Indications

Liver Transplant
• A liver transplant surgery is conducted to remove the diseased liver and replace it with a healthy liver
donated by either a living or a deceased donor. There are a huge number of people who are listed in the
waiting list for a liver transplant because the availability of donated liver is limited. This is the reason why
a liver transplant is an expensive procedure and is conducted only in rare cases
• Qualifications for Liver Transplant Recipient
• A healthy liver plays an important role in the human body. It plays a key role in absorption and storage of
key nutrients and medications and also helps eliminate bacteria and toxins from the blood.
• However, a healthy liver may get diseased over a period of time due to many reasons. Patients with the
following liver-related conditions are considered for the liver transplant procedure:
• Acute liver failure triggered by drug-induced liver injury among other reasons
• Chronic liver failure or end-stage liver disease due to liver cirrhosis
• Hepatic tumor or cancer
• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease
• Chronic viral hepatitis
• Diseases causing liver failure
Liver Transplant
• Some of the leading reasons that contribute to liver cirrhosis include the
following:
• Diseased bile ducts that carry the bile juice from the liver and small intestine to the gall
bladder
• Hemochromatosis, which is a genetic problem where the liver tends to build up iron
undesirably
• Wilson’s disease wherein the liver accumulates copper by itself
• Biliary atresia in children, a condition wherein an infant is born without the bile ducts or has
the ducts blocked or damaged
• Liver cancers such as cholangiocarcinoma, hepatoblastoma, or hepatocellular carcinoma

• Commonly used immunosuppressive agents in liver transplantation

liver transplant.xlsx
 Kidney Transplant
• A kidney transplant patient is more likely to enjoy bouts of energy and follow a less
strict diet as compared to patients who choose an alternative treatment. The kidney
performs several important functions in the human body. Even slight damage to the
kidneys can, therefore, cause a lot of problems. When the kidney is rendered
incapable of its main function, that is, removal of waste products from the blood, a
condition called uremia develops.
• Unfortunately, the symptoms of this condition do not develop unless 90 percent of
the kidney is damaged. This is the time when an individual would require a kidney
transplantation surgery or dialysis to restore the normal functioning.
• There are several other kidney diseases that warrant the need for a kidney
transplantation. Some of these conditions include the following:
• Deep-rooted problem in the anatomy of the urinary tract
• Extremely high blood pressure
• Glomerulonephritis
Kidney Transplant
• kidney transplant.xlsx
Bone Marrow Transplant
• A bone marrow transplant is a transplant containing all three types of
blood cells that develop in the bone marrow: red cells, white cells,
and platelets.
• Bone marrow is soft, sponge-like tissue that’s inside your bones. Stem
cells, which are a type of blood cell that makes other blood cells, are
stored inside it.
• With a bone marrow transplant, you get healthy stem cells to replace
your own bone marrow that’s either diseased or damaged. The stems
cells may come from your own body or from someone who donates
them to you.
• High-dose chemotherapy works better than standard dose to kill cancer cells, but it also wipes out
bone marrow. A bone marrow transplant lets doctors use high-dose chemo to try to cure the
cancer, then replace the damaged bone marrow.
• It can be used to treat several diseases and conditions:
• Leukemia: A type of cancer that happens in your blood cells.
• Lymphoma: A kind of cancer that happens in part of your immune system called the lymph system.
• Acute lymphocytic leukemia: A type of cancer that causes your bone marrow to make blood cells
that don’t work the way they should. It’s the most common type of cancer in children, but adults
can get it, too.
• Chronic lymphocytic leukemia: A kind of cancer that affects white blood cells called lymphocytes. It
happens most often in older adults.
• Multiple myeloma: A type of cancer that starts in the white blood cells found in your bone marrow.
• Aplastic anemia: A condition that happens when your bone marrow can’t make enough new blood
cells.
• Primary immunodeficiency: A disorder you’re born with that affects your immune
system and makes you more likely to get infections.
• Adrenoleukodystrophy: A genetic condition that damages the tissue around the
nerve cells in your brain.
• Hemoglobinopathies: A group of genetic disorders that affect red blood cells.
They include sickle cell disease.
• Myelodysplastic syndrome: A group of disorders that happen when there’s a
problem in your bone marrow and blood cells don’t work the way they should.
• Neuroblastoma: A type of cancer that starts in nerve cells in certain areas of your
body, like your adrenal glands, chest, abdomen, and neck. It most often affects
young children.
• POEMS syndrome: A blood disorder that damages nerves and affects other parts
of your body.
• Amyloidosis: A rare disease in which an abnormal protein is made in your bone
 Stem Cell Transplant
• Stem cell transplant is one modern technology that is undergoing rapid improvements.
Stem cell transplant has been used in recent times as a cure for cancer, but the technique is different from the
stem cell bank that is maintained these days for new born

• The bone marrow which is part of the bones is responsible for making blood cells. It is soft and spongy tissue
lodged inside the bone having hematopoietic stem cells. These cells either turn into bone marrow cells or
can turn into any other kinds of cells or the blood cells. But there are certain forms of cancers that can keep
these cells from developing normally.
• A patient is recommended to get a blood as well as bone marrow stem cell transplant if they are in a
condition which prevents the body from producing new healthy blood cells. Some of the conditions and
diseases that prevent the bone marrow from doing so are given below:
• Cancers like Myeloma, breast cancer, leukemia, Lymphoma may require stem cell transplant
• Blood diseases which may require are sickle cell anemia, aplastic anemia and thalassemia
• There are immune deficiency diseases like the congenital neutropenia, severe combined immunodeficiency
syndrome, chronic granulomatous disease may demand a stem cell transplant.
• The oncologist or hematologist shall decide for a stem cell transplant for a patient depending upon overall
age and health, severity of the diseases and other treatment possibilities.
• So the stem cell transplant is a kind of treatment to treat blood disorders or any types
of cancer. Even blood diseases are also treated with transplants. Previously patients had
to undergo a bone marrow transplant due to the fact that stem cells are collected from
the bone marrow. But today stem cells get collected from the blood. And for this
particular reason they are now called stem cell transplants. Nowadays stem cell
therapies are used to combat hair loss and many other aesthetic related issues.
• Some of the different types of stem cell treatments available are discussed below
• Autologous transplant: These kinds of transplants are known as auto transplant. This
kind of transplant has the scope of very high dose chemotherapy paired with
autologous stem cell rescue. In this process usually the doctors treat the cancel and
then make use of the stem cells from the patient itself. From the blood, stem cells are
collected and the health care team then freezes it. These cells are usually placed back in
the blood after thawing them in the frozen state post the chemotherapy. The cells take
almost 24 hours to reach the bone marrow and start multiplying to give rise to healthy
blood cells.
• Allogenic transplantation: This is better known as an allo transplant medically. In this case stem cells are
obtained from another individual. But this individual needs to be someone with whom the bone marrow
of the patient matches. Due to presence of proteins in white blood cells called the human leukocyte
antigens (HLA) it is important that bone marrow matching takes place. The most compatible stem cell
donor will have the HLA matching with that of the patient.
• But the process of matching can also give rise to a very severe condition named graft versus host disease
or GVHD but then it is not very likely. In this kind of a disease the healthy cells obtained from
transplantation will start attacking the cells of the patients. In such cases siblings are considered to be the
best match. And if they are not available then some other close family member can also work. Once the
donor is fixed then the patient starts receiving chemotherapy session with or without radiotherapy. The
other person’s stem is then placed in a vein via a tube. These cells unlike the previous ones are not frozen
so they can be given immediately after the completion of chemotherapy.
• There can be two types of Allo transplantation depending upon the age, condition and the disease that is
being addressed:
• The first kind is ablative where high dose of chemotherapy is used and in the second kind milder doses of
chemotherapy is employed.
• Parent child transplant and haplotype mismatched transplant: In these kinds of transplants which are
commonly employed the match found is 50% instead of 100% and the donor can be a parent, child or
brother and sister
• Once all pre-surgery tests are over, the medical and radiation
oncologists would conduct chemotherapy and radiation therapy
sessions to achieve the following things:
• Destruction of cancer cells
• Suppression of the immune system
• Preparation of bone marrow for receipt of new stem cells
• This preparatory step is also known as conditioning.
Nephrotic Syndrome
Nephrotic Syndrome
• Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in
your urine.
• Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your
kidneys that filter waste and excess water from your blood. Nephrotic syndrome causes swelling
(edema), particularly in your feet and ankles, and increases the risk of other health problems.
• Treatment for nephrotic syndrome includes treating the underlying condition that's causing it and
taking medications. Nephrotic syndrome can increase your risk of infections and blood clots. Your
doctor may recommend medications and dietary changes to prevent these and other
complications of nephrotic syndrome.

Signs and symptoms of nephrotic syndrome include:

• Severe swelling (edema), particularly around your eyes and in your ankles and feet
• Foamy urine, which may be caused by excess protein in your urine
• Weight gain due to excess fluid retention
• Fatigue
 Nephrotic Syndrome
• Treatment for nephrotic syndrome involves treating any underlying medical condition that may be causing your
nephrotic syndrome. Medications may include:
• Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and
also reduce the amount of protein released in urine. Medications in this category include benazepril, captopril and
enalapril. Another group of drugs that works in a similar way is called angiotensin II receptor blockers (ARBs) and
includes losartan and valsartan. Other medications, such as renin inhibitors, also may be used, though ACE inhibitors
and ARBs are generally used first.
• Diuretics. Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. Diuretic medications
typically include furosemide. Others may include spironolactone and thiazides, such as hydrochlorothiazide.
• Cholesterol-reducing medications. Medications called statins can help lower cholesterol levels. However, it's currently
unclear whether or not cholesterol-lowering medications can specifically improve the outcomes of people with
nephrotic syndrome, such as avoiding heart attacks or decreasing the risk of early death. Statins include atorvastatin,
fluvastatin , lovastatin , pravastatin , rosuvastatin and simvastatin.
• Blood thinners. Medications called anticoagulants help decrease your blood's ability to clot and may be prescribed if
you've had a blood clot to reduce your risk of future blood clots. Anticoagulants include heparin, warfarin, dabigatran,
apixaban and rivaroxaban .
• Immune system-suppressing medications. Medications to control the immune system, such as corticosteroids, may
decrease the inflammation that accompanies underlying conditions, such as minimal change disease, lupus and
amyloidosis.
Rheumatoid Arthritis
 Rheumatoid Arthritis

• Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just
your joints. In some people, the condition can damage a wide variety of body systems,
including the skin, eyes, lungs, heart and blood vessels.
• An autoimmune disorder, rheumatoid arthritis occurs when your immune system
mistakenly attacks your own body's tissues.
• Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining
of your joints, causing a painful swelling that can eventually result in bone erosion and
joint deformity.
• The inflammation associated with rheumatoid arthritis is what can damage other parts of
the body as well. While new types of medications have improved treatment options
dramatically, severe rheumatoid arthritis can still cause physical disabilities.
Rheumatoid Arthritis
Signs and symptoms of rheumatoid arthritis may include:
• Tender, warm, swollen joints
• Joint stiffness that is usually worse in the mornings and after inactivity
• Fatigue, fever and loss of appetite

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your
hands and your toes to your feet.
• As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most
cases, symptoms occur in the same joints on both sides of your body.
• About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve
the joints. Rheumatoid arthritis can affect many nonjoint structures, including:
• Skin
• Eyes
• Lungs
• Heart
• Kidneys
 Rheumatoid Arthritis
• The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had
rheumatoid arthritis.
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include
ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include
stomach irritation, heart problems and kidney damage.
• Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include
thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of
gradually tapering off the medication.
• Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints
and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava),
hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
• Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab
(Humira), anakinra (Kineret), baricitinib (Olumiant), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab
(Remicade), rituximab (Rituxan), sarilumab (Kevzara), tocilizumab (Actemra) and tofacitinib (Xeljanz).
• These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs
also increase the risk of infections. In people with rheumatoid arthritis, higher doses of tofacitinib can increase the risk of blood clots in
the lungs. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.
• Significant clinical improvement has been seen in many mycophenolate mofetil-treated RA patients who have been refractory to
treatment with a variety of disease-modifying anti-rheumatic drugs (DMARDs). Treatment with mycophenolate mofetil reduces
Systemic lupus erythematosus (SLE)
SLE
• Lupus is a systemic autoimmune disease that occurs when your body's
immune system attacks your own tissues and organs. Inflammation caused
by lupus can affect many different body systems — including your joints,
skin, kidneys, blood cells, brain, heart and lungs.
• Lupus can be difficult to diagnose because its signs and symptoms often
mimic those of other ailments. The most distinctive sign of lupus — a facial
rash that resembles the wings of a butterfly unfolding across both cheeks —
occurs in many but not all cases of lupus.
• Some people are born with a tendency toward developing lupus, which may
be triggered by infections, certain drugs or even sunlight. While there's no
cure for lupus, treatments can help control symptoms.
SLE
• No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may
be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease
characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve
or even disappear completely for a time.
• The signs and symptoms of lupus that you experience will depend on which body systems are affected by the
disease. The most common signs and symptoms include:
• Fatigue
• Fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the
body
• Skin lesions that appear or worsen with sun exposure (photosensitivity)
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's
phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss
 SLE
• Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms
should be treated and what medications to use requires a careful discussion of the benefits and risks with
your doctor.
• The medications most commonly used to control lupus include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium
(Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated
with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding,
kidney problems and an increased risk of heart problems.
• Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil),
affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach
upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking
these medications.
• Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of
lupus. High doses of steroids such as methylprednisolone (A-Methapred, Medrol) are often used
to control serious disease that involves the kidneys and brain. Side effects include weight gain,
easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of
infection. The risk of side effects increases with higher doses and longer term therapy.
• Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of
lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate mofetil (CellCept) and
methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver
damage, decreased fertility and an increased risk of cancer.
• Biologics. A different type of medication, belimumab (Benlysta) administered intravenously, also
reduces lupus symptoms in some people. Side effects include nausea, diarrhea and infections.
Rarely, worsening of depression can occur.
• Rituximab (Rituxan) can be beneficial in cases of resistant lupus. Side effects include allergic
reaction to the intravenous infusion and infections