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Life after Liver Transplantation

Clinic Visits

Regular follow-up is essential after a liver transplant . The frequency of clinic visits is usually twice a week immediately after discharge. The frequency gradually decreases to once weekly, then fortnightly and later monthly. Once the liver function is stable, frequency of clinic visits can decrease to once in 6 monthly to one year. However liver function tests should be carried out once in 1-2 monthly even in the long term.

What happens during a clinic visit?

The clinic visit is aimed at checking the function of the new liver and identifying any problems at an early stage, so that measures can be taken to rectify the problem. At each clinic visit, the recipient gives his blood tests – usually liver function tests (LFT) and blood tacrolimus levels in the morning. It is important that the samples are given while the patient is fasting and has not taken his regular transplant medications –especially tacrolimus (PROGRAF). The actual clinic is in the afternoon when a panel of doctors will review the test results, medication list and make any necessary modifications. New medications may be added, previous medications discontinued or their dose changed depending on the clinical status and blood results. The recipient should discuss any new problems with the team at that point.

How to get medical advice in between clinic visits?

For regular queries, it is best to contact through the unit transplant coordinator by email. You can also contact them and your doctors through telephone if required. In case of emergency, it is safest to come to the casualty where immediate care can be given and the transplant team will be contacted.

Taking care of yourselves after Liver Transplantation

Liver transplantation is a lifelong commitment. The better you take care of your new liver, the better and longer it will serve you. Taking prescribed medications correctly as advised by the transplant team and regular follow-up with the transplant team by clinic visits or e-consultations is very important.

Problems after Liver Transplantation

Transplant patients are at risk of complications related to rejection, the original liver disease or the medications that they need to take after a transplant.

Rejection

Rejection is not uncommon after liver transplant and up to a third of all transplant patients will develop signs of rejection in the first year after transplantation. The diagnosis is suspected based on blood investigations. Usually a liver biopsy under local anesthesia is necessary to confirm the diagnosis. The treatment depends on the severity of rejection. Mild episodes may be treated with some modification of their anti-rejection medications. More severe episodes will need admission and treatment with intravenous steroids. Rejection is completely treatable in over 90% of cases with these measures. Occasionally, stronger medications may be required to treat persistent rejection.

Infection

Patients who undergo liver transplantation have an increased susceptibility to infections due to the anti-rejection medications. The risk is high in the early post- transplant period and gradually decreases after the first 6 months. We advise patients to maintain good hygienic practices, avoid improperly cooked food, and avoid close contact with persons with active infection. They should seek early medical attention in case of any new symptoms. Some routinely prescribed antibiotics such as erythromycin, azithromycin interact strongly with anti-rejection medications and should be avoided. It is best to discuss any new medications with the transplant team before starting them.

Tumours

Transplanted patients have a slightly increased risk of tumours. This is related to the intensity of immunosuppression used in them.

Skin tumours are the most common type of tumours occurring in the transplant population and are also completely curable if identified and treated early enough. Measures to decrease the risk include avoiding unnecessary sun exposure and using sunscreen when going out. Monthly self-examination of the entire body using a mirror will help in identifying any new skin lesions such as moles, patches etc or change in the appearance of existing moles should be reported to the transplant team.

Head and neck tumours and lymph-gland tumours can also occur with higher frequency in liver transplant patients.

Other Drug related complications

These include kidney dysfunction, diabetes, cataracts, high blood pressure, thinning of bones. Regular checkups will help in identifying and treating them early and prevent permanent damage.

Complications related to the original Liver Disease

Patients who undergo liver transplant for hepatitis B or hepatitis C viruses and autoimmune liver disease should be monitored for the recurrence of the disease. Blood tests are usually the earliest indicator of disease recurrence, but a liver biopsy may be required to confirm the diagnosis.

Looking to the future: Living with a Liver Transplant

Liver transplant completely changes the life of a patient who is suffering from end- stage liver disease. The initial post-transplant period may be difficult due to frequent blood tests, clinic visits and the occasional hospital admission. However, by around six months most patients will be able to enjoy an active life, get back to their studies or work, take holidays. Unlike a kidney transplant, there is no time limit for a liver transplant and patients who have received liver transplants over thirty years ago in the West are still well. This is particularly important for children who have needed liver transplant. They have been able to lead a normal healthy life, complete their education, have a career and start a family as anyone else.