Recovery at the transplant centre

After a liver transplant you will be transferred from theatre to the intensive care unit (ICU). You will be kept asleep initially. ICU care is an essential part of the post-operative recovery and the length of your ICU stay will vary according to how sick you were going into the transplant and how well your body copes with the new liver.

Over the next few days, as you require less nursing support and monitoring, you will move to the main transplant ward.

Critical care doctors and nursing staff care for you in the intensive care unit (ICU). There is always a nurse at your bedside. The liver transplant team will also be involved with your care while you’re in the ICU.

The nurses and doctors looking after you will keep a close eye on your pulse, blood pressure, temperature and urine output. You will need regular blood tests, as least once daily and sometimes more often.

You will feel sore after the surgery. Pain is initially controlled by strong painkilling drugs delivered continuously via a drip (e.g. morphine).

This then changes to tablet painkillers as you recover.

Pain control is important to help you breathe deeply and cough, and to allow you to move freely.

Pain management

• There are specialist pain teams that can help you if your pain is not well controlled.
• It is important that your pain is well controlled. This will help you get out of bed earlier, and reduce the risk of blood clots in the legs and lungs. Good pain control will help you take deep breaths and reduce the risks of developing a chest infection. However, painkillers have side effects, including sickness, itching, drowsiness, and constipation.

Specialised equipment is used to monitor your recovery and give you essential fluid and drugs. When you wake up in intensive care, your tubes and drips are still in place.

Sometimes when you wake from the surgery, you will still be attached to a machine that helps you breathe (ventilator). This breathing tube is removed after you wake up and are able to breathe on your own.

When the tube is removed you can speak again although you will need oxygen via a mask. You may have a sore throat and a hoarse voice. A physiotherapist will help you with breathing exercises and coughing, which are important to prevent breathing problems or chest infections.

Some patients with liver disease also have problems with their kidneys, which may improve after a liver transplant. However, immediately after surgery they may need to be placed on a dialysis machine for a short time.

To start with you’ll need fluids to be given to you through a drip (intravenously into your vein).

You will be able to start drinking immediately and most patients will also be able to start eating soon after the transplant.

After the first 2-3 days, drains that were left in your tummy at the time of the operation will be removed and the plastic tubes in your veins will also be taken out. Your transplant team will see you daily and make these decisions.

You may feel quite bloated after your operation, as it is likely that your bowels will not be working properly for the first few days. Your transplant team will tell you when you can start eating and drinking again. You may need laxatives to help you open your bowels. The sooner you get out of bed and start moving around, the sooner your bowels will start working.

If you are still constipated after having laxatives, you may need an enema (a medication given up your anus) to help you open your bowels.

Within a day or two you will be helped to sit up in bed and encouraged to start walking. The nurses and physiotherapists will help you. It is very important to get out of bed as soon as possible after your operation to reduce the risk of blood clots in your legs and other problems after surgery.

You may have an ultrasound scan of your liver in the first few days after surgery. This is routine in some centres.

The physiotherapist will work with you to ensure you are mobile and safe to go home, and if you have stairs at home that you are able to climb these.

You will only be discharged from hospital when:

• You are physically strong enough
• Your immunosuppressant medication levels are adequate
• You have learnt enough about your condition to look after yourself at home. This will include information about your medications, knowing how to look for symptoms of rejection or infection, and information about any lifestyle changes you need to make.

Many medicines will be prescribed after a liver transplant, for example to prevent rejection or infection, or to manage pain.

All patients that have a liver transplant will need immunosuppressants. These lower your immune system and reduce the chance of your body rejecting your new liver.

Each transplant centre unit uses slightly different medicine doses and types. Before you leave the transplant centre, you will be given detailed information about your medicines and how to take them. You’ll also be told what other medicines or food to avoid.

It’s very important that you take all your new medicines as directed.

Learn more about transplant medicines

If you start taking any over-the-counter medications you should discuss this with your GP or liver transplant team first as they may affect your immunosuppressant medications. You should not take any herbal medications without speaking to your liver transplant team first.

You will be told if there are any foods to avoid.

If you require extra support at home (for example, help with cooking, cleaning, mobility, wound care), this will be discussed with you before you leave hospital.

An appointment will be made for you in the liver transplant clinic and you’ll be told the date, time, and location of this visit. To start with, most patients will be seen once a week in the transplant clinic after their operation.