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Liver Transplant


After Liver Transplant

As you recover from surgery, you will be followed closely by the transplant team. In the first few weeks after transplant, you will be seen frequently in our outpatient clinic. If you live outside the St. Louis area, you may be required to stay for the first few weeks following transplant for observation and can arrange temporary lodging near the hospital.

Once you are discharged from the hospital, you will be in regular contact with your nurse coordinator. You will have lab work twice a week for the first two months after transplant and then weekly until six months after transplant.  By the end of the first year, you should be decreased to a schedule of lab work that occurs once a month. You will return periodically to Barnes-Jewish Hospital for follow-up exams during the first year and then can expect to return for visits annually.

Throughout the entire transplant process, the transplant team will continue to communicate with your primary care physician. Over time, routine care will be transitioned to your primary care physician. In order to ensure continuity of care and the best outcome for you, we will follow you for the life of your transplant, while working closely with your primary care physician.

After transplant, your decisions and dedication to your own self-care will be vital to your health and the success of your transplant. You can help yourself by taking your medications as directed and being aware of side effects or signs of rejection.  It is also important to follow a healthy lifestyle with good nutrition and exercise and by seek support when needed.  The transplant team will be with you every step of the way to answer questions and offer guidance and care.

Visit the following sections to review the post-transplant process.
Medications
Rejection
Nutrition 
Follow-up Care

Medications

As a liver transplant recipient, medications will become a significant part of your life. Our transplant team will help you manage and understand your medications. We also will advise you about taking any over-the-counter medications.

You will require anti-rejection medications to suppress your immune system so your body doesn’t reject the transplanted liver. You will be more prone to infection, especially during the first three to six months after transplant, because your immune system is suppressed,

While you are taking medications, you need to carefully monitor and report any unusual side effects to your nurse coordinator.  Side effects vary by dosage and type of medication. Ask your nurse coordinator or doctor any questions you have about your particular medication.

More people than ever are eligible for drug coverage with the changes to prescription drug coverage through Medicare Part D (effective Jan. 1, 2006). 

Find out if the immunosuppressive drugs needed after transplant are covered.

Rejection

Your immune system may reject the organ because a transplanted liver is considered a "foreign object" to your body.  It is not uncommon for this to occur within the first month of transplant, although with our current treatment approaches this now only occurs in about 20 percent of patients nationally. 

In most instances, rejection can be treated by temporarily increasing the dose of your anti-rejection medication or by using a combination of medications.

While rejection of a transplanted organ is always a concern, the rejection rate of transplanted livers at Barnes-Jewish Hospital is very low. The risk of rejection decreases over time, but can occur at any time. It’s important to follow all medication regimens and physician orders to prevent rejection, and to recognize the early signs of rejection.

Early symptoms of rejection include:

Your immune system may reject the organ because a transplanted liver is considered a "foreign object" to your body.  It is not uncommon for this to occur within the first month of transplant, although with our current treatment approaches this now only occurs in about 20 percent of patients nationally.  In most instances, rejection can be treated by temporarily increasing the dose of your anti-rejection medication or by using a combination of medications. While rejection of a transplanted organ is always a concern, the rejection rate of transplanted livers at Barnes-Jewish Hospital is very low. The risk of rejection decreases over time, but can occur at any time. It’s important to follow all medication regimens and physician orders to prevent rejection, and to recognize the early signs of rejection. Early symptoms of rejection include:
  • fever over 101° F
  • flu-like symptoms such as chills, nausea, vomiting, diarrhea, headaches, dizziness, body aches, tiredness
  • abdominal pain or tenderness
  • increased liver function tests

Later symptoms include:

  • yellowing of the skin and eyes
  • dark urine
  • light, clay-colored stools
  • confusion
  • increased fatigue
  • abdominal swelling

If you experience any of these signs of rejection, call your transplant nurse coordinator immediately.

Rejection must be treated as soon as possible to avoid complications. It is usually treated by temporarily increasing the dose of your anti-rejection medication or by using a combination of medications.

Nutrition and exercise

It is normal to feel tired or weak as you recover from liver transplant surgery. With regular exercise and good nutrition, you will eventually get back to a more normal, active routine. Most patients are ready to return to work or school within two to three months after transplant, although it may take longer to build your energy and endurance.

In the hospital, you will receive physical therapy to help you regain your strength. Once you are home, the best activity in the first few weeks is walking. You should avoid strenuous activity and heavy lifting for the first three months after transplant. Activities and sports that pose a high risk of injury should be avoided entirely.

After transplant, your body has increased nutritional needs to allow for healing and to fight infection. You also need to rebuild muscle tissue and restore protein levels. Your transplant team dietitian will develop a diet plan specific to your needs to help in your recovery and keep you healthy after transplant. The dietitian also can help you with any special dietary instructions or diets to manage co-existing medical complications such as diabetes, high blood pressure or high cholesterol.

The development of diabetes is common after liver transplantation but often resolves within six months of the transplant, especially as medication doses are reduced.

Follow-up care

The patients in our program have good overall success rates due to close follow up for the life of your transplant.  Long-term care is provided by a transplant coordinator and a team of liver transplant specialists who work with your primary care physician.

For more information on the liver transplant program at Barnes-Jewish Hospital, call .

Using Transplant to Treat Live

Cholangiocarcinoma is a cancerous growth in one of the ducts that carries bile from the liver to the small intestine. Surgeons at Barnes-Jewish and Washington University are advancing treatment of the disease, transplanting the livers of some patients.

 
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