After a liver transplant for liver cancer

After your liver transplant, you wake up in the intensive care unit. You usually move back to the ward after a few days.

This information is for people who are having a liver transplant. We have separate information if you are having part of your liver removed. Your doctor might call this a liver resection or a hepatectomy.

When you wake up after your operation

In intensive care you have one to one nursing care. Your transplant team review you regularly and watch your progress closely.

These units are busy and often noisy places that some people find strange and disorientating. You'll feel drowsy because of the anaesthetic and painkillers.

It's common for people to have strange dreams or hallucinations during and after a stay in intensive care. These can seem very real and frightening. They usually get better with time but do talk to your hospital team if they continue. 

Tubes and drains

When you wake up, you have several tubes in you. This can be frightening, so it helps to know what they’re for.

You might have:

• drips to give you blood transfusions and fluids usually through a vein in your neck
• wound drains to drain any blood, bile or fluid from around the operation site
• a tube down your nose into your stomach (nasogastric tube) to drain bile and stop you from feeling sick
• a tube into your bladder (catheter) to measure how much urine you pass
• a small tube into a vein or artery to check your blood pressure

You may also have an oxygen mask on.

Electronic pumps may control any medicines you have through your drip.

Your wound

Your surgeon does the operation through a large cut in your tummy (upper abdomen). You have a dressing over your wound when you wake up. Your nurse will check the dressing to see if the wound needs cleaning. Try to keep your dressings dry.

Your surgeon closes the wound with metal clips or staples. Your nurse removes these after about 10 to 14 days.

The wound drains stay in until they stop draining fluid. Your nurse and the transplant team will check them regularly. The drains usually stay in for a few days, but it might be longer.

Painkillers

It’s normal to have pain after a liver transplant. You have painkillers to help.

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). Analgesia is another word for painkillers. 

You get painkillers to take home. Your nurse will talk to you about:

• how often to take them
• when to take them
• what side effects you may get 

Contact your transplant team if you still have pain or if it gets worse.

Eating and drinking

You can usually start drinking as soon as you wake up and feel able to. You might start eating small amounts the day after your operation depending on how you feel. Your nurse or dietitian might give you nutrition drinks to help until you are able to eat normally.

You might have a tube down your nose and into your stomach called a nasogastric tube. This drains fluid from your stomach and helps to stop you feeling sick. Your nurse will remove the tube once you are eating and drinking normally.

Getting up

Your nurses and physiotherapists will help you to move around as soon as possible. They'll check you're doing your breathing and leg exercises. This helps you recover. 

You might start by sitting up in bed or in a chair. Soon afterwards they will help you to start walking. You are less likely to get a chest infection or a blood clot if you are moving around.

Making progress

During the first few days after your operation, you’ll start to feel better. The drips and drains will come out, you’ll start eating and can move about better.

You’ll begin to feel like you’re making progress.

Blood tests and scans

You have blood tests every day to check how well your new liver is working. You might also need scans and samples taken of the liver (biopsy).

Preventing rejection of your new liver

Your immune system protects your body against infections by recognising foreign bodies, such as bacteria and viruses. It tries to destroy them. Unfortunately your immune system sees your new liver as foreign and will try to fight it.

To prevent this happening you take anti rejection medicines (immunosuppressants). You usually take these for the rest of your life. These medicines weaken your immune system so that it won't attack the liver.

Going home after surgery

You usually spend up to 2 weeks in hospital after a liver transplant, depending on your recovery.

When it's time for you to go home it is natural to feel a bit anxious. Remember that your doctor will only send you home once they believe you are well enough and you understand how to take the medication you need.

It’s important that you take it easy for some weeks after you get home. Your body won't have recovered completely and you’re still at high risk of getting an infection. 

Before you leave the hospital, the staff will spend time preparing you. They will talk to you about your medicines and the possible side effects. They will tell you how often you have follow up appointments, and what to expect when you go home. At first, you will see your transplant team weekly to check that all is going well.

When you go home, there are some important things to remember:

• Always take your medicines at the times scheduled; it is important not to miss any.
• Ask your transplant team if any of the medicines you take should be stored in the refrigerator.
• Talk to your transplant team about any new medicines or vitamins before you start taking them.
• Follow the advice from your transplant team about when it is safe to start your usual activities such as driving, exercise and work.
• Follow the information you get about a safe diet and foods that you should avoid. For example, make sure any meat you eat is cooked thoroughly.
• Know the signs of infection, rejection or bile duct problems. These include fever, tummy pain, and generally not feeling well. Contact your transplant team straight away if you’re worried.
• Stay away from people who are ill, including people who have colds.
• Stay away from crowds, especially where there is poor ventilation.
• Wash your hands often.
• Tell your doctor if you have a white coating on your tongue or spots in your throat - this might be caused by an infection called thrush.
• Women can also develop vaginal thrush so do let your doctor know if you have itching or discomfort.

Contacting the donor's family

Some people want to contact the family of the person whose liver they received. This is usually fine, but the contact needs to be anonymous. You can do this any time after your transplant.

Your transplant team can give you details of the donor family care service. They will help you to make contact with the donors family.

NHS Blood and Transplant service

The NHS blood and transplant service have information about liver transplants. This includes details about waiting lists, the transplant procedure and life after a transplant.