University of Virginia Health System

Liver Transplantation

After The Transplant

After surgery, the liver transplant recipient is taken directly to the Surgical Intensive Care Unit (average length of stay is 2-5 days). During this time the patient will be monitored closely and many of the tubes installed during the operation will be removed. With a stabilized condition, the patient will be transferred to the transplant floor of the hospital.

On the floor visiting hours are less restrictive and there is more privacy. The average hospital stay for transplant patients is approximately 2 weeks after surgery. (Patients who are more ill going into surgery can expect to have a longer recovery period and hospital stay.) While recovering, the patient will spend time learning how to manage after transplant. This begins with the taking of medications as soon as recovery has progressed adeqautely.

Re-operations following liver transplants are common (most of which are short). The most common indication for re-operation is bleeding; this usually occurs in the first 2-3 days after the transplant. Bile leaks and infections of the abdomen can also occur, usually about one week after the transplant. Some livers may fail to function properly and need to be replaced with another new liver. When repeat transplant is necessary, the operation is generally much shorter in length.

Two types of problems may develop in the early post-operative period. The first is ischemic injuryIschemic Injury: Damage caused to tissue as a result of reduced or blocked blood flow., which can occur during the recovery and preservation of the donor liver. Signs of this usually develop in the first seven days after transplant. A more frequent occurrence is rejection. Rejection (which is detected by review of lab results or by liver biopsy) can occur at any time after transplant. Most patients who undergo organ transplant will develop some degree of rejection. Rejection can usually be reversed with an adjustment to medications. In more serious instances hospitalization may be required.

What can I expect after I go home?

Close monitoring after transplant is important for preserving good health and a well functioning new organ. Maintaining a proper level of immunosuppression to keep the body from rejecting the liver while avoiding serious infections calls for ongoing review.  Because patients are most at risk for rejection and infection in the first 90 days after transplant, close monitoring during this earlyu period is particularly important during this early phase. 

Over time the amount of immunosuppression required by the patient to preotect the organ will be reduced gradually. Patients must complete lab testing twice weekly for the first 2 to 3 months. After 3 months, the lab schedule will be reduced; at one year post-transplant most patients will be asked to keep to a monthly schedule. Labs can be done at a hospital close to home.

Transplant patients will return to the transplant clinic 1-2 weeks after discharge from the hospital. Then pateints return every 3 months for the first year (in some cases more frequently). After the first year follow-up appointments will be annuall. Patients will also see their referring doctor within 2 weeks of discharge from the hospital.

Transplant Medications

It will be necessary for you to take the immunosuppressive medicines for the rest of your life in order to maintain your transplanted liver. Patients who do not take  medications as prescribed are at risk for rejection and loss of the liver. The following is a list of anti-rejection drugs that are commonly used.

• Neoral ® or Cyclosporine formulation
• Prograf ®
• Cellcept ®
• Azathioprine ®
• Deltasone ® or Prednisone formulation
• Rapamune

These medications have side effects. Some of those include tremors, increased weight, mood changes, increased blood pressure, vision changes, increased risk of infection, increased blood sugar and increased risk of cancer. Patients are encouraged to report any instance of these kinds of symptoms.

Other medications that will be prescribed include anti-ulcer, antibiotic and anti-fungal drugs. Most patients are discharged from the hospital after transplant on an average of 13 different medicines. In most instances these medicines will be reduced over time.