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Life after a Liver Transplant

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Once a patient is discharged, blood tests and medical visit are performed within the first 15 days after the transplant to check the state of the patient. Patients have to attend monthly appointments for the first 3 months, then every 2–3 months throughout the first year. These check-ups will become less frequent as the patient and any complications increasingly require less care.

Post-transplant complications

Rejection. Rejection occurs when the immune system, the body’s natural defence mechanism designed to protect against infections, is activated. The immune system identifies the new liver as a foreign object inside the body and tries to protect it by activating different defence mechanisms. There are two types of rejection:

Acute. Acute rejection is the most common type and usually happens in the first few months after the transplant; it always tends to be reversible.
Chronic. Chronic rejection develops more slowly and can result in the loss of the new organ.

There is always a risk of rejection, which is why it is so very important to take the immunosuppressant medication according to the prescription. A large proportion of patients experience at least one episode of rejection but, despite this, most cases are resolved satisfactorily. Although some rejections are asymptomatic, the potential signs of warning can be:

Fever or temperature of over 38 °C.

Yellowing of the skin, mucous membranes and eyes.

Itchiness.

Dark urine and/or pale faeces.

Tiredness and exhaustion.

Poor appetite, nausea or vomiting.

Infections. Transplant recipients often develop infections because immunosuppressive therapy reduces their bodies’ defences. Patients who receive a liver transplant can suffer bacterial, viral or fungal infections. They are commonly encountered in the surgical wound, blood, urine, lungs or bile during the first 3–6 months post-transplant.

It is therefore essential for patients to adopt preventative hygienic/dietary measures: frequent handwashing, strict food hygiene, adhere to medication, avoid contaminated environments, etc.

Immunosuppressive therapy

Immunosuppressants are designed to reduce the immune system’s activity and therefore help prevent organ rejection.

There are various immunosuppressive agents available:

Tacrolimus (Prograf®, Advagraf®, Tacni®, etc.)
Cyclosporine (Sandimmune®, Ciqorin®)
Mycophenolate mofetil, mycophenolate sodium (CellCept®, Myfenax®, Myfortic®, etc.).
Prednisone
Everolimus (Certican®)

Most of these medicines need to be monitored through blood tests in order to find the correct dose.

Patient lifestyle after a liver transplant

Diet. Correct nutrition helps patients recover sooner and maintain a good state of health. Eating a varied, balanced diet is the easiest way to ensure an intake of all types of nutrients. However, the patient’s new situation means strict hygiene measures must be applied when selecting and handling foods. These recommendations should be followed for the first 3 months post-transplant. Patients can then adhere to the basic standards of food hygiene recommended for the general population.

Physical exercise. Physical exercise forms part of the post-liver transplantation management designed to maintain and improve the patient’s health. The main aim is to prevent and control diseases associated with the post-transplant medication (osteoporosis) and a sedentary lifestyle that present a cardiovascular risk (high blood pressure, diabetes, high cholesterol, obesity). Patients are advised to go for strolls during the first 3 months, new activities and greater levels of intensity can be introduced later.

Do not smoke. Avoid smoky environments. Tobacco is harmful to the health and causes alterations in the cardiovascular and respiratory system. It also produces a significant increase in the risk of developing lung or throat cancer.

Alcohol. Do not drink alcoholic beverages. Alcohol is eliminated from the body by the liver and it provokes hepatic alterations. It also interferes with the absorption of medicines.

Sexuality. Patients can return to normal sexual activity as soon as they feel comfortable after being discharged from the hospital. If patients do not have a stable partner, they should exercise precaution, through the use of condoms, to avoid contracting a sexually transmitted infection (STI).

Men often experience impotence after receiving a liver transplant due to weakness and fatigue. Normal function is generally restored within a few months; if not, patients should discuss it with a urologist.

Travelling. Patients are recommended not to travel to countries with a poor healthcare system in the first year post-transplant. They can travel after this period, but should always discuss any plans with their doctor who will indicate whether or not the trip is suitable.

It is a good idea to take plenty of medication with you, in fact more than you consider necessary, plus the name of your medication and even a copy of your medical record. Carry medicines that you need to use during the journey in your hand language, presenting them separately at security controls.

Do not consume unbottled drinking water and ice cubes.

Social and emotional support. There are support associations that accompany transplant patients and their relatives through each of the stages of the disease.