Before liver transplant surgery, we re-evaluate patients to rule out possible infections or other conditions that may rule out a liver transplant. In addition, the nurses will ask patients to shower with special soap, have their labs drawn, have a chest X-ray, receive enemas and get an IV started. When patients are taken to the surgery suite, they'll be put to sleep with general anesthesia and the following steps are performed:
- An incision is made below the ribs.
- The native liver and gallbladder are removed, and the new liver will be attached to the blood vessels and bile ducts. A gallbladder is not required so a new one is not transplanted.
- Once the transplant is completed, the abdomen is closed with staples which will be removed in 14 days.
The transplant surgery can take anywhere from four to 8-hours under normal circumstances, depending on an individual's condition. Most patients who have had previous surgeries remain in surgery longer because of scar-tissue accumulation.
Recovery
Immediately following liver transplant surgery, patients will go directly to the intensive care unit, usually for two or three days. When patients first wake up, typically they'll feel groggy and sore. To prevent pneumonia, patients will be asked to take deep breaths, cough and exercise their lungs using an incentive spirometer. Typically, patients will be out of bed and into a chair the next day.
A patient's bowels must "wake up" before they are allowed to eat or drink. This is determined by when the individual's stomach starts to growl, they're able to "pass gas" and have a bowel movement. During this time patients will have a tube draining their stomach to prevent nausea. The tube will be removed when their bowels are awake, and at this time they'll be able to eat and drink.
Patients will have two tubes through their abdomen to drain the blood and fluid surrounding the new liver. These will be removed during the patients hospital stay as they recover. After these tubes are removed, some fluid may leak from the drain sites. If necessary, a small bag may be attached to the abdomen to collect this fluid until it stops draining.
When leaving the ICU, patients will move to the transplant care unit for the remainder of their hospital stay. Although many of our patients go home a week after their transplant, keep in mind that everyone recovers differently. After transplant, a patient's length of stay will depend on their individual condition.
After transplant, one of the most important things individuals can do is to get up and start moving around as soon as possible. The more active an individual is, the faster they'll recover from the surgery and decrease the chances of complications.
During the hospital stay, medications will be regulated and patients will be watched closely for signs of rejection and/or infection. As a patient recovers, they'll need to learn and remember many things, including when and how to take their medications and other important aspects of post-transplant care. We strongly encourage family members or close friends to participate in this learning process, as they will be assisting with the patient's care when they go home. It is helpful to remember at this time it may be difficult for patients to remember new things after having surgery, therefore the patient's support persons can help them remember what is being taught.
What to know before going home
Here's what patients will need to know before going home from the hospital:
- Medications. Individuals should learn the names of all their medicines, the dosages and the times they should be taken. A patient's dose of immunosuppression medications may need to be adjusted frequently, dependent upon the level of the drug in their blood. Patients will learn which medicines these are and how the doses will be adjusted.
- Laboratory tests. A patient's blood will be tested daily while in the hospital, and twice weekly when they go home (Mondays and Thursdays). Patients need to know when blood tests must be drawn, and what time to take their medicines, so the blood tests will provide the most accurate information.
- Clinic visits. Patients will need to know when their first clinic visit is scheduled, and the number to call if they have questions for the liver transplant coordinator. Patients will be seen in clinic the first or second week after going home, and then as often as the physicians determine is necessary.
- Maintenance of the transplant. Know the most common signs and symptoms that may indicate problems. They may include fever, pain, nausea, vomiting, diarrhea, blood in the stool, cough, sore throat or shortness of breath. If a patient or their caregiver has any questions or experience any of these symptoms, please contact a member of the transplant team.