Liver Transplant

WHAT YOU SHOULD KNOW:

Liver Transplant (Inpatient Care) Care Guide

A liver transplant is surgery to remove part or all of your liver and replace it with a healthy, donor liver. Your liver normally helps to remove waste products from your blood and helps with blood clotting. A donor liver may come from someone who has died, or from a living person.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • The fluids used during your surgery may build up in your abdomen and lungs. Extra fluid may make it hard for you to breathe. During surgery, your blood vessels may be damaged, and you may lose large amounts of blood. Your blood pressure may decrease, or you may have abnormal heartbeats during surgery. Rarely, you may have a heart attack during surgery when the blood begins to flow through your new liver. You may also have an increased risk for ulcers and bleeding in your stomach. You may have a decreased level of electrolytes (body salts), which may damage your heart and be life-threatening.

  • After surgery, bile (yellowish fluid from the liver) may leak from your bile ducts into your abdomen. You may get a wound, or an abdominal, lung, or blood infection. After surgery you are at an increased risk for blood clots that may travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Blood clots may form in the blood vessels of your liver. Your new liver may not function, and you may need a new liver right away. Other organs in your body may also fail, and be life-threatening.

  • After your transplant, you are at an increased risk for diabetes, kidney problems, and high cholesterol. You also may be at risk of bone and heart disease, and cancer. Your body may reject your new liver, and you may need another liver transplant. If you had liver cancer, your cancer may return, and you may need another transplant. If you have viral hepatitis, the virus may return and cause your new liver to fail. If you choose not to have a liver transplant, your symptoms may worsen, and become life-threatening.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • Antirejection medicine: These help prevent your body from rejecting your new liver. You may need to take this medicine for the rest of your life.

  • Antibiotics: You may be given this medicine before and after your surgery. Antibiotics help prevent infection from bacteria.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

    • Central venous pressure line: A central venous pressure (CVP) line is an IV put in a vein near your collarbone, or in your neck or groin. The CVP line can monitor the fluid and pressure in your blood vessels. The CVP line may also be used to give medicines or IV fluids.

  • Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag.

  • Nasogastric tube: A nasogastric (NG) tube is put into your nose, and down into your stomach. The tube may be attached to suction to keep your stomach empty.

  • Blood transfusion: You may need a transfusion during surgery if you lose a large amount of blood. During a blood transfusion, you will get whole blood, or parts of blood through an IV. You may also need a blood transfusion after your surgery.

During surgery:

  • Your caregiver will make incisions under each side of your ribcage. There will also be an incision made down the middle of your abdomen. Muscles and other tissues will be moved aside to help your caregiver see your liver better. Extra fluid found inside your abdomen may need to be removed. Your caregiver may then connect a large vein in your leg, a vein in your neck, and your portal vein to a bypass machine. Your portal vein is the large blood vessel that carries blood to your liver. A bypass machine keeps oxygenated blood pumping through your body and out of your liver during surgery. If bypass is not used, clamps will be used to stop the blood flow to your liver during surgery.

  • The blood vessels attached to your liver will be cut and closed to stop any bleeding. Your liver will be removed, and the donor liver will be replace it. The gallbladder attached to the donor liver will have been removed before the liver is transplanted. Your caregiver will sew the blood vessels of the donor liver to your blood vessels. The clamps, or bypass, will be removed to allow blood to flow through your new liver. Your caregiver will then attach your bile duct to the donor liver's bile duct. He may use stitches, surgical glue, or a laser beam to stop any bleeding. Drains will be placed around your liver to remove any extra blood and fluid after surgery.

  • Your caregiver will then close the incisions with stitches, and cover them with bandages. The bandages will help keep your wounds clean and dry, and help prevent infection.

After surgery:

You will be taken to a room where you will rest and be monitored. Caregivers will monitor your heart rate, blood pressure, breathing, and temperature closely. You may still have an ET tube in your mouth and throat. The ET tube is hooked to a machine called a ventilator that helps you breathe. The ET tube will not be removed until you can breathe well on your own. When you are fully awake you may still have many tubes in place. The tubes may make it hard for you to move, but are needed to monitor your condition. Do not get out of bed until a caregiver says it is okay, and someone is there to help you. Caregivers will check your wounds often for healing and any problems. The following may also be needed after your surgery:

  • Blood tests: You will need to have blood tests after surgery to check how your body is doing. You also will need to have arterial blood gas (ABG) tests. For an ABG, blood can be taken from your arterial line, or an artery in your wrist, arm, or groin. Your blood is tested for as oxygen, acids, and carbon dioxide.

  • Chest x-ray: This is a picture of your heart and lungs. Caregivers use it to see how your lungs are doing after surgery. Caregivers may use the x-ray to look for signs of infection or to look for fluid around your lungs.

  • CT scan or MRI: These tests use an x-ray machine or powerful magnets and a computer to take pictures of your abdomen. The pictures may show if your liver is working after surgery. You may be given a dye before the pictures are taken to help caregivers see the pictures better. Tell the caregiver if you have ever had an allergic reaction to contrast dye.

  • Doppler ultrasound: A Doppler ultrasound is a test to check the blood flow through the main artery in your liver.

  • EKG: This test records the electrical activity of your heart. It is used to check for damage or problems in your heart.

  • Intake and output: Your caregivers will need to know the amount of liquid you are getting. Caregivers will also measure the amount you urinate. While you have a catheter in, caregivers can measure the urine in the bag. After your catheter is removed, ask your caregivers if they need to measure your urine before you dispose of it. Caregivers will also measure the amount of fluid that collects in your surgery drains, and from your NG tube. When you are draining little to no fluid from your wound, your drains will be removed.

  • IV fluids: You may need extra fluids in your body after your liver transplant. The fluids are given through the IV in your vein. IV fluids are liquid solutions that contain water, sugar, and protein. They also may have electrolytes in them needed to prevent abnormal heartbeats after surgery.

  • Neurologic signs: Caregivers will check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after your surgery. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.

Medicines:

  • Antirejection medicine: These help prevent your body from rejecting your new liver. You may need to take this medicine for the rest of your life.

  • Steroid medicine: Steroids may be given to stop your body from rejecting your new liver. Steroids can also help decrease inflammation.

  • Pain medicines: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.

  • Proton pump inhibitor medicine: This medicine helps decrease the amount of acid that your stomach makes to prevent an ulcer.

  • Antimicrobial medicines: These prevent a bacterial, fungal, or viral infection.

Prevent deep vein thrombosis:

Deep vein thrombosis (DVT) is a condition where blood clots form inside your blood vessels. This can easily happen after surgery. Your caregiver may have you wear pressure stockings. These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots.

Nutrition:

  • Once you are able to breathe on your own and bowel sounds are heard, you may be able to eat. Your caregiver will listen to your stomach for bowel sounds with a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, or juice. When you are able to drink the liquids without problems, caregivers may then give you soft foods. Once you can eat soft food easily, you may begin eating your usual diet.

  • If you have problems eating or digesting food, you may be given total parenteral nutrition (TPN). It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat. TPN is usually put into your body through a large IV catheter, such as a central line. You may need TPN for several days or longer.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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