How will my body cope with the new liver?
The immune system is your body's natural defence mechanism. It is programmed to recognise and destroy anything unfamiliar. This includes the cells of a transplanted liver as well as the bacteria and organisms that cause infection.
Following a liver transplant, specific drugs are needed to prevent the immune system from rejecting the new liver. These are called immunosuppressants and you will have to take them every day for the rest of your life.
A combination of immunosuppressant drugs will be prescribed. These drugs will increase your risk of infection. During the first few months after transplantation, the need for immunosuppressant is at its highest. This is the time when you are at most risk of infection. The risk decreases when the doses are reduced after several months but it will always remain sensible to avoid close contact with people who have infections. You should also avoid eating any form of raw food. You will be monitored closely for signs of infection and treated if necessary.
Regular blood samples will determine the level of these drugs and the daily dosage will be changed if required by the transplant physician. If the levels are too low, the risk of rejection is greater and the doses will be increased. If the levels are too high, you may experience more side effects and the doses will be reduced. You must not change the dosage of your immunosuppressant drugs without consulting your doctor. Failure to take these medicines as prescribed can result in rejection of your new liver.
What are the possible side effects caused by immunosuppressants?
Like most medicines, immunosuppressants have some side effects.
Your immunosuppressant drugs, which are necessary to prevent rejection of your transplanted liver, will make it more difficult for your body to fight infections. Symptoms of cough or fever, which may have gone away on their own before your transplant, can be a warning sign of an infection. If you have any signs or symptoms of infection, you should call your transplant coordinator immediately. We will recommend for you to be seen immediately by a doctor to determine if you have an infection, and if so, how you should be treated.
Your transplant coordinator or the nurses will provide you with a medication timetable. Keep to it strictly and do not skip any medications without the approval of your doctor. The immunosuppressant drugs help to prevent the rejection of your new liver by your body; while other medications are meant to support your immune system which may otherwise be weakened by the immunosuppressant drugs. It is important to always check with our Transplant Centre if you are prescribed with any new drugs as there may be interactions with the immunosuppressant drugs.
What other medicines do I have to take?
For the first three to six months after transplantation, you will need to take the following medicines:
- Antibiotics - to reduce the risk of bacterial infection
- Anti-fungal liquid - to reduce the risk of fungal infection in your mouth
- Anti-acid agents - to reduce the risk of stomach ulcers and heartburn
- Any other medicines prescribed by your transplant physician, depending on your symptoms
Some prescribed medications can cause acne, dry skin, skin growth, brittle hair and unwanted hair growth. Some of these side effects can be avoided if you take precautions, whilst others may require you to see a doctor.
Do discuss your current medications with the pharmacist if you need to buy over-the-counter medicines for minor ailments (for example, paracetamol for a headache). Your General Practitioner may wish to contact your liver transplant physician before prescribing you with any new medicines.
How do I know if I am having a liver rejection?
Rejection is your body's way of recognising your donated liver as foreign and attacking it. Rejection can usually be reversed if it is diagnosed and treated early. You have to diligently take precautions and learn to watch out for signs of rejection that may require immediate medical attention.
- Elevated liver levels of enzymes - total bilirubin, SGPT (ALT), SGOT (AST), SGGT
- Fatigue
- Fever
- Abdominal pain or tenderness
- Dark or light coloured urine
- Yellow eyes and/or skin (Jaundice)
- Ascites (fluid in the abdomen)
- Itch
Increasing the chances of early detection of liver rejection:
- Have your blood and other laboratory tests as recommended by the transplant team
- Take your medications as prescribed
- Report signs of rejection immediately
Elevated laboratory results can indicate a possible rejection but only a liver biopsy can determine if you are having a rejection. Other factors can cause your liver enzymes to be elevated. For this reason, treatment of rejection should only be managed by your transplant physician.
Important facts about liver rejection:
- Elevated liver levels of enzymes - total bilirubin, SGPT (ALT), SGOT (AST), SGGT
- Having rejection does not always mean you will lose your liver
- You may feel perfectly well while having rejection
- Rejection may be acute (occurring suddenly), or chronic (occurring slowly over time)
- Rejection will get worse if it is not treated
- Rejection can occur any time
When do I need to have follow-ups and why?
Your transplant coordinator will provide you with a schedule of medical follow-ups, with laboratory tests and scans:
- Ultrasound - to make sure that all your main blood vessels leading to the liver are functioning normally and there is no collection of bile or blood;
- Percutaneous TranshepaticCholangiogram (PTC) - a dye is injected into the T-tube, which then highlights the bile ducts. It shows if there is a leak, blockage or other potential problems;
- Liver biopsy - to check for rejection of the new liver or hepatitis;
- Computed Tomography (CT) scan - it shows the liver from different angles; to detect infections and fluid collection;
- Endoscopic Retrograde Cholangiopancreatogram (ERCP) - a dye is injected through an endoscope, which is passed through the mouth to the stomach and intestine to the liver. It shows the biliary tree (the various ducts in and around the liver) as well as the ducts from the pancreas.
The purpose of the follow-ups is to track your progress and detect potential complications as early as possible. At every visit to our Transplant Centre, you will have to bring your post transplant file and medication timetable. Keep a journal and list any questions you and/or your family may have and bring it along during your follow-up visits.