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Liver Transplant

DAN examines diving possibilities for donor & recipient.My wife & I have been diving since 1975. We are both 45 years old. A year ago my wife's liver was removed and replace with a portion of mine (living donor - liver transplant). Her diagnosis, fulminate hepatic failure, is believed to stem from a mix-up in prescription medicines she took for rheumatoid arthritis. There was no other indication of disease in the biopsy. She has recovered extremely well.

She takes anti-rejection medicine, including tacrolimus and prednisone, and as we understand it, will remain on medications for life. Soon after I donated, I was cleared to dive. I had nothing more than lots of scar tissue. What are the diving indications for each of us, given this history?

The liver is one of the largest organs in the body. It produces bile, which is essential to the digestive system. The liver acts as a filter for the blood, contributes to fat, carbohydrate and protein metabolism, detoxifies drugs and manufactures numerous proteins, including coagulation factors. The truly amazing thing about the liver is that it is segmented into lobes that can be transplanted into another person and support that person's life with all of the necessary functions. The donor liver is able to regenerate the missing parts of the liver.

After the acute effects of the transplant operation have passed, your wound has healed and you can tolerate your average level of exercise, you, the liver donor, should be able to return to normal scuba diving.

Under similar conditions, your wife, the recipient, should also be able to dive. However, she should take a few precautions. Immunosuppressive drugs such as tacrolimus and prednisone can decrease an individual's ability to fight infection.

These drugs can cause high blood pressure in some individuals; tracrolimus and other medications used in transplant recipients can impair kidney function. These effects can be short-term or permanent. If such complications occur, your wife may need to reassess whether she can dive safely. Immunosuppression will also predispose her to infections: for example, mild ear or sinus barotrauma, otherwise tolerated by most divers, could lead to serious ear or sinus infections.

In addition, some recreational divers without health complications have experienced mild elevations of liver enzyme levels after repetitive dives. The use of ultrasound has detected bubbles in the hepatic vein -- the large vein draining blood from the liver -- after decompression.

While these elevated enzyme levels always return to normal, it is conceivable that local bubble formation can cause a slight leakage of enzymes from liver cells. There is no evidence that the liver is "damaged" in any way by diving. Thus far it is unknown whether these observations have any added significance for people after liver transplant.

However, we suggest that your wife dive conservatively: avoid diving deeper than 60-70 feet / 18-21 meters, limit herself to two dives per day, and take a day off in the middle of a diving week.

And, of course, both of you should remain well hydrated before, during and after diving.