Organ Transplant Recipients Twice as Likely to Develop Cancer, At Increased Risk of Developing 32 Types of Cancer

A study of more than 175,000 transplant recipients reveals their significantly increased risk of developing cancer, according to a study by the National Cancer Institute (NCI), part of the National Institutes of Health, that was published in the November 2, 2011 issue of the Journal of the American Medical Association.

A news release issued by NCI stated, "Organ transplant recipients in the United States have a high risk of developing 32 different types of cancer, according to a new study of transplant recipients which fully describes the range of malignancies that occur."

Researchers discovered that the most common cancers among transplant recipients were non-Hodgkin lymphoma, lung cancer, liver cancer and kidney cancer. Of particular interest to me was the following finding:

The risk of liver cancer was elevated only among liver recipients. Studies of cancer show, in this group, the occurrence of liver cancer can be partly attributed to recurrent hepatitis B or C infection in the transplanted liver, or to diabetes mellitus, which is also common among transplant recipients.

Organ transplants save lives, but there are numerous risks and challenges: Hypertension, diabetes (I was taking medication for these conditions almost immediately after my transplant), skin cancer (and 31 other types of cancer, according to this study), and much more. It's a lot to take on and for me, well worth it. But there's no denying organ transplants aren't for the faint of heart.

Photo by Johany López

Diabetes + Steroids = A Huge Challenge

In my last post about prednisone and its side effects, I mentioned how it wreaks havoc on my blood sugar. Controlling my glucose levels is critical, not just for the obvious reason that diabetes is very damaging to the body but also because I'm still battling metabolic syndrome.

I've discovered a great tool to help me track what I eat and blood sugar levels/insulin use: www.livestrong.com. The nutritionist at my endocrinologist's office gave me daily goals for calories, fat, carbs, fiber and protein, and when I record my food consumption on "My Plate" on the site, it provides a detailed breakdown of these components and more. Using the basic "My Plate" tool is free and for an affordable annual fee, you can get even more services. The website offers much more information related to health, diet, exercise, you name it.

One of the biggest eye-openers for me in this process has been discovering the benefit of fiber in my diet. Before I began taking steroids, I had noticed a significant correlation between fiber consumption and blood sugar levels. Fiber helps control blood sugar levels and much more: An aritcle in the August 2010 National Institutes of Health newsletter offers detailed information about the advantages of eating more fiber.

Photo by Rob Owen-Wahl

The Verdict: I Have Metabolic Syndrome

After reviewing my last set of lab results (8 tubes of blood - a personal record!) and considering the report from my recent biopsy, the concensus is that I have metabolic syndrome.

According to the National Institutes for Health,

Metabolic syndrome is the name for a group of risk factors linked to overweight and obesity. These risk factors increase your chance of having heart disease and other health problems, such as diabetes and stroke.

The five conditions described below are metabolic risk factors. You can develop any one of these risk factors by itself, but they tend to occur together. Metabolic syndrome is diagnosed if you have at least three of these metabolic risk factors.

A large waistline. This also is called abdominal obesity or "having an apple shape." Excess fat in the abdominal area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.

A higher than normal triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.

A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL is sometimes called "good" cholesterol because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk of heart disease.

Higher than normal blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps out blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

Higher than normal fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

Hmmm. I never did have a small waistline, even during my young skinny days, but I wouldn't quite describe myself as apple-shaped. Triglycerides and cholesterol have historically been good, too. But I've had to take blood pressures meds since my transplant. Also since then I've developed diabetes and take insulin injections twice a day.

Metabolic syndrome caused the significant build-up of fat in my liver that was detected in last month's biopsy, which is a key reason my liver function tests are showing poor results now. So here's what it's going to take to improve this situation:

* Lose weight (I've lost 7 pounds since April - off to a good start!)

* Control blood sugar better (I'm seeing my endocrinologist next week)

* Increase thyroid medication; TSH level is in range, but needs to be lower

I'm taking more meds, too - vitamin E, folic acid, higher dose of magnesium. I also may add another med after I see the endocrinologist next week.

What does all this mean for the Hep C treatment I'm currently on? I'll find out Tuesday when I visit my treatment coordinator. Apparently, the team at my transplant center has debated whether I should stay on or discontinue treatment, or even switch to a different type of Interferon.

I'll post an update after that appointment - and share some info I discovered about Metabolic Syndrome after liver transplant.

Photo by Jason Antony

The Next "Thing" is Here: Cataracts

Yeah, just picture me: Knee-high hose with orthopedic old lady shoes, gray cardigan buttoned wrong and - drumroll - those square disposable sunglasses covering my eyes plus nearly one-third of my face. Pretty!

But seriously... I just returned from an appointment with my opthamologist, whom I must see annually now due to transplant medication and diabetes (one of my post-transplant annual doctor visits). In the 18 months since I last saw her my vision overall is maybe a little improved (!) but I have a cataract developing in my right eye. Oh, fabulous!

The doc saw nothing at my last appointment, so this is a new condition. I brought home a brochure and will read up on cataracts, about which I know virtually nothing. What I thought I knew was that cataracts usually belong to the world of the elderly and surgery is required to remove them. Sure, I turned 50 a couple of months ago and while that made me eligible for AARP, I never imagined that it made me eligible for cataracts. It's an insult, frankly.

Apparently, my "poorly controlled" diabetes is probably the culprit here. The doc said that the cataract's growth is hard to predict: It could fully cover the lens in six months or six years. But she said not to worry, telling me "You'll know when it's a problem because you'll have trouble seeing and your vision will be cloudy all the time, no matter what you do. I won't have to tell you because you'll call me complaining about it."

So, I'm off to learn about cataracts. As soon as my eyes return to normal, that is - my pupils are still quite dialated at this point. Guess I'll wait until I can take off my new sunglasses.

Photo by Jacob Power