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Liver Transplant Patient Guide
Recovering at Home

Monitoring Health and A New Liver at Home

After a patient is discharged from the hospital, he may be asked to monitor:

  • Temperature - A patient should check and record temperature any time he feels chilled, hot, achy, or ill. This may be the first sign of infection.
    WARNING:
    DO NOT USE TYLENOL®, ADVIL® (Ibuprofen), aspirin, or other such products except under the direction of a physician, as these drugs may cause further symptoms.
    If a patient's temperature is higher than normal at any time, he should notify his transplant coordinator immediately. This is considered an emergency, because an elevated temperature could indicate a serious infection or rejection.
  • Blood pressure - A nurse or transplant coordinator will show how to measure blood pressure, if necessary. The top number (systolic) is noted at the first sound, and the bottom number (diastolic) is noted when the sound changes (not stops). It is important that a patient knows his normal blood pressure, normal changes, and when he should be concerned.
  • Pulse - If a patient is taking medication that affects heart rate, the nurse or coordinator will show how to check his own pulse at home.
    NOTE: If a patient experiences chest pain or has difficulty breathing, he should call 911 for an ambulance and go to the nearest emergency room. He SHOULD NOT attempt to drive himself.
  • Weight - The patient may weigh himself on a standard bathroom scale at the same time every morning (after going to the toilet). If he gains more than 2 pounds per day, he could be retaining fluid. This should be reported to the transplant coordinator.

Resuming Normal Activities

Although the patient is encouraged to resume normal activities after recovery, it is important to understand that having a new liver brings new responsibilities.

Skin and Hair Care

A patient will not need any special skin care unless he develops acne or dry skin. Generally, he should shower or bathe as often as necessary to keep his skin clean. Most soaps are appropriate.

Acne - Prednisone can cause acne on the face, chest, shoulders, or back. Cyclosporine can make the skin more oily. If acne develops, the patient should wash the area three times per day with a mild soap, scrubbing gently with a clean, wet washcloth. Rinse the soap completely from the skin to leave the pores open and clean.

Ways to control acne:

  • Keep hands away from the face and avoid rubbing the affected area. To avoid infections, do not pick or touch the acne.
  • Do not use cosmetics.
  • Avoid the use of medicated hypoallergenic cosmetics intended to cover acne. Wearing makeup will prevent acne from going away.
  • Do not rub or scrub the skin vigorously. This can irritate the skin.
  • Avoid soaps that contain creams and oils, because they will aggravate acne.
  • Do not use lotions for dry skin.
  • If the skin becomes very dry, stop washing those areas temporarily so the skin can recover its natural moistness.
  • Do not use RETIN-A® (tretinoin cream) on the skin without consulting a physician, because it will increase the sun sensitivity caused by prednisone.

WARNING: Remember that severe or infected acne must be treated by a dermatologist. If acne remains a problem, a member of the transplant team should be contected for advice.

Dry skin care - For problems with dry skin, use a mild soap and apply body lotion after bathing

Cuts and scratches - Wash minor cuts and scratches daily with soap and water. For treatment of large cuts, contact a physician immediately.

Skin growths - The transplant team should be notified if the patient discovers any unusual skin growths, rash, or discoloration.

Hair care - Prednisone will probably affect the condition of hair. Permanent hair dyes, tints, wave lotions, and bleach may cause hair to become brittle and to break. It is recommended that the patient waits until the prednisone dosage is lower than 10 mg per day before having a permanent or coloring the hair. The patient's hairdresser should be advised that the patient is taking prednisone and to use a good conditioner on the patient's hair.

Unwanted hair growth - If facial hair increases, use a hair-removal cream (depilatory). Be sure to follow directions carefully to avoid eye or lip irritation. An alternative is to bleach extra hair growth with a 50% peroxide solution. The patient might consider waxing or electrolysis to remove extra hair. Even if hair growth is excessive, do not alter medication. Contact the transplant team.

Sun exposure - Transplant patients have an increased chance of developing skin and lip cancers. Since the risk increases with time, the patient must always protect his skin from the ultraviolet rays of the sun that cause skin cancers.

  • Avoid midday (10 am to 3 pm sun, when ultraviolet rays are strongest.
  • Wear a hat, long sleeves, and slacks when outdoors unless using a sunscreen.
  • Use a sunscreen lotion with sun protective factors (SPF) rated at least 15.
  • Use a sunscreen lotion and lip balm every day (rain or shine) and apply to exposed areas, especially face, neck, and hands.

NOTE: Remember that sunscreen lotions wash off. Reapply the lotion as needed, especially after swimming.

Sexual Activity

In addition to returning to work or school as soon as possible, a patient may resume sexual activity as soon as he feels well enough. How quickly he feels ready will depend largely on his recovery progress. This is a subject that should be discussed during clinic visits.

When people experience transplantation, sexual functioning may be affected. Likewise, certain medications can interfere with sexual functioning. Some people avoid sexual activity because they are afraid of organ rejection or infection. If a patient has any of these concerns, he may want to check with his transplant team. If he is sexually active and does not have a steady sexual partner, it is essential to use condoms to reduce the risk of sexually transmitted diseases such as AIDS, syphilis, herpes, hepatitis, or gonorrhea.

Smoking

The Surgeon General has determined that smoking can be harmful to health. If the patient is a smoker, he may wish to join a stop-smoking group in his area. He should consult the Yellow Pages of your telephone book of the American Heart Association, American Lung Association, or American Cancer Society to find a local group.

Vacations and Travel

If planning a trip to a foreign country that requires immunization for smallpox, measles, German measles, or any other vaccine containing a live virus, the patient should ask the transplant team to send a letter to his local passport bureau stating that he cannot receive these vaccines. Because he is not immunized, however, travel to these countries may not be safe.

Dental Care

Precautions for dental care - Before the liver transplant, the patient may have received a dental consultation to ensure that all dental work would be completed before surgery. If the patient has dental pain, he should consult his dentist immediately. Before he has dental work done (including cleaning and polishing), he should check with his transplant team to see if he needs to take antibiotics.

Pregnancy

There have been a number of successful pregnancies among women who have had liver transplants, although pregnancy may have special risks for both the transplant recipient and the baby. Women should avoid pregnancy for at least 1 year following transplant surgery. Risks related to birth control should be discussed with the transplant team. Thereafter, the decision to have children must take a number of factors into account. This is a question that should be discussed with the transplant team.

Exercise

After transplant surgery, exercise is critical to mental health and physical well-being. Physical activity is also very important in helping decrease the effects of prednisone, which causes muscle weakness.

A daily exercise routine is essential to avoiding the muscle and total-body weakness that often occurs after a long illness or period of confinement. The program should be a progressive one in which the patient builds or increases his levels of exercise. In this way, he will obtain the full benefits of exercise without causing strain or serious injury to his body. Before starting on any exercise program, he should remember to check with his transplant team. They will give him advise regarding an exercise routine that will best meet his needs.

WARNING: If a patient experiences any of the following symptoms, he should stop or delay exercise until he consults his physician:

  • pain or pressure in the chest, neck, or jaw
  • excessive fatigue that is not related to lack of sleep
  • unusual shortness of breath
  • dizziness or light-headedness during or after exercise
  • persistent rapid or irregular heart rate, new since the transplant, during or after exercise.

Diet and Nutrition

Eating properly is an important part of the recovery process. A nutritionist can help in developing an eating plan that provides a balanced diet to meet a certain patient's needs. The number of calories a patient requires will be based on whether he needs to gain, maintain, or lose weight and on his level of activity.

Healthful food - Diet should include a variety of foods, such as:

  • fruits
  • vegetables
  • whole-grain cereals and breads
  • low-fat mile and dairy products or other sources of calcium
  • lean meats, fish, and poultry or other sources of protein
Use of sodium (salt), sugar, and fat - Use of salt may be restricted to help limit fluid retention and to control blood pressure and blood sugar. A low-fat, low-sugar diet will help control weight and blood sugar. Consult a nutritionist regarding the use of salt, sugar, and fat in a diet.

Alcoholic Beverages

Do not drink alcoholic beverages. Alcohol must be broken down by the liver. This process can lead to liver damage. Also, medications such as PROGRAF®, SANDIMMUNE®, IMURAN®, and BACTRIM® are broken down by the liver and, if combined with alcohol, could harm the liver.

Signs to Watch Out For

While primary concerns involve infection and rejection, many other problems, such as colds or flu, adjustment of other medications, and minor infections can be handled by a local physician. A patient needs to take precautions and learn to watch for signs of infection and rejection that necessitate notifying a local physician or transplant team immediately. These include:

  • a fever that continues for more than 2 days
  • shortness of breath
  • a cough that produces a yellowish or greenish substance
  • a dry cough that continues for more than 1 week
  • prolonged nausea, vomiting, or diarrhea
  • an inability to take prescribed medication
  • bleeding, bruising, black stools, red or rusty-brown urine
  • a rash or other skin changes
  • pain, discharge, or swelling at the T-tube site
  • vaginal discharge or itching
  • burning discomfort with urination
  • exposure to mumps, measles, chicken pox, or shingles
  • unusual weakness or light-headedness
  • emergency-room treatment or hospitalization
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USC Hepatobiliary, Pancreas and
Abdominal Organ Transplant

1450 San Pablo Street
Healthcare Consultation Center 4
Suite 6200
Los Angeles, CA 90089

For Liver, Pancreas & Bile Duct Surgery,
please call (323) 442-7172
Fax: (323) 442-7173

For Organ Transplant Information,
please call (323) 442-5908

Fax: (323) 442-5721

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