Liver Transplant Treatment

Self-Care at Home

Home care involves building up endurance to carry out daily life activities and recovering to the level of health that the patient had before surgery. This can be a long, slow process that includes simple activities. Walking may require assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy and to prevent pneumonia. Diet may at first consist of ice chips, then clear liquids, and, finally, solids. It is important to eat well-balanced meals with all food groups. After about 3-6 months, a person may return to work if he or she feels ready and it is approved by the primary doctor.

• Preventing rejection: Home care also involves taking several medications to help the liver survive and to prevent the patient's own body from rejecting the new liver. A person with a new liver must take medications for the rest of his or her life. The immune system works to protect the body from invading bacteria, viruses, and foreign organisms.

  Unfortunately, the body cannot determine that the newly transplanted liver serves a helpful purpose. It simply recognizes it as something foreign and tries to destroy it. In rejection, the body's immune system attempts to destroy the newly transplanted liver. Without the intervention of immunosuppressive drugs, the patient's body would reject the newly transplanted liver. Although the medications used to prevent rejection act specifically to prevent the new liver from being destroyed, they also have a general weakening effect on the immune system. This is why transplant patients are more likely to get certain infections. To prevent infections, the patient must also take preventive medications. There are 2 general types of rejection, as follows:

  • Immediate, or acute, rejection occurs just after surgery, when the body immediately recognizes the liver as foreign and attempts to destroy it. Acute rejection occurs in about 2% of patients.
    
    
  • Delayed, or chronic, rejection can occur years after surgery, when the body attacks the new liver over time and gradually reduces its function. This occurs in 2-5% of patients.

• The first 3 months after transplantation is when the patient requires the most medication. After that time, some medicines can be stopped or their dosages decreased. Some of the medication is dosed according to the patient's weight. It is important for the patient to be familiar with the medications. It is also important to note their side effects and to understand that they may not occur with everyone. The side effects may lessen or disappear as the doses of medicine are lowered over time. Not every patient having a liver transplant takes the same medications. Some commonly used medications are as follows:

• Cyclosporine A (Neoral/Sandimmune) helps prevent rejection. It comes in pill and liquid form. If the liquid is given, it is important to mix the liquid in apple juice, orange juice, white milk, or chocolate milk. The patient can "shoot" it directly into the mouth and then follow it with any liquid. Cyclosporine should not be mixed in a paper or Styrofoam cup because they absorb the drug. It should only be mixed in a glass container directly before taking the drug.
  
  
• Tacrolimus (Prograf) helps prevent and treat rejection and works in a similar way to cyclosporine. Certain medications and substances, including alcohol, antibiotics, antifungal medicines, and calcium channel blockers (high blood pressure medications), may elevate levels of tacrolimus and cyclosporine. Other medications, including antiseizure medicines (phenytoin and barbiturates) and other antibiotics, may decrease tacrolimus and cyclosporine levels.

• Prednisone (Deltasone, Meticorten), a steroid, acts as an immunosuppressant to decrease the inflammatory response. Initially, prednisone is given intravenously. Later, prednisone is given in pill form. Prednisone may cause the following side effects:
  
  
  • Increased susceptibility to infection
    
    
  • Weakened bones (osteoporosis)
    
    
  • Muscle weakness
    
    
  • Salt and water retention
    
    
  • Potassium loss
    
    
  • Easy bruising
    
    
  • Stretch marks
    
    
  • Nausea
    
    
  • Vomiting
    
    
  • Gastric (stomach) ulcers
    
    
  • Increased cholesterol and triglyceride levels
    
    
  • Increased hunger
    
    
  • Blurred vision
    
    
  • Rounded face ("chipmunk cheeks")
    
    
  • Enlarged abdomen
    
    
  • Inability to sleep
    
    
  • Mood swings
    
    
  • Hand tremors (shaking)
    
    
  • Acne
    
    
  • Steroid dependency

  Note: Patients must never stop or reduce the prednisone without medical advice. The body normally produces small amounts of a chemical similar to prednisone. When a person takes in extra amounts of this substance, the body senses this and may reduce or stop its natural production of this chemical. Therefore, if a person suddenly stops taking the medication form of prednisone, the body may not have enough natural prednisone-like chemical available. Serious side effects may result.

• Azathioprine (Imuran) is an immunosuppressant that acts on the bone marrow by decreasing the amount of cells that would attack the new liver. The dose is based on the person's weight and white blood cell count.

• Muromonab-CD3 (Orthoclone OKT3) is an immunosuppressant used for people who are rejecting the transplant, for those in whom prednisone is not working well enough, and for those who cannot take tacrolimus or cyclosporine.
  
  
• Mycophenolate mofetil (CellCept) is an antibiotic that acts as an immunosuppressant and is used for acute rejection.
  
  
• Sirolimus (Rapamune) is an antibiotic used as an immunosuppressant.

• Sulfamethoxazole-trimethoprim (Bactrim, Septra), an antibiotic, acts to prevent Pneumocystis carinii pneumonia, which occurs more often in people who are immunosuppressed.

• Acyclovir/ganciclovir (Zovirax/Cytovene) acts to prevent viral infections in people who are immunosuppressed. These drugs work particularly against cytomegalovirus (a type of herpes virus) infection.

• Clotrimazole (Mycelex) comes in a troche (lozenge) and prevents yeast infection of the mouth.

• Nystatin vaginal suppository is an antifungal that prevents vaginal yeast infection.

• Baby aspirin is used to decrease blood clotting and to prevent blood clots from forming in the new liver's arteries and veins.