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Post Liver Transplant Patient Care

After a 10-hour liver transplant operation, patients will be transferred to the intensive care unit for careful monitoring for 2-3 days or longer. They will then be moved to the liver transplant center to continue recovery. During recovery in the center and afterwards, patients must follow medical advice including taking medications, exercising lightly, maintaining good hygiene, and returning for follow up visits with the liver transplant team.

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56 views15 pages

Post Liver Transplant Patient Care

After a 10-hour liver transplant operation, patients will be transferred to the intensive care unit for careful monitoring for 2-3 days or longer. They will then be moved to the liver transplant center to continue recovery. During recovery in the center and afterwards, patients must follow medical advice including taking medications, exercising lightly, maintaining good hygiene, and returning for follow up visits with the liver transplant team.

Uploaded by

chan kim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Post Liver Transplant

Patient Care

Ver.: 7/2015
General information after liver transplantation

1) In Intensive Care Unit

After a 10- hour liver transplant operation, you will be transferred to


the Intensive Care Unit (ICU) for meticulous management.
Doctors of Liver Transplant Team will continue to take care of your
treatment.

The first couple of days after the operation are most critical. You will
be connected to some monitoring equipment, drainage, arterial or
venous catheters, or a ventilator, etc. The medical staff will observe
and evaluate your condition with the help of the monitoring equipment.
Generally, you will stay and be monitored in ICU for 2-3 days, or longer.
When your condition is stabilized, you will be transferred to the Liver
Transplant Centre for further management and observation. Doctors
will monitor your progress every day and decide on your transfer.

2) In Liver Transplant Centre

Return to General Ward

During your stay in ward, you should follow the advice and guidance of
the medical and nursing staff. Don’t be anxious and upset. Support
and encouragement from family and friends will contribute to your
recovery.

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Liver Transplant Centre

Post operation wound pain management

You will have patient control analgesia (PCA) for pain control through
intravenous after operation. Then doctors and anesthetists will
prescribe oral or intramuscular medications regularly. You can also
ask the medical and nursing staff for the medications or further
information if needed.

Post operation blood checking

After the transplant, you will have blood checking every day. You
should follow instructions given by nursing staff and take FK506 or
Sirolimus, etc. after blood taking. Doctors will correct drug level
daily by adjust the drug dosage accordingly and assess your recovery
progress.
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Post operation diet

After the operation, doctors will advise you to resume a regular diet as
soon as possible to obtain adequate nutrition. When you first resume
diet, you will experience loss of appetite, nausea, flatulence, or even
vomiting. This is probably because the residual effects of anesthesia
and slow bowel movement after the surgery. You will recover in a few
days and your appetite will gradually improve. We recommend you
to reduce the regular meal size and eat between regular meals. Do
not get too full and avoid taking a lot of liquid before and after
meals. The nurse will arrange you clean diet and drinking water, see
figure 1, so family does not need to bring you food. Dietitian will also
see you and design the postoperative eating plan.

Figure 1: Post liver transplant clean diet and water

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Post operation care and exercise

Apart from obtaining sufficient nutrition and taking medications at


specific times, mild exercise is essential for recovery. In the first few
days after surgery, you should get out of bed and sit on chair for at least
1-2 hours every day. Please do more deep breathing exercise because
it helps your lungs to expand and enables you to cough up sputum
easily or use your self-financed breathing exerciser (see figure 2).

Figure 2: Breathing exerciser

Besides, the physiotherapist will teach you to exercise your legs by


cycling, see figure 3, so that your leg muscles can be strengthened,
blood circulation is increased, and the risk of complications such as
venous thrombosis of the legs is reduced. The level of exercise, e.g.
walking, can be increased progressively.

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Figure 3: Bike: for limb exercise

Financial difficulty

The medical social worker can provide assistance if needed. Please


contact our ward nurse.

Foot drop

If it occurs, the occupational therapist will design you a pair of splints


to maintain the foot curvature and prevent the condition from getting
worse, see figure 4.

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Figure 4: Foot splints

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Guide to daily hygiene

1) Personal hygiene

Personal hygiene is essential before and after operation. A daily


shower or bath keeps your skin clean and prevents growth of bacteria.
If you worry that the wound will get wet in bath or shower, we
recommend you to clean your body with a wet towel and change clothes
that are in close contact with the body every day during hospitalization
with the help of your family or hospital healthcare assistants. When the
wound heals and the staples are removed, you will be able to bathe or
shower as usual. Remember to dry the gaps in an incision and keep
the incision dry and clean. If there is oozing from the wound or you
suspect an infection, please contact the doctors immediately.

If you find your skin dry, you may use a mild bathing lotion and apply
moisturizing lotion after bath or shower.

Also, it is important to keep your home clean. Clean your home


regularly (e.g. once a week), to eliminate pest and prevent infection.
In addition, you can use 1:99 bleach to clean your toilet and water
channels.

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2) Quit smoking and drinking

Please do not smoke and drink. Smoking damages your lung and
predisposes you to chest infection.

Alcohol harms the liver further. Please quit drinking.

No alcoholic
drinks and
Smoking

3) Avoid crowded public places

In the first 3 months after liver transplantation, you should avoid


visiting crowded public places like cinemas, restaurants and department
stores, etc. If it cannot be avoided, please wear mask and perform
hand hygiene in public places. We suggest your friends and relatives
to wear masks if they want to visit you in the first 3 months after liver
transplantation.

Avoid contact with animals and birds to prevent infection.

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4) Exercise and social activity

During your recuperation period or the first few weeks after hospital
discharge, you will feel tired easily. Please do more deep breathing
exercise and take more rest. Sometimes you will find weakness in the
muscles all over your body, and leg muscles in particular. This is a
result of a lack of exercise after surgery and a side effect of steroid. To
strengthen the leg muscles, you are recommended to progressively
increase the level of exercise. Walking, cycling and working out on
exercise bikes are good choices.

If your feel any discomfort during exercise, like shortness of breath,


dizziness, chest pain, tachycardia or palpitations, please stop your
exercise immediately and have rest. If the situation does not improve,
you can seek advice from your doctor.

Exercise can improve your muscle strength, reduce side effects of some
drugs and prevent constipation. However, in the first three months
after liver transplantation, you should avoid heavy lifting work and
vigorous exercise. Basically, you can do whatever you want to do
gradually, including sit-ups, abdominal exercises and swimming, which
help to tighten abdominal muscles, and flatten your tummy. We
encourage you to return to school or work as soon as possible, but in the
first 3 months of recuperation, please seek advice from the doctors and
consider your health condition before making a decision.

If you plan on a trip to a foreign country, please seek advice from your
Transplant Team doctors first.
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5) Dental care

After liver transplantation, you should beware of oral hygiene and keep
your teeth healthy. Always brush your teeth and rinse your mouth
after eating. If you receive dental care or dental treatment, please let
the dentist know that you are a liver transplant patient and that
you are on immunosuppressant.

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6) Pregnancy

For female patients, menstruation may temporarily stop after surgery,


but there is still a chance to get pregnant. Contraceptive methods
should be practiced. You are advised to wait at least one year
following transplantation before trying to conceive.

Immunosuppressant can interfere with the effects of certain kinds of


oral contraceptive pills. If you would like to take oral contraceptive
pills, please discuss with your doctor.

If you decide to have children, please discuss your plan with the
Transplant Team doctors. Although a number of women are able to
have children after liver transplantation with minimal risk to the mother
and baby, pregnant transplant recipients will need to be closely
followed.

7) Avoid contacting patients with infectious diseases

If your friends or relatives suffer from infectious diseases such as


influenza and pneumonia, or in particular communicable diseases such
as chicken pox and hepatitis, please avoid physical contact with them.
If they are members of the household, they should take general
precautions, for example, use separate tableware and utensils, and cover
their mouth when coughing, etc. Also, it is important for you to wear
mask and perform hand hygiene frequently too. However, it is still
possible for you to be infected.

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If you are infected, you should inform the Transplant Team doctors,
who will give you advice and arrange necessary treatment.

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Guide to follow up visits after liver transplantation

After discharge from the hospital, you are responsible for continuing
appropriate treatments and cares according to the advice given by the
Liver Transplant Team. After discharge, you will go to the Liver
Transplant Clinic on 4/F, Block S, Specialist Clinic, Queen Mary
Hospital for routine follow-ups as scheduled. If you notice obvious
abnormality in your body, please report to the Liver Transplant
Team for further management.

1) Liver Transplant Centre Hotline

If you have any problems after discharge, please call our:


Hotline﹕22555800 (install record phone) (Monday to Friday)
We shall call you back in office hour

Notice: If you feel discomfort, such as fever, vomiting and diarrhea,


please seek medical help as soon as possible.

2) Return for follow-ups as scheduled

In general, follow-up visits will be more frequent at the early


period after discharge. You are necessary to return for follow-up,
so that the doctor is able to give you safe and appropriate medical
instructions.

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Rejection and infection are commonly seen in liver transplant
patients, so you need to undergo blood tests and evaluation.
Please remember to bring along the required dosage of
immunosuppressant e.g. FK506 on the day of follow-up visit, and
take it after blood drawn at the outpatient clinic (no dispensing of
drugs at S4 OPD setting).

For diabetes mellitus patients: If there is no special instruction,


please have your breakfast and insulin injection before going to the
clinic. If necessary, referral to a diabetes specialist will be
arranged to you.

You should record clearly your medications and the dosages


prescribed by the Liver Transplant Team doctors. Keep enough
medications (an amount enough until the next scheduled visit).
Without the doctors’ instruction or a phone call indicating a change
of medications, never stop taking or change your medications.

3) Follow up

In general, the blood result on the day of follow up cannot be


released at the time to see the doctor. However, all the blood test
results will be screened by our Liver Transplant surgeons, if there
is any change of medication or dosage, our liver transplant
coordinator will contact and instruct you accordingly. Therefore,
if you change address or telephone numbers, please update
your record at S4 OPD counter as soon as possible.
********End********
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