How Should Home Care Be After a Liver Transplant?

Going home after transplantation is usually a happy and emotional event. However, in the first weeks, this feeling of happiness may be accompanied by anxiety and even mild depression. It is of great importance to understand that recovery is a process that takes weeks. Therefore, it should be keep in mind that it will take some time for patient and his/her relatives to get used to the new lifestyle. Because living with organ transplantation is a time-consuming learning process. Most people are easier to overcome if they are active, especially when they make determined efforts to get through the long rehabilitation process. 

With the end of the first sensitive phase lasting about three months, almost all liver transplant patients can return to their prior and pre disease lives. After liver transplantation, it is also very important that those which are learned in hospital under the control of the organ transplant team be implemented at home. Due to the increasing responsibilities of patient and their relatives, some changes may be needed in their life.

Remember that you can contact the transplant team whenever you need after transplantation.

Patient Care After Liver Transplantation

• Care Of The Surgical Wound

The wound should be kept clean using antiseptic soap. If redness, swelling or fluid formation appears in the wound, the doctor should be notified immediately.

• Care Of The Bile Stent

If there is a stent placed to drain the bile, the skin may become infected in the area where the stent enters. To prevent this;

• Clean the area around the stent with an antiseptic soap. 
• Avoid violent movements that may damage the wound or displace the stent. 

If you experience any of the following problems with bile stent, you should contact your doctor immediately;  

• Redness of the skin around the bile stent, 
• Warming in the bile stent area, discharge from this area, 
• Rupture of the suture attached to the bile stent, 
• A change in the apparent length of the bile stent

• Fever Monitoring

If you feel you have a fever, have a shivering, feel ache or pain anywhere in your body, be sure to check your fever. This may be the first sign of infection or rejection. If you have a fever above 38 celsius degrees, you should contact your organ transplant team or doctor immediately. Do not use any medication without your doctor’s permission..

• Blood Pressure and Pulse Monitoring

Your nurse will inform you on how to measure your blood pressure and pulse. It is important to know your normal blood pressure and pulse. So, if you see a difference in values, you can report it to your doctor.

Dental Care

You should use a soft toothbrush. In this way, you will not harm your gums. Brush your teeth after each meal and rinse your mouth with an antiseptic mouthwash. If you have a denture, you should definitely clean thoroughly after each meal. It is important to visit the dentist regularly every six months to prevent infections and caries. 

If you do not have serious problems with your teeth, you should not go to the dentist in the first six months after surgery. No matter how long it has been passed since your liver transplant, you should not take antibiotics 24 hours before and 48 hours after any dental operation. 

This treatment is called prophylaxis (prevention) and your doctor will tell you when to take the antibiotic

General Body Cleaning

Compliance with hygiene rules after transplantation is extremely important. At this point, you must absolutely follow the rules below for your general body cleaning.

• When washing your hands, use liquid soap instead of bar soap. 
• Change hand and face towels daily basis. 
• Always wash your hands before-after meals and after toilet. 
• Clean your nails thoroughly with a nail brush. 
• Blood is an ideal growth medium for bacteria. On menstrual days, female patients need to change their pads and tampons regularly. 
• Since the hygienic substances used to clean the vagina can destroy the microorganisms in the vagina, it can be enough to use soft soap and wash it regularly with water

Do Not Exposure To The Sun

Too much sunlight is harmful to everyone. Ultraviolet (ultraviolet) rays in sunlight can cause early ageing of the skin, sunburn and skin cancer. It should be kept in mind that Liver transplant patients carry a higher risk of developing skin cancer and necessary precautions should be taken.

• Avoid midday sun (from 10am to 15pm) when the sun’s rays are strongest. Sit in the shade whenever possible.
• As long as you are outside and not wearing sunscreen, wear a hat, long-sleeved clothing, and light pants.
• In spring and summer, use a high quality sunscreen with a sun protection factor of at least 15. Apply cream to all areas exposed to the sun, especially the face, neck and hands. Keep in mind; sun rays can be harmful even on cloudy days. Reflection of UV radiation from sea, sand, snow and concrete can also cause sunburn. Do not go to the solariu
• Do not go to the solarium
• Pay attention to your moles. If you find that a mole has changed its color or is taking shape outside its borders, contact your doctor. Because the immune system is suppressed, moles are more likely to become cancerous in transplant patients

Nutrition and Diet

Proper nutrition after transplantation is highly important. The cortisone drug used in this period will cause an increase in appetite, an increase in blood sugar and salt and water retention of the body. For this reason, you need to consume low-sugar and low-salt foods. Before the transplant, it is normal to lose weight

The points you should pay attention in your diet:

• Weigh in every day.
• Avoid sugary foods such as cakes and biscuits between meals.
• When you feel hungry, eat some fruits or vegetables (low calorie)
• Try to drink about two liters of liquid every day. This is beneficial for your kidneys.
•  Always wash and peel fresh fruits
• Always peel the vegetables growing in the soil, such as potatoes, and boil them in boiling water.
• Cooking vegetables in a pressure cooker will preserve the vitamins they contain. It is also important for saving time and electricity.
• Cooking vegetables in a pressure cooker will preserve the vitamins they contain. It is also important for saving time and electricity.
• Another side effect of cortisone is that it causes your body to store salt. This can cause the body to retain water and high blood pressure. Salt consumption should be restricted.

Exercises

Exercises burns the weight you gain, thus it helps you keep your weight under control. It is important to exercise daily to strengthen your muscles, which are weakened by a long period of illness. Your exercise program should progress gradually, and should be a program that gradually increases your exercise level. In this way, you can get all the benefits of exercises without causing injury or serious injury to your body. The best exercises is walking. Especially walking in nice and clean weather will help you sleep better and your intestines work better. Climbing stairs is also a good way to start exercising, but be careful not to overdo it and rest when you are tired. Cycling, swimming and walking are very useful to increase your overall muscle strength, and if all goes well, you can revert to other hobbies such as tennis and running as soon as three months after surgery. Before starting any exercises program, you should definitely consult your doctor or organ transplant team.

Alcohol

Since alcohol can be broken down by the liver and cause liver damage, you should stay away from any alcoholic beverages. Since the transplanted liver is much more sensitive to the effects of alcohol than the normal organ, even a small amount of alcohol can cause serious damage.

Smoking

Quit smoking! Stay away from smoking, which are harmful not only for you but also for everyone’s health. Do not smoke or not be in smoking areas.

Vacation

There is no reason to prevent you from traveling to different parts of the country or the world. However, do not prefer places where there may be insufficient health conditions. Discuss your travel plans with your doctor before going on any vacation. Do not forget to take enough medication for the whole trip leave an address where you can be reached.

Sexual Intercourse

In successful transplants, after a few months, you can start your sexual activities again when you feel well enough. Most men regain their virility. A few months after surgery, the menstrual cycles of most women also return to normal. However, some medications can reduce sexual function. If you experience a problem, you can ask your doctor or transplant team for help. Kissing someone is not a problem unless you have an infection such as a cold or herpes. It is also important that both parties take a bath before sexual intercourse.

Some of the immunosuppressive pills should not be used because they reduce the effectiveness of birth control pills. Intrauterine devices, such as spiral, are also not recommended due to the increased risk of infection. Condoms are the best way to prevent both infection and unwanted pregnancies

Vaccines

You should not get vaccinated with any living or attenuated vaccines (such as oral polio, measles). You can get vaccinated with killed or inactive virus vaccines, such as tetanus, but before get vaccinated, you should definitely inform your doctor or organ transplant team.

Pets and Plants 

Pets are not recommended normally due to the risk of infection. Fish, reptiles and small rodentia have the lowest risk of infection. Dogs are another option, and it’s easier to keep a short haired dog clean. Cats should be avoided because of toxoplasmosis infection. Besides, birds are not recommended because they carry staphylococcus bacteria. If you have a pet, you should avoid contact with its fecal and wear rubber gloves when cleaning the cages. But if you have the opportunity, you can ask someone else to do this job.

Do not allow your animal to lick your hand or face; But if this happens by accident, you should immediately wash this area with soap and water. Potted houseplants are not recommended because of the danger of infection from soil microbes. Because of the high risk of infection, you should not engage in gardening, field and soil work within the first year of transplantation. Later on, you can engage in gardening little by little; but keep away doing things like planting plants or picking leaves, and always wear gloves

Immunosuppressive Drugs

They are used to prevent rejection of the transplanted liver by weakening your immune system. However, immunosuppressive drugs make patients more prone to infections. Therefore, a balance between conflicting requirements is needed to prevent rejection and maintain adequate defense against infection. In order to protect a transplanted organ, the amount of immunosuppressive medication decreases after the first months of surgery. 
Nevertheless, immunosuppressive drugs should be taken for many years after liver transplantation. Under no circumstances should the amount of medication be reduced without a doctor’s permission. Immunosuppressive drugs will be taken for life after transplantation surgery. Because patients have different reactions to these drugs, each immunosuppressive regime is tailored to the patient’s personal needs. Therefore, the amount of medication taken by each patient varies.