Liver Transplant

Liver transplant is surgery to replace your liver with a liver from another person (donor liver). You may need a liver transplant if no other treatment can make your liver healthy again.

Liver transplant is a major surgery. You will work with a team of health care providers (transplant team) to help you prepare for the procedure and help you recover.

A donor liver may come from a living person, or it may come from someone who has died and donated his or her liver. If you need a liver from someone who has died, your name will be put on a waiting list for the donation. If you receive a liver from a living person, only a part of that person’s liver will be taken and used. Over time, your body will make new liver tissue.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you smoke or use tobacco products.
• Whether you are pregnant or may be pregnant, if applicable.

What are the risks?

This is a major surgery. Problems may occur, such as:

• Bleeding.
• Infection.
• Seizures.
• Blood clots in the blood vessels of the new liver.
• Leaking of fluid (bile) from the new liver.
• The new liver not working (graft failure).
• Your body’s disease-fighting system (immune system) attacking the new liver. This is called rejection.
• Damage to other structures or organs.
• Emotional problems and stress caused by the long recovery and the need to limit contact with other people after the procedure.
• Problems caused by medicines, such as an allergic reaction or a higher risk of:
  • Infections.
  • Diabetes.
  • Kidney problems.
  • Heart disease.
  • Bone thinning (osteoporosis).
  • Cancer.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You will have many tests, including blood tests and imaging tests.
• Ask your health care provider how your surgical site will be marked or identified.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can affect how medicines work and may slow the healing process. If you need help quitting, ask your health care provider.
• You may need to plan for a long recovery time with limited activity. You may need psychological and emotional counseling to prepare for the procedure and the long recovery.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• A long, thin tube (central line catheter) will be inserted into a blood vessel in your neck or groin. This tube will be used to give you fluids and medicines.
• A catheter will be inserted into a blood vessel that carries blood away from your heart (arterial catheter). This catheter will be used to check blood pressure and get blood samples during the procedure.
• You may be given medicines to help prevent infection and rejection of the liver.
• A catheter will be inserted into your bladder to drain urine during and after surgery (urinary catheter).
• A tube will be placed through your nose, into the back of your throat, and down to your stomach (nasogastric tube, NG tube). This tube will be used to drain your stomach fluids.
• An incision will be made in your abdomen.
• Your liver will be removed by cutting and temporarily closing off (clamping) the major blood vessels of the liver.
• The donor liver will be attached to your blood vessels.
• The tube that drains bile out of the new liver (bile duct) will be attached to the upper part of your intestine.
• Tubes will be placed near the new liver and brought out through your abdomen to drain excess fluids from the area (surgical drains).
• Your incision will be closed with stitches (sutures) or staples and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may breathe through a tube in your throat. While this breathing tube is in place, you will be given medicine that keeps you asleep (sedated). If there are no early signs of bleeding or rejection, the breathing tube will be removed.
• You may continue to have:
  • A central line catheter. You will be given IV nutrition through this tube until you can start eating normal foods.
  • An arterial catheter.
  • A urinary catheter.
  • A nasogastric (NG) tube.
• You will be given medicines that:
  • Help to relieve pain.
  • Help to prevent rejection of the new liver.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.

Summary

• Liver transplant is a major surgery. A transplant team will help you prepare for and recover from your surgery.
• This procedure is done with general anesthesia. This means that you will be asleep during the procedure. You may continue to be asleep (sedated) for a period of time after the procedure.
• A risk of this procedure is that your body may reject the liver from another person (donor liver). You will be monitored closely for symptoms of rejection.

Liver Transplant, Adult, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness in your abdomen.
• Fatigue.
• A weak disease-fighting system (immune system).
• Changes in mood.

Follow these instructions at home:

Work closely with your team of health care providers (transplant team). Learn as much as you can about your condition so that you have an active role in your treatment and recovery.

Watching for rejection

Rejection means that the immune system is attacking the new liver. This is most common in the first few months after surgery. If you have changes in certain body measurements or have certain signs or symptoms, you may be having a rejection response.

Take the following measurements every day. Ask your health care provider how to measure your:

• Temperature.
• Blood pressure.
• Weight.

Watch for any of the following signs or symptoms of possible rejection:

• Fever.
• Loss of appetite.
• Nausea or vomiting.
• Pain in your abdomen.
• Sudden weight gain.
• Yellowing of the skin or the whites of the eyes (jaundice).
• Dark-colored urine.
• Clay-colored stools.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. These include pain medicines.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• You will need to take medicines to prevent your body from rejecting the donor liver (immunosuppressants) for the rest of your life.
• Develop a routine to make sure you take all your medicines correctly and at the right time each day.
• Ask your health care provider what side effects you should be aware of.

Eating and drinking

• Work with a nutrition specialist (dietitian) to make sure that you eat enough calories and healthy foods.
• Avoid foods that are high in salt (sodium), sugar, or saturated fat.
• Ask your health care provider if you need to take supplements or vitamins.
• Do not eat raw or undercooked foods. Those foods raise your risk of infection.
• Drink enough fluid to keep your urine pale yellow.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Rest as told by your health care provider.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
• Ask your health care provider what activities are safe for you and what activities you should avoid.
• Until your health care provider approves:
  • Do not travel far from your hospital, clinic, or transplant center.
  • Do not drive or use heavy machinery.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you.

Lifestyle

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Do not have any alcohol.

Preventing infection

• Certain medicines that you take may raise your risk of infection. Make sure that you:
  • Wash your hands frequently with soap and water. If soap and water are not available, use hand sanitizer. Have close friends and family members also wash their hands often with soap and warm water.
  • Do not share cups, bottles, utensils, or other personal items, such as toothbrushes.
  • Avoid close contact with people who are sick.
  • Stay away from pets such as reptiles, birds, and rodents.
  • Avoid contact with soil, stool (feces), and mold.
• Ask your health care provider when it is safe for you to get vaccines, and ask which vaccines are safe for you.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important. You will need to return to your hospital, clinic, or transplant center often to have:
  • Blood tests.
  • Liver function tests.
  • Liver imaging tests.
• Protect yourself from the sun by:
  • Wearing sunscreen (with an SPF 30 or higher).
  • Avoiding outdoor activities when the sun is strongest (between 10 a.m. and 4 p.m.).
  • Wearing a wide-brimmed hat and sunglasses.
• Talk with your health care provider if you are having any emotional problems during your recovery, such as sadness, stress, or anxiety.

Contact a health care provider if:

• You have redness, swelling, or pain around your incision.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have side effects from medicines.
• You have any changes in your temperature, blood pressure, or weight.
• You have any symptoms of an infection, such as:
  • Cough.
  • Nasal stuffiness (congestion).
  • Sore throat.
  • Diarrhea.
  • Sores on your skin or in your mouth.
  • White patches on your mouth or tongue (oral thrush).
  • Burning pain while urinating.

Get help right away if:

• You have difficulty breathing.
• You become very tired or sleepy.
• You have a seizure.
• You have any signs or symptoms of possible rejection.

Summary

• Work closely with your team of health care providers (transplant team) during your recovery. It is important for you to have an active role in your recovery and your treatment.
• Stay close to your hospital, clinic, or transplant center. You will need to return often to have follow-up tests.
• Make sure that you know when to call your health care provider and when to call emergency services.