When to notify your transplant coordinator immediately:

• If your temperature is higher than normal. High fever is an indication of serious infection or rejection;
• If you experience chest pain or have difficulty in breathing, immediately call for an ambulance;
• Any excess weight gain beyond normal may be an indication of fluid retention;
• Pain, pus discharge or swelling at the T-tube site;
• Coughing yellowish or greenish substance;
• Prolonged nausea, vomiting or diarrhoea;
• Inability to take prescribed medications, e.g. due to vomitting;
• Black stools;
• Red or rusty-brown urine;
• Rash, unusual skin growths or discoloration;
• Vaginal discharge or itching;
• Burning discomfort with urination;
• Exposure to mumps, measles, chicken pox or shingles;
• Unusual weakness or light-headedness that is not related to lack of sleep or food;
• Emergency room treatment or hospitalisation.

While infection and rejection is of primary concern, other general medical problems such as cold or flu can be attended by your own physician. You have to diligently take precautions and learn to watch out for signs of infection or rejection that may require immediate medical attention.

Your transplant coordinator or the nurses will give you a timetable for the various medications you will have to ingest. Keep to it strictly and do not skip any medications without the approval of your doctor. The immunosuppressant drugs are to prevent the rejection of your new liver by your body. Other drugs are meant to support your immune system as the immunosuppressant lowers your immune system and you are more prone to infections or ailments.

Always check with our clinic if you are prescribed any new medications as they may be interactions with the immunosuppressants.

Your transplant coordinator will also provide you with follow-up visits schedule with your transplant surgeon and for lab tests and scans :

• Ultrasound – to make sure that all the main blood vessels leading to the liver are functioning normally and there is no collection of bile or blood;
• Percutaneous Transhepatic Cholangiogram (PTC) – a dye is injected into the T-tube, which then highlights the bile ducts. It shows any leak, blockage or other potential problem;
• Liver biopsy – to check for rejection of the new liver or hepatitis;
• CT Scan – it shows the liver from many different angles to detect infections and fluid collections;
• Endoscopic Retrograde Cholangiopancreatogram (ERCP) – A dye is injected through an endoscope, which is passed through the mouth to the stomach and intestine to the liver. It shows the biliary tree (the various ducts in and around the liver) as well as the ducts from the pancreas.

The purpose is to track your progress and detect potential complications as early as possible. During every visit to our clinic, you will have to bring your post transplant file and medication timetable. Keep a journal and list any and all question you and/ or your family may have and bring it along during your follow-up visits.

Certain patients have other medical conditions as well and they would require special dietary needs. Post-transplant nutritional requirements differ from pre-transplant needs. The goal is to achieve adequate or near balance intake to allow the surgical wound to heal and to keep up the patient energy needs. A nutritionist/ dietician can help in developing an eating plan that would benefit your needs. Nutritional recommendation and recipes can be found in “Post-Transplant Nutrition” chapter.

After you go home, try to resume normal daily activities when the pain is manageable and you feel comfortable enough to be independent of your caretakers for small chores. Houseplants and gardening should not be a problem as long as you wear gloves. You can have pets at home, although it is best if you do not have birds in the house. Pets should be vaccinated and reviewed by a vet regularly. Do not clean up pets’ motion/ vomit/ litter tray/ bedding etc. ask another family member to do this.

Certain prescribed medications can cause acne, dry skin, skin growth, brittle hair and unwanted hair growth. Some of these side effects can be avoided if you take precautions whilst others may require you to see a doctor.

SIDE EFFECTS	ADVICE
Acne	Do not touch or pick on the acne. Avoid medicated hypoallergenic cosmetics to cover acne or soap that contains creams and oils because they can aggravate the acne. If the skin becomes very dry, do not use lotions but stop washing those areas temporarily so the skin can recover its natural moistness. Do not use Retin-A (tretinoin cream) as it will increase the sun sensitivity caused by prednisone, an immunosuppressant, thus increasing the risk of developing skin or lip cancer
Dry skin	Use mild soap and apply body lotion after bathing
Skin growth, rashes or discoloration	Contact your transplant coordinator immediately
Hair	It is recommended that you wait for your prednisone dosage to lower before having your hair colored or bleached. If facial hair increases, use a hair removal cream, avoiding your eye and lip area. Do not alter your medication without consulting your transplant surgeon
Skin or lip cancer	Immunosuppressant drug causes the skin to be hypersensitive to the sun. Prolong exposure to the sun increases the risk of developing skin and/ or lip cancer. Try to protect your skin from the UV rays by using sunscreen and lip balm everyday, cover up as much as possible and avoid the midday sun (10am to 3pm) when the UV rays are the strongest
Stress, Anxiety, Depression	Sometimes, the recipients are overwhelmed by the whole procedure and what follows next, that they can get depressed or anxious. Family and friends support plays a vital role in helping them to get back on their feet by helping to ease them back into the normal routine, work or school. There may be a support group in your country for transplanted patients and their caretakers. You can hear other recipients’ and/ or donors’ experience that may be almost similar to yours and share your concerns with them

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