Discharge from the hospital
While the patient recovers from the operation, the family should take the opportunity to learn about precautions to be taken after discharge, understand the schedule for testing and follow-up appointments, become familiar with medicines, learn about symptoms and signs of potential problems, and understand the mechanism used to contact the liver transplant team round the clock in case of urgent problems.
At the time of discharge, patients will receive a discharge summary with detailed instructions about testing, and a medication schedule, which should be discussed with the transplant coordinator. Patients also receive a copy of the investigation chart, and a blood sugar and blood pressure monitoring chart, which they should be familiar with and learn how to fill.
After discharge, patients are required to undergo tests and visit the post-transplant clinic every 5-7 days. They should therefore stay in the vicinity of the hospital for 4-6 weeks after discharge. The house where the patient would be staying after discharge should be prepared best to prevent incidence of infections.
- The house should be thoroughly cleaned with disinfectants
- The accommodation should be close to the hospital with available transportation 24 hrs a day. There should not be too many stairs, and the locality should be neat and clean
- Patients are encouraged to walk and avoid using the wheel chair
- The number of visitors should be restricted for a few weeks
- Patients should avoid meeting people who are ill and report any illness/fever/flu/cold persistent cough/ pain in abdomen/ loose motions or transmissible infections or infectious diseases such as influenza, pneumonia, chicken pox, hepatitis etc.
- Patients should avoid contact with any animals and birds
- For the first 3 months, patients are advised to wear a mask and avoid crowded places like malls, cinemas, restaurants, department stores, etc. After this, patients can resume their regular social calendars.
Personal hygiene and wound care
- Frequent hand washing with soap, especially before eating, and hand washing with antiseptic solution after using the bathroom should be practiced by all living in the house.
- Oral hygiene should be maintained by brushing teeth daily, and rinsing mouth after eating
- Finger nails should be trimmed
- After discharge, dressing might need change 2-3 times a week
- Few donors/patients may be discharged with a drain tube in the abdomen, which is removed few days after discharge
- While one has wound dressings and drain bags, the body should be cleaned with a wet towel only. Only freshly washed clothes should be worn daily
- Once the wound heals, and bags are removed patients/ donors can use waterproof dressings, and bathe normally before every dressing or dressing change
- Donor stitches/ staples are generally removed within 2-3 weeks and recipients within 3-4 weeks unless absorbable stiches,which do not need removal, are used
- Once the staples are removed, the incision should be kept clean and dry. Patients/donors can bathe normally
- If the incision oozes some fluid or if the dressing nurse says that there is some infection in the wound, please insist that the nurse speaks to the transplant team immediately. Note that the dressing nurses are trained to evaluate the condition of the wound, decide the frequency of dressing changes and timing of staples/ stitches removal, in consultation with the doctor.
Diet and Nutrition
Patients may suffer a loss of appetite after surgery. The appetite slowly improves with time. It is important, however, to follow a high protein diet to facilitate wound healing and liver regeneration. If necessary, the dietician will advise supplements in diet. If patients prefer a certain type of meal or cuisine, they should check with the dietician.
Food – how to prepare /consume
- Food should be cooked hygienically
- Wash utensils well before cooking
- Wash and cook in clean water
- Use boiled/ filtered water
- Drink plenty of liquids; intake is not restricted, as before transplant
- Salt restriction is not necessary unless one has high blood pressure
- Eat plenty of fresh fruits and green leafy vegetables after washing well and peeling off their skin
- Consume a balanced, low-fat, high protein diet
- Eat foods rich in calcium, such as skimmed milk, cheese, soya, eggs, chicken, fish
- In a few weeks, patients can followthe diet they did before the transplant
Food to avoid
- Avoid deep fried or greasy foods
- Do not eat leftover food
- Avoid raw eggs or mayonnaise
- Avoid partially cooked food
- Avoid red meat
- Avoid overripe fruits
- Do not consume expired packaged foods
- If potassium is high, avoid foods such as banana , coconut water, fruit juices/pulp
- If blood sugar is high, avoid sweets and fruits such as mangoes
Activity and exercise
- At the time of discharge, patients are generally allowed active walking and routine activities like bending and climbing stairs. Regular exercise increases energy levels, strengthens muscles, and makes the patient feel more active
- It is common to experience weakness and mild abdominal discomfort at the site of the operation, especially with movements for the first few weeks to months after transplant. Do not postpone exercising because of this. The transplant team should be contacted if the patient has severe discomfort with movements.
- Perform deep breathing exercise to expand lungs and help cough out sputum
- The physiotherapist will teach limb exercises, so that limb muscles are strengthened, blood circulation is increased, and the risk of complications such as venous thrombosis is reduced
- Speak to transplant physiotherapists to progressively increase the level of exercise and optimize the exercise schedule
- Take adequate rest and sleep
- Avoid lifting heavy weights (>5kgs), including babies, or performing abdominal exercises, including abdominal exercises, weight training and swimming.
Tests and appointments
Being regular with follow-up tests and hospital visits are very important in making the transplant a success.
- Donors need to follow-up every 5-7 days for the first 1 month, after which they will have to get tested and reviewed after 3 months, and after 1 year.
- Recipients need life-long follow-up, very frequently initially, and less often later, as per the schedule given at discharge. Once the reports become stable and medicines well adjusted, patients can travel, e-mail their reports to the doctor and visit the clinic once in every 3-6 months
- In case of problems, please call the transplant team. Please identify a local physician or gastroenterologist for an urgent situation
- Routine monitoring of blood pressure, blood sugar, diet intake, exercise, insulin administration, and other parameters are advised at discharge. Post-transplant co-ordinators will teach the patient and the donors the same, which should preferably be performed by a family member. Maintain a file and keep charts of all lab reports in chronological order, and the dose of immunosuppressant taken, and carry the file during clinic visits
- In case patients need dressing changes, physiotherapy or administration of injections at home, the family should make arrangements for a nurse or physiotherapist.
At the time of discharge, patients are generally prescribed 10-15 medicines. Some of these may be injections. As they make progress, the number of drugs is reduced. After about 1 year most patients need only 1-2 anti-rejection medicines, besides those for pre-existing illnesses. Patients and their families should familiarize themselves with the medicines prescribed and ensure that patients consume the prescribed medication.