Life After The Transplant

Resuming life after transplant

  • Quality of life: Most patients are able to lead a comfortable and healthy life. After transplant they return to work, and enjoy an excellent quality of life
  • Work /sports: A majority of people can return to their normal daily activities, 2-3 months after surgery. Children can resume schooling after 3 months. Playing sports and exercising frequently is possible after 3 months although it is advisable to avoid contact sports such as boxing, karate, rock climbing etc. for 6 months. It may take longer for patients who are very sick before the transplant. Initial family support is very crucial to lead an active and productive life in the long term.
  • Driving/travelling: One can resume driving in about 2 months after a transplant. It is recommended that patients should not drive themselves after taking pain medications as they may contain narcotics. If the seat belt rubs against the wound, one can place a towel between the abdomen and the seat belt. Most patients can undertake occasional train/plane travel in 2-3 months. If the patient is travelling to another city or country, he/she should discuss the trip with the transplant team to make sure that the patient carries enough supply of medications, and is put in touch with a doctor locally who can take care of urgent problems.
  • Sexual activity/pregnancy/breast-feeding: There are no restrictions on sexual activity and these may be resumed when one feels comfortable. Donors can resume sexual activity within a month, and recipients in 2-3 months. Women should not conceive for up to 6 months after donation and 12 months after transplantation. For recipients, use of oral contraceptives and hormones should be done in consultation with the hepatologist and gynaecologist. Recipients who are planning to conceive should discuss the same with the transplant team as some medicines may have damaging effects on the child or may be passed into breast milk causing problems in nursing babies. Some medicines might have to be stopped or changed before pregnancy.
  • Dental care: The patient should see the dentist every 6 months. The dentist should be told about the transplant because patients might have to take antibiotics before any dental procedure.

Possible complications after liver transplant

Doctors and coordinators from the transplant team discuss various possible complications and risks of transplant before surgery, though very few patients experience any of them. Most of these problems can be diagnosed easily and treated in time. Complications after liver transplants may occur early (within 1 month) or late. Some complications patients may experience are

  • Bleeding: Patients may suffer bleeding after the operation, which can be controlled with medicines and blood products, but may rarely require re-opening of the abdomen to stop the bleeding.
  • Primary non-functions: In rare cases, the transplanted liver may not work well, which is called primary non-function. It is more common in deceased donor transplantation and may require an emergency re-transplantation.
  • Thrombosis: A blood clot in an important blood vessel of the liver (hepatic artery, portal vein or hepatic veins) is a serious problem and may require an urgent CT scan, angiography, liver angioplasty, re-operation to remove the clot or even re-transplantation.
  • Bile Leak: Bile may leak from the anastomosis (joint) of the bile duct or cut edge, requiring further tests. It may either resolve spontaneously in a few weeks, or may require the fixing of a stent in the bile duct by endoscopy or by a radiologist.
  • Post-operative infections: These can usually be identified and treated effectively with antibiotics, anti-fungals and antiviral drugs. Immunosuppressant drugs reduce the patient’s resistance to infection, and make infections harder to treat, especially if the infecting organism is resistant to antibiotics or if the patient is weak. CMV (cytomegalovirus) infection is common in transplant patients. The risk of infection becomes less as the requirement for anti-rejection medicines reduce over time. If there is a white coating on the tongue, the transplant team should be informed because it may be a fungal infection known as oral thrush. Women are more prone to vaginal yeast infection.
  • Rejection: Rejection can be prevented by taking anti-rejection immunosuppressive medicines. If these are not taken, even many years after the transplant, rejection may occur. Therefore, these drugs must be taken for the rest of the patient’s life. Rejection does not always make one feel ill or have any symptoms, and is commonly diagnosed through blood test or a liver biopsy. Mild rejection is common, especially in the first few months, however it does not mean that one is losing the liver. It is not a serious problem because it can be treated and reversed with higher doses of anti-rejection medicines and steroids, and does not cause loss of liver function in the long term.