Over 4,000 liver transplants a year are performed in the U.S. About sixty to seventy percent of liver transplant patients are alive and well after five years. While there are some side effects from medications taken to suppress the immune system (so the transplanted liver will not be rejected) most patients lead full, productive lives. In fact, many even have children. The use of new anti-rejection drugs and other medications are constantly improving the results of liver transplantation.

Donor livers and matching

Livers are donated from either live donors or deceased donors. Deceased donors are the responsibility of organ procurement organizations around the country. Deceased donor livers are distributed and allocated by UNOS (United Network for Organ Sharing) based on blood type. Live donors are persons who wish to donate part of their liver for you. They undergo an extensive workup to see if they can safely donate. If you know someone who wishes to donate part of their liver for you, have them contact our office at 717-531-6092 or 800-525-5395 and speak to the live donor coordinator for more information.

Reasons and risks

Transplantation is performed for acute fulminant liver failure or progressive chronic liver disease that is not responsive to any other medical or surgical treatment. It is assumed that without transplantation, your liver disease will ultimately be fatal. With liver transplantation, it is believed that your life expectancy will be prolonged and that there is a good likelihood that you will be able to resume a productive life.

You and your family must understand the procedure and make a commitment to follow a lifelong, disciplined medical program to prevent injury or rejection of the new liver. This requires you to take prescribed medication and maintain close contact with your family doctor, hepatologist, and transplant surgeon.

Our Adult Liver Transplant Patient Information Handbook is available for download.

After your transplant

Daily tasks

You will be asked to monitor your weight on a daily basis and your blood pressure and temperature twice a day and record them on the chart that will be included in your patient teaching manual.

• Take your temperature in the morning and in the evening. Call the transplant team if your temperature rises above 100 degrees F. Do not take medication to lower your temperature unless instructed to do so by your transplant physician.
• Check your weight every morning before breakfast, after you have gone to the bathroom. An increase in weight may mean that you are retaining fluids, or that you may need to control your calories.
• Take your blood pressure every morning and evening. If the top number is > 160 or if the bottom number is > 100 report it to the transplant team.

Potential complications

Numerous complications can occur after your transplant surgery. Surgical connections involving the bile duct or hepatic artery can leak or become blocked. Bleeding can occur in your abdomen after surgery requiring another operation.  Infections can occur in your abdomen or in your chest. On a rare occasion, the new liver will not start working right away and you may require a second transplant. Your condition will be constantly monitored with lab tests taken daily to determine your recovery.

Rejection

The biggest problem facing all transplant patients is the possibility of donor liver rejection. Rejection is the body’s attempt to get rid of a foreign substance, in this case your new liver. There are several kinds of rejection, and they can be a common and life-long issue.

• Acute – This is the most common type of rejection, and while it can happen anytime, it usually occurs during the first two weeks to six months after surgery.
• Chronic – This type of rejection can happen at any time, including years after the transplant.

A common cause of (chronic) late rejection is not taking your medication, skipping days, or taking the wrong dosage. The medicines that you take will help lessen the number or severity of the rejection episodes, but may not completely prevent them. Almost everyone has a rejection experience at one time or another. Most rejections that happen shortly after surgery can be treated medically. If you have rejection symptoms, come to the hospital immediately for treatment. The quicker you receive treatment, the more successful the treatment is likely to be.

Some of the signs of rejection are:

• Fever above 100ºF 
• Flu-like feelings   
• Back or abdominal pain                   
• Yellow skin or eyes (late sign, this is also called jaundice)
• Itching
• Swelling or tenderness over the new liver
• Gray-colored stools
• Dark, tea-colored urine

It is also important to remember that you may be experiencing rejection without any obvious signs or symptoms. That is why it is so important to have your blood tested on a regular basis.

Sometimes it may be necessary to do a biopsy of the transplanted liver to determine if there is rejection or another problem that needs treated. This would necessitate being at the hospital for a day. You will need to have a driver as you will not be allowed to drive for one day after the procedure.

Infection

The medications you take to prevent rejection will also place you at greater risk for infection, as they suppress your immune system. Common areas for infection are your lungs, bladder, or the incision site. You will be on medication for the first six months to help decrease your risk of getting an infection. Be sure to tell your family that family members who are ill should not come to visit.

Notify the transplant coordinator:

• If you have a cough that lasts longer than 3 days
• If you get pain in your chest or short of breath with the cough, or if you cough up anything green or yellow
• If you have any pain or burning when you urinate
• If you have any blood or blood clots in your urine or the urine becomes cloudy or foul smelling
• If you notice your incision getting red, swollen, or secreting pus or fluids

Diabetes

Some of the immunosuppression medications you take may cause diabetes. Diabetes is an increased level of glucose (sugar) in your blood. Signs of diabetes may include being thirstier, urinating more often, having blurred vision and being confused. Call your transplant coordinator if you have any of these signs. Your blood glucose levels will be monitored for the first year to help detect any problems early.

If you should develop diabetes, you will be given teaching on how to deal with this problem. In some cases, diet, weight loss and exercise can control it. Some people need oral hypoglycemic medications or insulin to help control their diabetes.

High blood pressure

High blood pressure is also a common side effect of some of the medications you take. You may need another medication to control your blood pressure. Following your vital signs schedule carefully will help detect this problem and allow early treatment to avoid complications from high blood pressure. Call your transplant coordinator if your blood pressure consistently reads higher than 160/100.

You will be taking medication for the rest of your life in order to prevent your body from rejecting your new kidney. While hospitalized, you will be told what medicines to take, what each medicine does, and common side effects of each medicine by the pharmacist, your nurses, and coordinator. You must become familiar with the names, dosage, and recording of all your medications. The number and dosage of the medicines will be lowered as you improve. Never stop taking a medicine without talking to the transplant team.

Also, you must never take prescriptions from your family doctor or over-the-counter medicines, without first talking to the transplant team. This includes common medications such as aspirin or Tylenol. Many drugs cause serious side effects in patients taking anti-rejection medications. Telephone the transplant program before taking new medicines, even on an emergency basis and even if ordered by a physician in an emergency room. Call your transplant coordinator FIRST!

Outcomes

For further information please visit the Scientific Registry of Transplant Recipients (SRTR) website.

Data source: UNOS/Scientific Registry of Transplant

For further information please visit the Scientific Registry of Transplant Recipients (SRTR) website.

Data source: UNOS/Scientific Registry of Transplant