Liver transplant medicines

You will need to take immunosuppressant medicines to reduce the risk of liver rejection. This usually consists of 2 or 3 different medicines. The doses of these medicines usually reduce over time, but some immunosuppressant medicines will be needed for the lifetime of the liver transplant.

It is extremely important that you take your immunosuppressant medicines as prescribed. You are at risk of rejection of the liver if your immunosuppression levels are too low. You are also at increased risk of medicines side effects if your immunosuppression levels are too high.

The immunosuppressant medicine levels in your blood will be checked regularly.

Common immunosuppressants and their side effects include:

• Tacrolimus: in high doses, this can impair kidney function. Blood sugars can be raised. Tremors can occur.
• Ciclosporin: this can also impair kidney function.
• Steroids (e.g. prednisolone): this can cause high blood pressure, increased appetite and thinned skin. Blood sugars can be raised.
• Mycophenolate mofetil: this can cause diarrhoea or nausea. The number of white cells in the blood can be reduced. Women who wish to get pregnant and are taking mycophenolate mofetil should discuss with their transplant team if they need an alternative immunosuppressant.
• Azathioprine: the number of white cells in the blood can be reduced.

You will need antibiotic and antiviral medicines to reduce the risk of infection. These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

You will need painkillers for the first few months.

You may need medicines to lower your blood sugar levels, especially if you had diabetes before the transplant.

You may need medicines to lower your blood pressure.

These are known as anticoagulants and work to thin your blood and prevent clots. Some transplant patients will be prescribed anticoagulants to reduce the risk of blood clots.

Some immunosuppressants and blood thinners can cause stomach irritation, so you are likely be given medicines to protect the lining of your stomach.

Unless your doctor says otherwise, you will need to continue to take any medicines you were taking before your transplant for other health issues. You may also need other medicines for new health issues that have been diagnosed during or since your transplant.

Because immunosuppressants work by lowering your immune system, this means you are more likely to pick up infections. You will be given some extra medicines to prevent infection alongside the immunosuppressant medicines in the first few months after transplant.

Learn more about liver transplants and infections

Some of the immunosuppressant medicines can weaken your bones (osteoporosis). This is particularly true for women after the menopause.

Your liver transplant team will advise you whether you need a bone scan to measure how strong your bones are (“bone density”), and whether you need medicines to strengthen your bones. If you break a bone following your liver transplant, tell your transplant team.

Weight gain is common after a transplant, especially in the first year. Some of the medicines, in particular prednisolone, may cause weight gain or increase your appetite.

Patients who have diabetes before the transplant may find that their blood sugars are more difficult to control in the first three to six months after the transplant. This is usually due to the immunosuppressant medicines, which can increase your blood sugars. Some patients that weren’t diabetic before the transplant become diabetic following the transplant. Again, this is usually due to the immunosuppressant medicines, and also due to weight gain.

Increased blood pressure can occur with some immunosuppressant medicines. This can often be resolved by amending the dosage, if possible.

Immunosuppressants can irritate your stomach lining. Your care team is likely to give you medicines to help protect your stomach and prevent these side effects.