Liver Transplantation Health Article

Aftercare

Following surgery, the patient will wake up in the surgical intensive care unit (SICU). During this time, a tube will be inserted into the windpipe to facilitate breathing. It is removed when the patient is fully awake and strong enough to breathe on his or her own. There may be other tubes that are removed as the patient recovers. When safe to leave the SICU, the patient is moved to the transplant floor. Walking and eating will become the primary focus. Physical therapy may be started to help the patient become active, as it is an important part of recovery. When the patient begins to feel hungry and the bowels are working, regular food that is low in salt will be given.

A patient should expect to spend about 10 to 14 days in the hospital, although some stays may be shorter or longer. Before leaving the hospital, a patient will be advised of: signs of infection or rejection, how to take medications and change dressings, and how to understand general health problems. Infection can be a real danger, because the medications taken compromise the body's defense systems. The doctors will conduct blood tests, ultrasounds, and x rays to ensure that the patient is doing well.

The first three months after transplant are the most risky for getting such infections as the flu, so patients should follow these precautions:

• Avoid people who are ill.
• Wash hands frequently.
• Tell the doctor if you are exposed to any disease.
• Tell the doctor if a cold sore, rash, or water blister appears on the body or spots appear in the throat or on the tongue.
• Stay out of crowds and rooms with poor circulation.
• Do not swim in lakes or community pools during the three months following transplant.
• Eat meats that are well-cooked.
• Stay away from soil, including those in which house-plants are grown, and gardens, during the three months following transplant.
• Take all medications as directed.
• Learn to report the early symptoms of infection.

To ensure that the transplant is successful and that the patient has a long and healthy life, a patient must get good medical care, prevent and treat complications, keep in touch with doctors and nurses, and follow their advice. Nutrition plays a big part in the success of a liver transplant, so what a patient eats after the transplant is very important.

Medications needed following liver transplantation

Successfully receiving a transplanted liver is only the beginning of a lifelong process. Patients with transplanted livers have to stay on immunosuppressant drugs for the rest of their lives to prevent organ rejection. Although many patients can reduce the dosage after the initial few months, virtually none can discontinue drugs altogether. For adolescent transplant recipients, post transplantation is a particularly difficult time, as they must learn to take responsibility for their own behavior and medication, as well as balance their developing sexuality in a body that has been transformed by the adverse effects of immuno-suppression. Long-term outcome and tailoring of immunosuppression is of great importance.

Cyclosporine has long been the drug of experimentation in the immunosuppression regimen, and has been well-tolerated and effective. Hypertension, nephrotoxicity, and posttransplant lymphoproliferative disease (PTLD) are some of the long-term adverse effects. Tacrolimus has been developed more recently, and has improved the cosmetic adverse effects of cyclosporine, but has similar rates of hypertension and nephrotoxicity, and possibly a higher rate of PTLD. Prednisone, azathioprine, and tacrolimus are often combined with cyclosporine for better results. Newer immunosuppressive agents promise even better results.

There has been a recent, welcome development in renal sparing drugs, such as mycophenolate mofetil, which has no cosmetic adverse effects, does not require drug level monitoring, and is thus particularly attractive to teenagers. If started prior to irreversible renal dysfunction, recent research demonstrates recovery of renal function with mycophenolate mofetil. There is little published data on the use of sirolimus (rapamycin) in the pediatric population, but preliminary studies suggest that the future use of interleukin-2 receptor antibodies may be beneficial for immediate post-transplant induction of immunosuppression. When planning immunosuppression for adolescents, it is important to consider the effects of drug therapy on both males and females in order to maintain fertility and to ensure safety in pregnancy. Adequate practical measures and support should reduce noncompliance in this age group, and allow good, long-term function of the transplanted liver.