​​​​​​​​​​​Where do I go after my surgery?

After your transplant surgery, you will go to the intensive care unit (ICU). The ICU team will care for you. How much time you spend in the ICU is different for everyone.

Once you are stable and your breathing tube has been removed, you will be sent to an inpatient unit.

You will be weak after your surgery, but you will slowly resume an active role in caring for yourself.

What can I do in the hospital after my surgery to help with my recovery?

• Follow the instructions of your healthcare team.
• Ask for medicines when you are in pain.
• Practice deep breathing and coughing techniques.
• Change positions in bed and keep moving your arms and legs.
• Work with the physiotherapist to help regain your strength.
• Work with the occupational therapist to help you get back to your daily activities.

If you have mental health issues like depression or anxiety, it’s possible that these may get worse after your transplant. Your post-transplant team can refer you to a mental health specialist. Visit Help in Tough Times for a list of resources that you can access when you’re feeling stressed or are having a difficult time.

When will I be able to leave the hospital after my liver transplant?

After a liver transplant, everyone stays in the hospital for a different amount of time.

You will leave the hospital when:

• You have learned how to take your own medicines.
• You are able to recognize the signs of infection and rejection.
• The surgical and medical teams decide that you are medically and physically stable enough to go home.

What happens after I leave the hospital?

It is important to know that getting a transplant means a lifetime commitment to medical treatments.

If you live outside of the Edmonton area, you and your support person should be prepared to stay in Edmonton for 3 months.

Your transplant team will follow you closely. Your follow-up appointments and tests may take up a lot of time. Make sure you and your support person have a way to get to and from your appointments, as you may not be able to drive yourself. You will need to take time off work during the recovery period. The length of the recovery period can be different for everyone.

You will need to go to appointments to see your surgeon and liver specialist. How often you visit the clinic depends on your medical needs.

You will go for many lab tests after you leave the hospital. The number of lab tests will go down over time as your bloodwork gets to your new normal. Having lab tests is how your transplant team knows if the liver transplant is working well and if you are taking the right amount of medicines (anti-rejection medicines) to prevent your body from rejecting the new liver.

You may need to attend physiotherapy and occupational therapy appointments.

Once the transplant team says it’s OK to go home, they will try to have your blood tests and other follow-up support done closer to where you live.

What can I do to help with my recovery and overall health?

• Eat a balanced diet and maintain a healthy weight. Your transplant dietitian can help you.
• Exercise regularly following the guidelines that your therapists and doctors give you.
• Do not drink alcohol.
• Do not smoke or vape.
• When travelling, always bring enough medicine for the length of your trip and a few extra days’ worth in case of delays.
• When going out into the sunshine, wear a hat and sunscreen and do not get a sunburn. Avoid tanning beds. The medicines needed to prevent rejection of your transplant increase the risk of skin cancer.
• Take good care of your teeth. See a dentist regularly. Before any major work on your teeth or mouth, call your transplant team.
• Keep seeing your family doctor and any other healthcare providers for your general healthcare needs.
• Tell the transplant team if there are any changes in your medical condition or the medicines you take. Check with your transplant team before taking any over-the-counter vitamins, medicines, or supplements.
• Remember that you just had a major surgery. You may experience strange emotions, feelings, or nightmares during your recovery. Ask your transplant team about being referred to someone to help you cope during these times.

Having these items at home can help you collect information that your healthcare team uses to watch your recovery and overall health:

• bathroom scale that measures in kilograms
• thermometer that measures in Celsius
• blood pressure cuff
• notebook, app, or computer document to record your temperature, weight, and blood pressure

What kind of medicine will I need to take after my liver transplant?

Anti-rejection medicines (also called immunosuppression medicines) prevent your immune system from attacking the transplanted liver.

You will need to take anti-rejection medicines every day for the rest of your life. Not taking these medicines as instructed, or missing doses, may lead to your liver not working properly or not working at all.

Take these medicines at the same time of day that you took them in hospital. Never stop taking these medicines without first talking to a member of the liver transplant team.

When you take anti-rejection medicines:

• You will need to get bloodwork done often to monitor your medicine levels.
• Many drugs and some foods will interact with your anti-rejection medicines. Talk to the transplant team or your pharmacist to learn more about which drugs and foods to avoid.
• Tell your pharmacist, dentist, and all other healthcare providers that you are taking these medicines.
• Do not get pregnant or get someone pregnant while on anti-rejection medicines without first talking to a member of the transplant team.
• Anti-rejection medicines can increase your risk of some types of cancer. For more information, talk to the transplant team.

There are other medicines you might also need to take:

• medicines to protect your stomach from ulcers caused by other medicines
• antibiotics, antivirals​, or both to help protect you against infection
• water pill (also known as a diuretic) to help your body remove extra fluid
• medicines to keep up with essential nutrients like calcium, magnesium, or iron

You are responsible for taking your medicines. Talk to your doctor, pharmacist, inpatient nurse, or transplant coordinator to understand:

• the name and reason for each medicine
• when to take each medicine
• how to take each medicine
• side effects of each medicine
• what to do if you forget to take a dose
• when to order more medicine so it doesn’t run out

Your healthcare team will teach you about your medicines while you are in the hospital. While in hospital, you will start giving yourself the medicines with directions from the nurses. This will help you become familiar with the number of new medicines you will need to take at home by yourself.

What is rejection?

Rejection happens when the transplanted liver is attacked by your own immune system. The best way to prevent rejection is to take your anti-rejection medicines on time, take the right dose, and complete lab work as scheduled.

It is very important to watch for any signs of rejection so that your doctor can treat it quickly. Possible signs of rejection may include:

• fever
• fatigue
• abdominal pain
• vomiting
• diarrhea
• increased liver enzymes (this will show in a blood test)

If the transplant team thinks that rejection may be happening, you may need a liver scan and a liver biopsy. A biopsy is a procedure where a needle is used to take a small sample of your liver for testing. If rejection is confirmed, your transplant team may increase the doses of your anti-rejection medicines or give you different medicines.

Rejection can happen at any time. Talk with your transplant coordinator if you have any questions or concerns about rejection.

How can I avoid getting sick after my liver transplant?

After transplant, you have a higher chance of getting an infection. It is important to take steps to protect yourself from getting sick, like washing your hands and avoiding contact with people who are sick. Stay up to date on all immunizations.

Watch for possible signs of infection:

• temperature greater than 38°C
• sweating, chills, and shaking
• shortness of breath
• cough that creates mucus
• pain, redness, or swelling
• change in colour, amount, and smell (odour) of your urine (pee) or stool
• burning when you pass urine (pee)
• open sores that have drainage

You may be given medicines for a period of time after your transplant to help prevent some of these infections.

Call your transplant coordinator right away to report signs of infection. If they are not available, call Health Link at 811.

If you have shortness of breath, chest pain, uncontrolled high fever, or any other severe symptoms, go directly to your nearest emergency department.