Once your liver transplant is complete, you will be moved to an intensive care unit (ICU).
A ventilator will assist you with your breathing. A tube will be inserted through your nose and into your stomach to provide you with nutrients and fluid. These tubes can normally be removed after a few days.
After the transplant, you are likely to be in some pain. You will therefore be given pain relief as required.
Most people are well enough to move out of the ICU and into a hospital ward within a few days of having a liver transplant. They can leave hospital within two to three weeks.
Recovering from a liver transplant can be a long, slow process. Aim to gradually build up your health and fitness. It may take three to six months before you are ready to return to work and resume normal activities.
Immunosuppressants
After a liver transplant, one of the biggest risks is that your immune system will not recognise the new liver and begin to attack it. This is known as rejection.
To prevent rejection, you will be required to take medicines that suppress your immune system. These medicines are called immunosuppressants.
As the risk of rejection is highest in the first three months after a transplant, it is likely that you will initially be given a relatively high dose of immunosuppressants.
Your dose will then be reduced to a level thought high enough to prevent your immune system rejecting your new liver, yet low enough to minimise unpleasant side effects (see below).
To assess how well the immunosuppressants are working, it is likely that you will be given regular blood tests when you first start taking them.
Achieving the balance between preventing rejection while minimising side effects can be challenging. It may take several months before the optimal dose for you is achieved.
Types of immunosuppressants
Two main types of immunosuppressants are used to treat people after a liver transplant:
- calcineurin inhibitors
- corticosteroids
Each type of medication is discussed in more detail below.
Calcineurin inhibitors
Calcineurin inhibitors work by blocking the effects of a protein called calcineurin, which is responsible for activating a type of white blood cell known as T cells. The immune system uses T cells to fight infection.
Blocking the effects of calcineurin should mean that your immune system will not send T cells to attack the tissue of your new liver.
The two most widely used calcineurin inhibitors are ciclosporin and tacrolimus, which can be given either in tablet or capsule form, or as an injection.
Common side effects of ciclosporin include:
- numbness or tingling in different parts of your body
- loss of appetite
- nausea and vomiting
- high blood pressure
- headaches
- tremor (uncontrollable shaking or trembling)
- muscle pains or cramps
- increased growth of hair on your skin
Common side effects of tacrolimus include:
- difficulties sleeping
- tremor
- high blood pressure
- diarrhoea
- changes in mental states, such as feeling unusually anxious or confused
- seizures (fits)
- hair loss
- skin rash
- itchy skin
For a complete list of side effects, see the Medicines information section on ciclosporin and tacrolimus.
Although these side effects may be troublesome, you should never stop or reduce the recommended dose of immunosuppressants because it could lead to your liver being rejected.
Staff at the transplant centre may give you additional treatments to help you cope better with any side effects.
Ciclosporin and tacrolimus can react unpredictably with a wide range of other medications, including over-the-counter medications and herbal remedies such as St John’s Wort.
Always check with your pharmacist or GP before you begin taking any other medication.
Taking calcineurin inhibitors will make you much more vulnerable to infections. Long-term use of calcineurin inhibitors increases your chance of developing skin cancer, diabetes and kidney failure. For more information, see liver transplant – complications.
Corticosteroids
Corticosteroids can penetrate the wall of immune system cells. Once inside the cells, corticosteroids can 'switch off’ the genes responsible for releasing many of the chemicals that the immune system would otherwise use to attack your new liver.
A widely used corticosteroid in liver transplant patients is prednisolone.
Common side effects of prednisolone include:
- mood swings
- any wounds or cuts taking longer to heal
- ulcers in the mouth and throat
- muscle weakness
- fluid retention
- weight gain
For a complete list of side effects, see the Medicines information section on prednisolone.
Around 1 in 20 people have serious mental health symptoms while taking prednisolone, such as:
- thinking about suicide
- having hallucinations (seeing or hearing things that are not real)
- feeling very confused and having problems thinking clearly
- having strange, unusual and frightening thoughts
If you experience any of these symptoms, contact your GP or a member of your care team immediately. If this is not possible, telephone your local out-of-hours service or NHS Direct on 0845 4647 for advice.
The long-term use of corticosteroids can lead to more serious side effects, such as:
Because of this, it is recommended that your dosage of corticosteroids be slowly reduced, then withdrawn in the first year after your transplant. However, in some cases this is not possible.
Again, always seek advice from your pharmacist or GP before you begin taking any other medication.
Taking corticosteroids will make you more vulnerable to infection. You will be particularly vulnerable to the measles virus and the varicella-zoster virus, which causes chickenpox and shingles. Therefore avoid anyone known to have an active measles, chickenpox or shingles infection.
