Care After Surgery
Before your transplant you will receive a copy of the Center for Liver Disease and Transplantation's "Patient's Guide to Healing and Health After Liver Transplantation." This easy-to-read binder is available in both Spanish and English.
Below is an overview of our guidelines for care after transplant.
After your liver transplant, you will be required to take medications to help your new liver function smoothly. Your body's immune system will recognize your transplanted organ as a foreign object and attempt to protect you by rejecting it. To protect your new liver, we prescribe a variety of medications to suppress your body's natural immune response.
Standard treatment is Prograf® or Neoral® plus Cellcept® or Myfortic® and prednisone. Most patients are weaned to Prograf® alone within 12 months.
After transplantation, you will be taking immunosuppressant medications for the rest of your life.
These medications have side effects that can include high blood pressure, excessive hair growth or loss, hand tremors, mood swings, weight gain, bone loss, and diabetes.
Not everyone experiences the same effects and some are temporary; others will continue as long as you take the medicines. We will monitor and alter your medication regimen to minimize side effects and reduce dosages as quickly as possible, ensuring your new liver functions at its best. Although the amount of immunosuppressive medications required will decrease over time, they will be necessary for the rest of your life.
As with any other surgical procedure, in rare instances, complications may arise after liver transplantation.
BleedingThere is a small risk of bleeding at the anastomosis, the place where the blood vessels from donor and recipient were sewn together. This is minimized by monitoring clotting factors in the blood after surgery and measuring output from the drains placed during the operation.
Hepatic Artery ThrombosisIf a clot forms in the hepatic artery it can cause the liver to malfunction. We perform abdominal ultrasound the day after your surgery to look for this condition and will monitor you throughout your postoperative recovery. If found, medications or surgical repair can minimize permanent damage and avoid the need for re-transplantation.
Bile Duct LeaksThe ducts that drain from the new liver are attached to a bile duct or portion of intestine in the recipient. This connection can leak and bile can drain into the abdominal cavity, causing infection. If a bile leak occurs, a catheter may be inserted into the abdomen to allow external drainage. This is temporary and can usually be managed without surgery.
Your body will recognize your new liver as foreign and develop immune cells, called lymphocytes, to attack it. This is called rejection, and many recipients will experience some degree of rejection after transplantation. Rejection as a cause of graft loss is extremely uncommon, however, when it happens it is usually easily reversed with medications. The first rejection commonly occurs within three months after the operation. You are monitored closely during this time so the warning signs of rejection can be spotted early and steps taken to control it.
A biopsy of the liver is usually necessary to diagnose the extent of the rejection taking place, and to rule out any other problems. Biopsy results will help determine which anti-rejection therapy would be best for you.
Because your immune system is suppressed by medications after transplantation, you are at higher risk for developing certain infections. We will prescribe other medications to prevent the more common post-transplant infections. You will need to routinely monitor your temperature at home, and make certain adjustments in your daily living to avoid contracting harmful infections. Your CLDT team will provide the instructions you need to make these necessary changes.
If you suffered from Hepatitis B or C prior to receiving your new liver, it is possible to experience a recurrence of the virus after transplantation. Fortunately, antiviral therapy can protect the new liver against hepatitis B recurrence in nearly all cases. To help identify and control any recurrence, you will be screened with blood tests and liver biopsies at regular intervals. If recurrence is detected, medications will be prescribed.