How to Help a Loved One Recover From a Liver Transplant
In this article, we will look in detail about how to care for a loved one after liver transplant. So before going into the details of care, I have summarised briefly about liver transplant and how one has to get prepared for the caring process.
A liver transplant is a major operation that takes place over the course of a few hours. It can take between 6-12 hours, or even more, depending on the situation, patient's health condition, and the surgeon’s approach. During a transplant, the donor liver is implanted into the patient, and as it is a foreign body, the immune system will fight to destroy this new liver. In order to overcome this, immunosuppressants are prescribed, but these can lead to other problems like infections, etc., as the immune system is suppressed.
A person who has undergone a liver transplant has to be looked after very well after the transplant process. The person who cares for the patient should have a good knowledge about all the after care, symptoms of rejection and infections, the diets that need to be provided, the medication process, check-up schedules, etc. They have to monitor the patient closely for a long period of time, until they completely recover.
What to Expect After the Liver Transplant
- After the transplant, the patient will be taken to an intensive care unit (ICU) and kept there for a few days, where a nurse will be looking after them. The period of stay in intensive care unit will depend on each individual’s health condition.
- The patient will experience some pain after the transplant process and pain relievers will be given
- A ventilator will be fitted, to help with breathing for the first few days as the patient will find it difficult to breathe by themselves.
- Tubes will be inserted through the nose into the stomach to provide the patient with nutrients and fluids. Some patients will have a T tube to drain bile and some others will have their intravenous tubes and catheters on, all depending on individual’s health conditions.
- When the patient is well enough to leave the ICU, they are moved into the hospital ward where they stay for a few weeks. This can be 2 weeks or more depending on each patient’s health condition.
- Recovery process is a slow and long process and can take from 3 months up to a year depending on individual health conditions. There will be regular check-ups that will have blood tests and x-rays taken and this can continue for few to many years.
- The immune system will not recognise the new liver and will start to attack it. This process is called rejection. In order to overcome this, medicines called immunosuppressants have to be taken and these suppress the immune system. Initially higher doses are given as the risk is high during the first few months and later reduced, but still sufficient enough to prevent the immune system from rejecting the new liver but at a dose that will minimise side effects.
- A balance has to be maintained between the rejection and side effects. The immunosuppressants have to be at a dosage level so that the liver is not rejected, and at the same time not cause any other side effects due to immune system suppression. This dosage is calculated by having regular blood tests right from the time the immunosuppressants are taken.
- People who have undergone a liver transplant can have risks due to anaesthesia (breathing problems and reactions to medicines, etc), risks due to surgery (bleeding, infection, heart attack, etc) and risks after surgery (diarrhoea, fever, jaundice, tenderness, swelling, etc.).
There are two main types of immunosuppressants that are given to patients who have had a liver transplant.
- Calcineurin inhibitors
These immunosuppressants have a number of side effects, but should not be stopped or reduced as this can lead to the new liver being rejected. They also react with other over-the-counter medicines and herbal medicines. So it is always best to discuss any side effects with your doctor or health professional. Also if you have to take any other over-the-counter or herbal medicines, it is best to consult your doctor before doing so.
Calcineurin inhibitors, as the name indicates, inhibit the protein called calcineurin. These proteins are responsible for activating the T cells (a type of white blood cells in the immune system that fight against infection). This inhibition process, stops the immune system from sending T cells to attack the new liver. There are different calcineurin inhibitors and these are available in the form of tablets, capsules or injections. They have various side effects and they can be even serious ones like cancer, diabetes and kidney failure.
Side effects of Calcineurin inhibitors are:
- Problems with sleeping
- High blood pressure
- Shaking or trembling
- Muscle pain or cramps
- Feeling anxious or confused
- Loss of appetite
- Itchiness and rashes in skin
- Hair loss or excessive hair growth depending on the type of calcineurin inhibitor taken
Corticosteroids work by penetrating the walls of the immune cells and switching off the genes that are responsible for releasing many chemicals into the immune system to attack the new liver. These immunosuppressants have many side effects and including mental health symptoms.
Side effects of Corticosteroids are:
- Fluid retention
- Suicidal thoughts
- Frightening thoughts
- Weight gain
- Muscle weakness
- Mood swings
- Longer healing time for wounds
Long term use of corticosteroids can lead to other serious health issues and hence they are gradually reduced and stopped. Doctors prescribe alternative medicines after that.
Every year, hundreds and thousands of people undergo liver transplant. The patient’s family or friends or whoever will be looking after the patient after the discharge from hospital will need to have all necessary information and support to look after them well.
Liver Transplant: The Surgery, Recovery and Quality of Life | Q&A
How to Care for a Loved One After the Transplant
It is not an easy thing, seeing a loved one go through all the pain and trauma of a liver transplant. Looking after patients who have just come out of a liver transplant is a very sensitive job. There are so many things to consider and know before getting involved and requires lot of dedication. Let us look at the support required in this process.
- The first step is identifying the person or people who will provide support for the patient. In most cases, families look after the patient, for example, parents, children, spouse, partner, near relatives. In some cases close friends look after the patient during the recovery process. So after identifying the people, be it friends or relatives or family, a schedule or timetable needs to be drawn based on the availability of each person, so that no schedule is missed off, as this can create problems with the patient skipping food, medication, struggling for personal care etc. Also it is best to plan these well ahead of the operation, that is when the doctors decide that the patient will need a liver transplant. This will avoid confusions after the operation.
- After identifying the people, the patient needs to give consent in order for the hospital, health professionals and the entire medical team involved to discuss medical issues about the client with the authorised people (family, friends or relatives). The best idea would be to discuss about these even before the operation so that things go smoothly after the operation and the patient can relax not wanting to worry about these issues.
- The person or people who will be looking after the patient will have to get to know the medical team, and be in touch with them constantly as they are the only source that will be able to help you with any support, information and advice that you require.
- Do not fail to attend meetings organised by the medical team about care after the operation and recovery process, so that it helps you learn about these processes and makes caring a lot easier.
- If the patient has children or pets, make sure that all arrangements are made before the operation to look after the children or pets, so that the patient can be at rest and stay in peace that they are being looked after.
- Follow all the instructions of care and recovery process and understand them well before the patient is discharged, as each patient will have specific instructions depending on their health and needs.
- Speak to support groups who provide advice, speak to friends and families who have looked after patients and helped them recover successfully in the past, to medical professionals who are experienced in this field, to patients who have successfully recovered from liver transplants, as these will help you gather more information and give you ideas on how to care for your loved one.
- Learn about the signs of rejection and infection, this is very important as sometimes the patient will not be in a situation to recognise them.
- You yourself (the person who cares) need to be of good physical and mental health to look after the patient. So prepare yourself to this process. If you are anxious or worried or emotionally disturbed, you cannot focus completely on looking after your loved one.
A liver transplant saved my life
How to Care for a Loved One, Continued
- Now the next important step is preparing the patient’s home. As we know, the immunosuppressants will increase the chances of infection and hence the patient’s home has to be cleaned thoroughly and disinfected. This will help to lower the chances of infections. Recovery time and success in recovery depends mainly on avoiding infections.
- The patient may need special items that need using through the recovery period. So have a discussion with the medical team and prepare a list of items that need purchasing, also buy anything that you think will help with the recovery of the patient.
- After the patient has arrived home, help the patient with medications; take utmost care not to skip any medicines and also make sure they are given at the right time each day. It is good habit to record the medicine administration along with time of administration on a chart.
- Temperatures and blood pressures will have to be monitored on a regular basis and recorded on a chart. Make sure you do that at the right intervals / time.
- The incision from the operation will have to be looked after for any infections or other issues. Some patients may still have a few tubes fitted in their body and care has to be taken with all of these, by keeping them clean, clearly following instructions and advice from the medical team, as otherwise this can lead to serious infections. Also utmost care has to be taken not to put any pressure in the incision area and also care has to be taken not to touch or hurt that area and surrounding areas by any means.
- Give your loved one nutritious food, high in fibre. Reduce salt, fatty and greasy food. Some fruits like apples (contains pectin, that eases the workload of the liver), prunes (these are dry plums and are high in anti oxidants), berries (high in antioxidants and help with liver function) and other citrus fruits (helps with cleansing toxins and stimulates the production of bile) are good for the liver.
- Monitor their bowel movements and the colour of urine and stools. Any difference in colour or constipation has to be reported to the medical team and help sought.
- Help with transporting them for medical appointments and other places while they are in the process of recovery. Initially the visits will be more frequent, like once or twice a week for various tests following transplantation. The frequency will decrease after a few weeks or months depending on your loved one’s health condition.
- Help them with resolving finance related queries if they are happy for you to do so. They may also require help with managing finances.
- Help with all household activities and shopping till they recover completely and are well enough to do that by themselves.
- Support them with mobility during the early stages of recovery and also accompany them for physical activities, as they can recover faster with support. Even if they are unable to move, lend your support and help them with walking.
- Visitors may want to visit the patient. So it is important to create a schedule that allocates a specified period of time for visit and also states the duration of visits as long visits and crowds can be overwhelming for the patient and have high risk for infections. Visitors also need to follow instructions from the medical team regarding washing their hands and other related things so as to avoid infections.
- Make sure you have disinfectants and soaps in stock, and wash your hands after every task to avoid infections.
- Finally the most important thing is emotional support. Your loved one would have gone through a lot of stress and emotional struggle during the whole process, right from diagnosis, operation through to recovery and this can be very painful and can be a struggle with many. They may be frightened. Also medications have huge side effects and can affect the patient’s mental health. So they will need lot of emotional support. Sit and talk to them, listen to them, talk about happy things, motivate and keep them calm and positive as all these will help with speedy recovery. You can also arrange for counselling if required, with advice from the medical team.
Disclaimer: The contents of this article are for general information only and should not be used as an alternative or substitute for medical advice from your own doctor or other health care professionals. Always consult your GP or health professional if you are concerned about your health, or the health of your loved one, in any way.
I hope this hub has been of some use to you. Please correct me if there is any error. I would like to have your feedback, and to listen to your thoughts and experiences. Please do not hesitate to share them in the comments section below.
Thank you for reading.