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, dieticians and allied healthcare team at Gleneagles Hospital will educate and guide patients and their caregivers on post-transplant care prior to their discharge from the hospital.
Patients are required to 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 monitor 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 are adjusted based on the doctor’s diagnosis.
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 its cells. 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 inform the transplant coordinator who will advise on when to take the next dose. You should not take additional anti-rejection medications to make up for missed doses.
Patients on anti-rejection medications should not consume 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 informing the transplant coordinator or doctor as it can affect the absorption of your anti-rejection medication. You should also inform 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 help to prevent organ rejection, this can still happen in some cases. This condition can, however, still be reversed if the signs are detected and treated early.
Signs of rejection:
- Dark, tea-coloured urine
- Yellow 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 vigilant 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. Patients should avoid crowded places, for example, especially during the cold or flu season. Washing hands frequently 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:
- Redness or white spots on the tongue or in the mouth
- Redness, swelling or foul smelling discharge on open wounds
- Persistent cough without shortage of breath.
- Flu-like symptoms
- Painful or burning sensation during urinating
Nutrition after liver transplant
Before you are discharged, a dietician 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 practice safe food handling to prevent infection from food-borne diseases. The dietician and nurses will advise you on how to handle food safely and what foods to be mindful 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 such as steamboat 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 unhygienic environments
Regular activities after transplant
Exercise – It is recommended to resume exercise in order to maintain your weight and physical health. However, you should avoid driving for up to six weeks after your transplant, and avoid activities that strain your abdomen for at least two 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 six 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 are able to resume sexual activity within a few months after the transplant, female transplant patients should wait at least one 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 metabolised 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 annually so that your physician can supervise and manage your health appropriately.
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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