After a liver transplant for liver cancer

After your liver transplant, you wake up in the intensive care unit. You usually move back to the ward within a day or so.

This information is for people who are having a liver transplant. We have separate information if you are having part of your liver removed. Your doctor might call this a liver resection or a lobectomy.

In intensive care you have one to one nursing care. Your surgeon and anaesthetist review you regularly and watch your progress closely.

These units are busy and often noisy places that some people find strange and disorientating. You'll feel drowsy because of the anaesthetic and painkillers.

Tubes and drains

When you wake up, you have several tubes in you. This can be frightening, so it helps to know what they’re for.

You might have:

• drips to give you blood transfusions and fluids usually through a vein in your neck
• wound drains to drain any blood, bile or fluid from around the operation site
• a tube down your nose into your stomach (nasogastric tube) to drain bile and stop you from feeling sick
• a tube into your bladder (catheter) to measure how much urine you pass
• a small tube into a vein or artery to check your blood pressure

You may also have an oxygen mask on.

Electronic pumps may control any medicines you have through your drip.

Your wound

Your surgeon does the operation through a large cut in your tummy (upper abdomen). You have a dressing over your wound when you wake up. The dressing stays in place for a couple of days. Your nurse cleans the wound and puts new dressings on.

Your surgeon closes the wound with metal clips or staples. Your nurse removes these after about 10 to 14 days.

The wound drains stay in until they stop draining fluid. Your nurse changes the bottles attached to them every day. The drains usually stay in for a few days, but it might be longer.

Painkillers

It’s normal to have pain for the first week or so. You have painkillers to help.

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). Analgesia is another word for painkillers. 

You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.

Eating and drinking

You usually will be able to drink as soon as you wake up and feel able to. You might start eating small amounts the day after your operation depending on how you feel. Your nurse or dietitian might give you nutrition drinks to help until you are able to eat normally.

You might have a tube down your nose and into your stomach called a nasogastric tube. This drains fluid from your stomach and helps to stop you feeling sick. Your nurse will remove the tube once you are eating and drinking normally.

Getting up

Your nurses and physiotherapists will help you to move around as soon as possible once you’re back on the liver unit. They'll check you're doing your breathing and leg exercises. This helps you recover. 

Making progress

During the first few days after your operation, you’ll start to feel better. The drips and drains will come out, you’ll start eating and can move about better.

You’ll begin to feel like you’re making progress.

Blood tests

You have blood tests every day to check how well your new liver is working. You might also need scans and samples taken of the liver (biopsy).

Preventing rejection of your new liver

You will start to take anti rejection medicines. These are also called immunosuppressants. Your transplant team will explain how to take these when you go home.

Your immune system protects your body against infections by recognising foreign bodies, such as bacteria and viruses. It tries to destroy them. Unfortunately your immune system sees your new liver as foreign and will try to fight it.

To prevent this happening you take anti rejection medicines, usually for the rest of your life. This medication weakens your immune system so that it won't attack the liver.

The most common anti rejection drugs include:

• tacrolimus (Prograf)
• prednisolone or other steroids
• cyclosporin (Neoral)
• mycophenolate mofetil (Cellcept)
• azathioprine

Most people have a combination of these drugs, such as tacrolimus, azathioprine and prednisolone.

One major side effect from all these drugs is that they increase your risk of getting infections. The risk is highest during the first few months because this is when you have high doses of these drugs. You have regular blood tests while you are taking anti rejection drugs, to make sure you're taking the right amount.

Rejection after a liver transplant can be immediate (acute) or long term (chronic).

Going home after surgery

You usually spend 8 to 10 days in hospital after a liver transplant, depending on your recovery.

When it's time for you to go home you’re likely to feel a bit anxious and might be worried about not having the doctors and nurses around. This is natural, but remember that your doctor will only send you home once they believe you are well enough and you understand how to take the medication you need.

It’s important that you take it easy for some weeks after you get home. Your body won't have recovered completely and you’re still at high risk of getting an infection. 

Before you leave the hospital, the staff will spend time preparing you. They will talk to you about your medicines and the possible side effects. They will tell you how often you have follow up appointments, and what to expect in the first year after your transplant. At first, you will see your doctors weekly to check that all is going well.

When you go home, there are some important things to remember:

• stay away from people who are ill, including people who have colds
• stay away from crowds, especially where there is poor ventilation
• wash your hands often
• know the signs of infection including fever, a sore throat, or just generally not feeling well
• tell your doctor if you have a white coating on your tongue or spots in your throat - this might be caused by an infection called thrush
• women can also develop vaginal thrush so do let your doctor know if you have itching or discomfort
• always take your medicines at the times scheduled; it is important not to miss any
• ask your doctor or pharmacist if any of the medicines you take should be stored in the refrigerator
• talk to your doctor or transplant nurse about any new medicines or vitamins before you start taking them
• talk to your specialist before you start driving again

Diet

Your transplant team will give you information about a safe diet and some foods that you should avoid. For example, make sure any meat you eat is cooked thoroughly. Avoiding some foods can reduce the risk of infection such as listeria or salmonella.

Contacting the donor's family

Some people want to contact the family of the person whose liver they received. This is usually fine if the contact is anonymous.

The transplant coordinator will help you write to the donor’s family. Usually this happens several weeks or months after the transplant. Ask your transplant coordinator about this if it's something you would like to do.