it stores bile

Gastroenterologist - a physician who specializes in the care of the digestive tract

Glucose - a type of sugar found in the blood

Graft – a transplanted organ or tissue

Graft Survival - when a transplanted tissue or organ is accepted by the body and functions properly

Helper T Cell - the specialized white blood cell that tells other parts of the immune system to combat infection or foreign material

Hematocrit - a measure of the red-blood-cell content of blood

Hemochromatosis - a condition that develops when too much iron builds up in the body

Hemodialysis - a method of dialysis in which blood is purified by circulating through an apparatus outside the body

Hepatic - relating to the liver

Hepatitis - inflammation of the liver

Hepatocellular Carcinoma - liver cancer

Hepatologist - a physician who studies the liver and treats liver disease

Hepatomegaly - an enlarged liver

Hepatorenal Syndrome - Kidney failure that occurs in cases of advanced liver disease secondary to cirrhosis

Herpes - a family of viruses that infect humans; herpes simplex causes lip and genital sores; herpes zoster causes shingles

Histocompatibility - the examination of antigens in a patient, often referred to as "tissue typing" or "genetic matching". Tissue typing is routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients. This helps to decrease the likelihood of "rejecting" the transplanted organ

High Blood Pressure or Hypertension - Occurs when the force of the blood pushing against the walls of the blood vessels is higher than normal because the blood vessels have either become less elastic or have gotten smaller. Hypertension causes the heart to pump harder to move blood through the body. It can cause kidney failure and heart disease if not treated

Immune Response - any defensive reaction to foreign material by the immune system

Immune System - the body’s natural defense system against foreign substances, such as bacteria, viruses, some types of cancers, and transplanted organs or tissues

Immunosuppressive Agents - medications given to prevent rejection of a transplanted organ or tissue

Imuran® - an immunosuppressive drug used to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine

IV or Intravenous - refers to giving medicines or fluids directly through a vein

IV Catheter - a small needle with a hollow tube inserted into a vein and used to give medicines or fluids

Jaundice - yellowing of the skin and eyes caused by excess bile products in the blood

Kidney - one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. They function is to remove the body’s waste materials and maintain fluid balance through the production of urine

Liver Enzymes - substances produced by the liver and released into the blood; enzymes are measured to assess liver function

Living-Related Donor (LRD) - a blood relative who donates an organ

Match - the compatibility between recipient and donor; the closer the match between donor and recipient, the greater potential for a successful transplant

Microemulsion - a suspension or mixture of tiny droplets of one liquid in a second liquid, such as the smooth mixture that is formed when Neoral® (cyclosporine capsules and oral solution for micro emulsion) combines with fluids in the digestive system

Nephrologist - a physician who studies the kidney and treats kidney disease

Neutrophil - a type of white blood cell

Non-Alcoholic Steatohepatitis (NASH) - inflammation of the liver caused by a build up of fat in liver cells

Non-Compliance - failure of patients to follow the instructions and recommendations of their medical team, such as not taking medicine as prescribed or not showing up for clinic visits

Orally - by mouth

Organ Preservation - methods used to preserve organs while they are out of a donor’s body to be transplanted to a recipient

Organ Procurement and Transplantation Network (OPTN) - The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. Administered by UNOS (United Network Organ Sharing), it provides a unique public-private partnership that links all of the professionals involved in the donation and transplantation system

Organ Procurement Organization (OPO) - An organization designated by the Centers for Medicare and Medicaid Services (CMS) that is responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation

Organ Rejection - an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted liver)

Paracentesis - a procedure in which a small needle is inserted through the abdominal wall to remove fluid that has built up in the abdominal cavity

PCP (Pneumocystis Carinii Pneumonia) - a type of pneumonia seen primarily in patients whose immune systems are suppressed

Platelet - a small blood cell needed for normal blood clotting

Portal Hypertension - high blood pressure in the veins that filter blood form the intestines to the liver

Potassium - a mineral essential for body function

Prednisone - a manufactured steroid hormone taken by most transplant recipients of a transplanted organ or tissue to help prevent rejections

Prograf® - See tacrolimus

Psychiatrist - physician who diagnoses and treats mental disorders

Rapamycin (Rapamune®) - medicine that belongs to a group of medicines known as immunosuppressive agents used to lower the body's natural immunity and prevent organ rejection in patients who receive kidney transplants

Rejection - an immune response against grafted tissue in which a recipient’s body rejects tissue or organ transferred from a donor

Renal - refers to the kidney

Sensitized - being immunized, or able to mount an immune response, against an antigen by previous exposure to that antigen

Shingles - a herpes virus infection that usually affects a nerve, causing pain in one area of the body

Sodium - a component of table salt (sodium chloride); an electrolyte that is the main salt in blood

Status - indicates the degree of medical urgency for patients awaiting heart or liver transplants

Survival Rates - indicate how many patients or grafts (transplanted organs) are alive or functioning at a set time post transplant

Systolic - the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers

Tacrolimus - a drug the helps keep the body from rejecting a transplanted organ. Brand name is Prograf®

Thrush - a fungus infection in the mouth

Triglycerides - a form of fat that the body makes from sugar, alcohol, and excess calories

T Cells - a white blood cell responsible for the body's immunity. T cells can destroy cells infected by viruses, graft cells, and other altered cells

T-tube - a tube placed in the bile duct that allows bile to drain into a bag outside the body

Tissue Typing - a blood test performed prior to transplantation to evaluate the closeness of tissue match between the donor and recipient

UNOS (United Network for Organ Sharing) - a national agency that maintains a national computerized transplant waiting list and helps locate donor organs

Urinary Tract Infection (UTI) - an infection of one or more parts of the urinary tract

Varices - enlarged veins in the digestive tract that could bleed

Ventilator - a machine that helps a patient breathe

Virus - a germ that causes infection

Waiting List - After a patient has concluded evaluation by the transplant physician, he/she is added by the transplant center to a national waiting list. Lists are specific to both geographic area and organ type. Each time a donor organ becomes available, UNOS generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency, and time a patient has been on the waiting list

White Blood Cells - cells in the blood that fight infection; part of the immune system

Wilson’s Disease - rare inherited disorder that causes a build-up of copper in the liver and other organs of the body

Which are the most common liver diseases?

In adults, cirrhosis of the liver is one of the most common reasons for which liver transplantation is performed. In children, the disease most often treated by liver transplantation is biliary atresia.


What is the treatment for liver disease?

There are effective medicines used for the treatment and complications of liver diseases. If the liver is not failing, treatment for complications of the liver disease may be all that is required. Frequent medical treatment can delay, but not eliminate, the need for transplantation.


When is liver transplantation a recommendation for treatment?

If medical treatment allows prolonged survival with good quality of life transplantation would be reserved for the future. Ideally transplantation is performed before the terminal stage of the disease when the patient would be too ill to withstand major surgery and would not survive the wait for a suitable donor.


How is the decision for transplant made?

Once the transplant physician determines that transplantation is the most suitable treatment option, the patient undergoes a transplant evaluation by our transplant team in conjunction with the patient’s primary care physician. The patient and family's input is very important in this process and they must clearly understand the risks involved with proceeding to transplantation.


Are there any major risks involved?

With transplantation there are risks common to all forms of major surgery, as well as technical difficulties in removing the diseased liver and implanting the donor liver. One of the major risks for the patient is not having any liver function for a brief period. Immediately after surgery, bleeding, poor function of the grafted liver, and infections are major risks. The patient is carefully monitored for several weeks for signs of rejection of the liver.


What is the recovery time?

This depends on how ill the patient was prior to the surgery. Most patients should plan on spending a 4 to 5 days in the intensive care unit, and about 10 to 12 days in the hospital transplant unit.


What happens during the recovery period?

In the intensive care unit there is very careful monitoring of all body functions including the liver. Once the patient is transferred to the hospital transplant unit, the frequency of blood testing, etc. is decreased, eating is allowed and physical therapy is used to regain muscle strength. Medications to prevent rejection are initially given by vein, but later by mouth. Frequent tests will be done to monitor liver function and detect any evidence of rejection.


If a transplanted liver fails to function or is rejected, what can be done?

A failing transplanted liver can be replaced by a second (or even third) transplant.


Do recipients of liver transplants take medicines to prevent rejection for the rest of their lives?

Yes, however, as the body adjusts to the transplanted liver, the amount of medicine needed to control rejection is reduced.


What is the medical follow-up after transplantation?

Routine follow-up consists of regular blood tests to detect sign of rejection or other complications. You will be scheduled to see your transplant surgeon on a regular basis. You will also need to be followed by your own physician. It is very important to keep all your medical appointments.


Is there a chance of recurrence of the original disease in the new transplanted liver?

If the disease was caused by hepatitis B or C viruses then recurrence is likely. Other types of liver disease do not recur.


Do the donor and the recipient have to be matched by tissue type?

For liver transplants, the only requirements are that the donor and recipient need to be approximately the same size, and of compatible blood types. No other matching is necessary.


What lifestyle changes are necessary after a liver transplant?

Most patients can return to a normal or near-normal lifestyle 6 months to 1 year after a successful liver transplant. When practical, transplant recipients should avoid exposure to people with infections. Maintaining a balanced diet, getting regular exercise and staying on prescribed medications are all important ways to stay healthy.

Pancreas Transplant

Allograft - a graft (organ) from another individual.

Antibody - a protein produced by the body to eliminate foreign substances, such as bacteria

Anti-rejection Drugs - see immunosuppressive agents.

Antigen - a substance that triggers an immune response. This response may be the production of antibodies which try to inactivate or destroy the antigen of a transplanted organ.

Bacteria - small germs that can cause disease.

Biopsy- the removal and examination of tissue sampling for diagnosis.

Chronic hyperglycemia - extended periods of blood glucose levels above normal range.

Diabetes - a disease in which patients have high levels of sugar in their blood

Deceased Donor - an individual who has recently died of causes that do not affect the function of an organ to be transplanted.

Diabetic Lesions - microscopic damage to the kidneys; most often the result of chronic hyperglycemia.

Dialysis - the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed.

Immune Response - any defensive reaction to foreign material by the immune system

Immune System - the body’s natural defense system against foreign substances such as viruses, bacteria, some types of cancers, and transplanted organs or tissue

Immunosuppressive agents - drugs that help treat or prevent the immune system from rejecting an organ or tissue transplant.

Insulin - substance produced by the pancreas that helps the body absorb blood sugar from the blood into cells to produce energy.

No glossary terms available

Non-compliance - failure of patients to follow the instructions and recommendations of their medical team, such as not taking medicine as prescribed or not showing up for clinic visits

Organ Procurement and Transplantation Network (OPTN) - The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. Administered by UNOS (United Network Organ Sharing), it provides a unique public-private partnership that links all of the professionals involved in the donation and transplantation system.

Organ Procurement Organization (OPO) - An organization designated by the Centers for Medicare and Medicaid Services (CMS) that is responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation.

Organ Rejection - an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted kidney).

Pancreas - a small organ, approximately six inches long, located in the upper abdomen and connected to the small intestine. It is an essential organ in the digestive process and it produces insulin.

Pancreas After Kidney Transplant (PAK) - a pancreas transplant that is done after a kidney transplant.

Pancreas Transplant Alone (PTA) - a pancreas transplant without a kidney transplant.

Rejection - an immune response against grafted tissue in which a recipient’s body rejects tissue or organ transferred from a donor.

Simultaneous Pancreas and Kidney Transplant (SPK) - a transplant procedure where both a kidney and the pancreas are transplanted at the same time.

Survival Rates - indicate how many patients or grafts (transplanted organs) are alive or functioning at a set time post transplant.

Type I Diabetes - an autoimmune disease in which the body does not produce any insulin to control an individual’s blood sugar, most often occurring in children and young adults.

Type II Diabetes - a metabolic disorder resulting from the body’s inability to properly use insulin. It often can be controlled with diet, exercise and oral medication or insulin injections.

UNOS (United Network for Organ Sharing) - a national agency that maintains a national computerized transplant waiting list and helps locate donor organs.

Virus - a germ that causes infection.

Waiting List - After a patient has concluded evaluation by the transplant physician, he/she is added by the transplant center to a national waiting list. Lists are specific to both geographic area and organ type. Each time a donor organ becomes available, UNOS generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency, and time a patient has been on the waiting list.

Who qualifies for a pancreas transplant or a combined kidney-pancreas transplant?

The indication for a pancreas transplant is type I insulin dependent diabetes in a patient with a well functioning kidney or transplanted kidney. The indication for a combined kidney-pancreas transplant is type I insulin dependent diabetes with kidney failure.


I have type II insulin dependent diabetes, do I qualify for a pancreas transplant?

Unfortunately not; type II diabetes is caused from insulin resistance, not lack of insulin production. A new pancreas would not provide sufficient insulin production to maintain an insulin-free state.


Will my insurance pay for a pancreas or combined kidney-pancreas transplant?

Private insurance, as well as Medicare and Medicaid, provides coverage for pancreas transplants. However, the costs may not be fully reimbursed. Our financial coordinators can assist you with information and planning.


How long will it take before I don't need insulin?

Typically, you are insulin-free immediately after surgery, but in rare cases it can take 24-48 hours.


How long will I wait for a pancreas transplant?

The waiting list varies according to blood type. The range is three months to two years.


Do I have to continue to have follow-up appointments at the Transplant Center?

Yes. Immediately after transplant you will appointments every two to three months. Visits will be annually after two years.


How long will I be in the hospital?

The average length of stay is 7 to 10 days, but it could be longer.


How long will my organs last?

Each pancreas transplant is different but the overall success rates of pancreas transplant are very good. Average national pancreas graft survival rates are: 90% at one month, 85% at one year, and 70% at five years.


How will I be evaluated as a transplant recipient?

The process begins with a referral from your physician. Our transplant specialists review your medical records, and contact you and your physician to inform you of expectations and schedule a half-day appointment for a pre-transplant evaluation. Following the evaluation, our transplant team makes a recommendation whether to proceed with the transplant process.

Additional Resources