Reply to 'Episode "Wilson" discussion'
Reply to the Episode "Wilson" discussion at house_wilson, which ran way over the LJ reply character-limit. Possible spoilers ahead.
1) Will Wilson's friend live through the episode? Will he die even with Wilson's donation surgery? If he dies, what do you think Wilson will do?
One of the questions I have been asking myself these past few days.
Scientifically, even with immunosuppressive medication, there is a chance of graft rejection which may be caused a myriad of different factors (even if Wilson is type O, the universal donor), and can also happen at any time (perhaps immediately or years down the line). There are three main ones, but I don't think it would be sensible to go diving into them when we aren't even sure such a thing would happen. Also, the liver is a very special and curious organ. (^^) Liver transplantation is unique in that the risk of chronic rejection decreases over time, although recipients need to take immunosuppressive medication for the rest of their lives.
I have decided it is not possible to tell the conclusion to part 1 with the current information, so I'm going to simply wait until I watch the episode and be pleasantly (or not so pleasantly) surprised. Doesn't mean we can't hypothesize like good little scientists while we're waiting though. :D
2) According to the description of the global promo, is the transplant really that risky or is House worrying too much because it's Wilson? Will we get some sick!Wilson?
[Please note:
- I am making several hypotheses here.
- Also, I am no doctor, but I did do Biology to Advanced Level and my father passed away due to liver cancer, so there has been a fair amount of reading done on the subject.
- Another thing. If it's NOT liver transplant, the whole of parts 2 and 3 of this reply are VOID. xD]
Since Wilson's friend looks jaundiced in the promo, and kidney failure can be supplanted by dialysis, I hypothesize it is liver donation. Living donor liver transplantation (LDLT) is considered to be even more technically demanding than cadaveric donor liver transplantation. LDLT over here in the UK is practically nonexistent, though doctors are campaigning for a change.
Mortality rate, whilst lowish considering modern day amenities (~0.5-1%), is still significantly higher than that of say, kidney donation (~0.03%). That being said, those were global averages, and considering by country gives an estimation of LDLT mortality being reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to improve further as surgeons gain more experience in this procedure. Postoperative donor complications in Japan were reported to be 12% in one study. Lancet. 2003 Aug 30;362(9385):674-5. Very occasionally, a second operation is needed.
While the heart drives the body and the brain is the conductor for the whole orchestra that is the human body, the liver is basically the powerhouse for the entire system. Most of the body's major chemical reactions take place in the liver, and the surplus heat generated by such reactions are used to heat your body via both radiative (rest your hand over your abdomen; you'll find the skin there intrinsically hotter than that over anywhere else on the surface of your body) and circulatory means.
Several MAJOR arteries run through and around the liver - most notably the almighty hepatic portal vein (which provides ~75% of the liver's blood supply), and the hepatic arteries. Nick one of those accidentally and there's going to be problems.
3) Are there renewed hopes of seeing House "nurse Wilson back to health" with these spoilers? Will House have to help Wilson once again? Do we dare hope for some hugging or hand holding?
The liver is the only internal human organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver (which, might I add in a personal opinion, is PRETTY FUCKING EPIC 8DD). A human liver is known to grow back in no less than 8 years. However recent studies seem to suggest regeneration may occur faster than originally thought:
"Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% ± 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% ± 12.37% of the original liver volume, whereas that for left graft donors was 91.99% ± 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation." Liver Regeneration and Splenic Enlargement in Donors after Living-Donor Liver Transplantation (You can download the full pdf on the page if you are interested.)
More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. (Howard J. Worman. The Liver Disorders Sourcebook, McGraw-Hill, 1999) The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations.
In conclusion, hopefully this recovery time will provide ample opportunity to show some affection/feelings. ;) I know I'm game to see some!
4) Will there be repercussions to this episode that will continue on in episode 11 (which apparently will have lots of House/Wilson)?
Probably. Both mental and physical, I can only assume (the latter of which I addressed above).
5) Happy that there will be a bit of Huddy storyline on this episode Y / N?
N = No, not "happy". But only because in my highly biased opinion, I think that "Huddy" storyline has no place in such an episode. And also because I sullenly predict that there will be little House/Wilson in the "Cuddy-centric" episode.
6) Will this be one of the best episodes of the season or of THE WHOLE WORLD Y / Y? =D
Gosh, I certainly hope so. :D :D :D
1) Will Wilson's friend live through the episode? Will he die even with Wilson's donation surgery? If he dies, what do you think Wilson will do?
One of the questions I have been asking myself these past few days.
Scientifically, even with immunosuppressive medication, there is a chance of graft rejection which may be caused a myriad of different factors (even if Wilson is type O, the universal donor), and can also happen at any time (perhaps immediately or years down the line). There are three main ones, but I don't think it would be sensible to go diving into them when we aren't even sure such a thing would happen. Also, the liver is a very special and curious organ. (^^) Liver transplantation is unique in that the risk of chronic rejection decreases over time, although recipients need to take immunosuppressive medication for the rest of their lives.
I have decided it is not possible to tell the conclusion to part 1 with the current information, so I'm going to simply wait until I watch the episode and be pleasantly (or not so pleasantly) surprised. Doesn't mean we can't hypothesize like good little scientists while we're waiting though. :D
2) According to the description of the global promo, is the transplant really that risky or is House worrying too much because it's Wilson? Will we get some sick!Wilson?
[Please note:
- I am making several hypotheses here.
- Also, I am no doctor, but I did do Biology to Advanced Level and my father passed away due to liver cancer, so there has been a fair amount of reading done on the subject.
- Another thing. If it's NOT liver transplant, the whole of parts 2 and 3 of this reply are VOID. xD]
Since Wilson's friend looks jaundiced in the promo, and kidney failure can be supplanted by dialysis, I hypothesize it is liver donation. Living donor liver transplantation (LDLT) is considered to be even more technically demanding than cadaveric donor liver transplantation. LDLT over here in the UK is practically nonexistent, though doctors are campaigning for a change.
Mortality rate, whilst lowish considering modern day amenities (~0.5-1%), is still significantly higher than that of say, kidney donation (~0.03%). That being said, those were global averages, and considering by country gives an estimation of LDLT mortality being reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to improve further as surgeons gain more experience in this procedure. Postoperative donor complications in Japan were reported to be 12% in one study. Lancet. 2003 Aug 30;362(9385):674-5. Very occasionally, a second operation is needed.
While the heart drives the body and the brain is the conductor for the whole orchestra that is the human body, the liver is basically the powerhouse for the entire system. Most of the body's major chemical reactions take place in the liver, and the surplus heat generated by such reactions are used to heat your body via both radiative (rest your hand over your abdomen; you'll find the skin there intrinsically hotter than that over anywhere else on the surface of your body) and circulatory means.
Several MAJOR arteries run through and around the liver - most notably the almighty hepatic portal vein (which provides ~75% of the liver's blood supply), and the hepatic arteries. Nick one of those accidentally and there's going to be problems.
3) Are there renewed hopes of seeing House "nurse Wilson back to health" with these spoilers? Will House have to help Wilson once again? Do we dare hope for some hugging or hand holding?
The liver is the only internal human organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver (which, might I add in a personal opinion, is PRETTY FUCKING EPIC 8DD). A human liver is known to grow back in no less than 8 years. However recent studies seem to suggest regeneration may occur faster than originally thought:
"Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% ± 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% ± 12.37% of the original liver volume, whereas that for left graft donors was 91.99% ± 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation." Liver Regeneration and Splenic Enlargement in Donors after Living-Donor Liver Transplantation (You can download the full pdf on the page if you are interested.)
More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. (Howard J. Worman. The Liver Disorders Sourcebook, McGraw-Hill, 1999) The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations.
In conclusion, hopefully this recovery time will provide ample opportunity to show some affection/feelings. ;) I know I'm game to see some!
4) Will there be repercussions to this episode that will continue on in episode 11 (which apparently will have lots of House/Wilson)?
Probably. Both mental and physical, I can only assume (the latter of which I addressed above).
5) Happy that there will be a bit of Huddy storyline on this episode Y / N?
N = No, not "happy". But only because in my highly biased opinion, I think that "Huddy" storyline has no place in such an episode. And also because I sullenly predict that there will be little House/Wilson in the "Cuddy-centric" episode.
6) Will this be one of the best episodes of the season or of THE WHOLE WORLD Y / Y? =D
Gosh, I certainly hope so. :D :D :D