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  • Gleneagles Singapore

Liver Transplant Recovery

  • Liver Transplant Recovery

    After a liver transplant, it is important for transplant patients to care for their new organ, which includes possible lifestyle changes, regular exercise, healthy diet, taking medications and going for follow-up medical appointments regularly.

    The transplant coordinators, dietitians and allied healthcare team at Gleneagles Hospital will educate and guide patients and their caregivers on post-transplant care before they are discharged from the hospital.

    Outpatient check-ups

    Patients must attend check-ups at least twice a week for the first 2 months after they are discharged. This will allow the specialist(s) to check on the patient’s condition and keep track of the recovery process. Organ transplants have the highest risk of organ rejection within the first 60 days after the transplant, so it is very important that the specialist checks on the patient regularly. After the first 2 months, the frequency of visits is adjusted based on the doctor’s diagnosis. 

    Anti-rejection medicine

    Liver transplant recipients must take anti-rejection medications for the rest of their lives. These medications are also known as immunosuppressants, and they help prevent the patient’s body from rejecting the new liver. A strong immune system may recognise the new liver as ‘foreign’ and attack it. Anti-rejection medications can lower your immune system and prevent it from attacking the new organ, but they can also increase the risk of getting infections.

    It is important that anti-rejection medications are taken as prescribed at the same time every day. If you miss a dose, you must tell the transplant coordinator who will advise on when to take the next dose. You should not take extra anti-rejection medications to make up for missed doses.

    Patients on anti-rejection medications should not eat certain foods, such as pomelo and grapefruit, as these can affect the effectiveness of the immunosuppressant. Similarly, do not take new medications, including traditional or over-the-counter medication, without telling the transplant coordinator or doctor as it can affect the absorption of your anti-rejection medication. You should also tell your dentist, doctor or surgeon that you are taking anti-rejection medications before undergoing any dental or medical procedure. 

    Recognising rejection and infection

    While anti-rejection medication helps prevent organ rejection, it can still happen in some cases. This condition can, however, still be reversed if the signs are discovered and treated early. 

    Signs of rejection:

    • Fever
    • Dark, tea-coloured urine
    • Yellowish eyes
    • Jaundice (yellowish skin and eyes)
    • Pale or clay–coloured stools
    • Chills, aches and unexpected tiredness

    Other than the risk of organ rejection, liver transplant patients also need to be alert about infection, especially since the anti-rejection medication that they take will reduce the body’s ability to fight infection. Patients need to practise good personal hygiene and take precautions to reduce the risk of getting an infection, eg. avoiding crowded places especially during the cold or flu season. Washing hands often and avoiding new vaccines can also help prevent infections. After their discharge, patients should check their temperature twice a day for the first month, and contact their transplant coordinator if any of the below signs occur:

    • Fever
    • Redness or white spots on the tongue or in the mouth
    • Redness, swelling or foul smelling discharge on open wounds
    • Persistent cough without shortness of breath.
    • Flu-like symptoms
    • Painful or burning sensation during urinating
    • Diarrhoea

    Nutrition after liver transplant

    Before you are discharged, a dietitian will advise you on maintaining a healthy, balanced diet that will help your body heal and prevent infection. Depending on your medical condition, your doctor may place you on a special diet. It is important for liver transplant patients to maintain a healthy weight. Weight gain and obesity can damage your new liver and increase your risk for chronic diseases such as high blood pressure and heart disease. 

    With a weakened immune system caused by anti-rejection medication, it is important to practise safe food handling to prevent infection from food-borne diseases. The dietitian and nurses will advise you on how to handle food safely and what foods to be careful of.

    Be careful to:

    • Wash your hands before and after handling food
    • Avoid raw or partially cooked food, especially meat, shellfish, seafood and eggs
    • Wash all fruits and vegetables before cooking and eating them
    • Avoid eating from salad bars, buffets or other shared dishes due to possible contamination by others and unsafe food temperatures
    • Avoid unpasteurised milk and cheese
    • Lower your salt and sugar intake
    • Try to drink about 2 litres of boiled water daily
    • Avoid foods that may be prepared in unclean environments

    Regular activities after transplant

    Exercise – It is advised to resume exercise to maintain your weight and physical health. However, you should avoid driving for up to 6 weeks after your transplant, and avoid activities that strain your stomach for at least 2 months after your surgery, including heavy lifting and sit-ups.

    Sun exposure – Transplant patients have a chance of developing skin cancer when exposed to the sun. Use sunblock with at least SPF 30, wear long-sleeved shirts and a hat if you expect to be outdoors for a long time. You should also examine your skin regularly for abnormal growths or patches.

    Travel – Unless you are returning to your own country, you should avoid travelling within the first 6 months after your liver transplant. Your transplant coordinator will also advise you on which areas to avoid, as some countries may increase the risk of infection for liver transplant patients.

    Family planning – While you can resume sexual activity within a few months after the transplant, female transplant patients should wait at least a year after their transplant before conceiving. You should also consult your doctor before breastfeeding due to your anti-rejection medication.

    Alcohol – Liver transplant patients should avoid alcohol whenever possible. Alcohol is processed by the liver and will cause harm to the new liver.

    Pets – While pets can continue to be a part of your family life, you should avoid contact with pet faeces and urine, especially bird droppings. Animal faeces can contain microorganisms that can cause serious infection to patients with weakened immunity.

    Annual screening – Besides complications to the new liver, liver transplant patients are also more vulnerable to other medical conditions due to their weakened immune system. As such, liver transplant patients should undergo a detailed health screening yearly so that your physician can supervise and manage your health properly. 

    For more information on recovery after a liver transplant, the Asian American Liver Centre has an extensive guidebook on liver transplant recovery.

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