Liver Transplant

WHAT YOU SHOULD KNOW:

• A liver transplant is surgery to replace your diseased or damaged liver with a donor (another person) liver. Your liver is an organ that lies in the upper right side of your abdomen (stomach). Your liver has many functions including removing waste products from your blood. It breaks down your blood so your body can better use the nutrients. Your liver also helps control your blood clotting. Donor livers may come from someone who has died, or from a living family member. You may receive a whole liver, or just a part of a liver. Partial liver transplants are done because the liver is the only organ that can renew itself, if it is healthy.
  
  
• You may need a liver transplant if you have liver failure. Liver failure may be caused by certain diseases that scar your liver and cause it to harden. Viral hepatitis infections may cause your liver to swell and fail. You may need a transplant because of liver cancer. Drinking too much alcohol, too often, also may lead to liver damage and failure. When you need a liver transplant, you will be placed on a transplant list. You may need to wait for a long period of time before a donor liver is found. When a donor liver is found and ready, you will be called to the hospital.
  
  
• During surgery, your caregiver will make incisions (cuts) in your abdomen down to your liver. Your failing liver will be removed, and the donor liver will be secured in place. When your new liver is in place and blood is flowing through it, your caregiver will close your abdomen. You may be watched closely in the hospital for a few weeks after your surgery. With a liver transplant, your symptoms such as abdominal pain, swelling, and yellowing skin may resolve. If you have cancer, it may prevent it from spreading. A liver transplant may even cure your cancer.

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:

• When you have severe liver failure, you have an increased risk of dying before a donor liver is found. You may have an allergic response to the medicines used during, and after your surgery. 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. Medicines used after surgery may increase your risk for infection or slow your healing. You also may have an increased risk for ulcers (open sores) 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, 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 you may die.
  
  
• After your transplant, you are at an increased risk for diabetes, kidney problems, and high blood cholesterol (fat). You also may be at risk of getting bone and heart disease, and cancer. Your body may reject (not accept) 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 you may die. Talk to your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form 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.
  
  
• IV: An IV is a tube that is placed in your vein for giving liquids and medicines.
  
  
• Antibiotics: You may be given antibiotics before, and after your surgery. Antibiotics help prevent infection from germs called bacteria.
  
  
• Immunosuppression medicine: These medicines are given to help your body accept your new organ. They also help prevent your body from rejecting it. You may be given this medicine before your surgery. You will also need this medicine after surgery, and for the rest of your life.
  
  
• Pre-op care: You may be given medicine that makes you relaxed and sleepy right before your surgery. You are taken on a stretcher to the room where your surgery will be done. You will then be moved to a table or bed.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may have a tube placed in your mouth and throat. This tube is called an endotracheal (ET) tube. Usually, you are asleep before your caregiver puts the tube into your throat. You will be asleep and free from pain during surgery.
  
  
• 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: This is a tube placed into an artery (blood vessel), usually in your wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line is used to measure your blood pressure and may be used for taking blood.
    
    
  • Central venous pressure line: A central venous pressure (CVP) line is a thin tube 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 (vacuum) 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 cuts under each side of your rib cage. There also will be a cut made down the middle of your abdomen. Muscles and other tissues will be moved aside to help 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 livers bile duct. Your caregiver may use stitches, special glue, or a laser beam to stop any areas of bleeding. Drains will be placed around your liver to remove any extra blood and fluid after surgery.
  
  
• Your caregiver will then close the cuts with stitches, and cover them with a bandage. The bandages will help keep your wounds (surgery areas) 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 watch 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 watch 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 also may 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 the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Chest x-ray: This is a picture of your 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 like pneumonia, or to look for fluid around your lungs.
  
  
• Computed tomography scan and magnetic resonance imaging: During these tests, a special machine takes pictures of you abdomen. These tests may be needed if your liver is not functioning as it should after surgery. The pictures may help your caregiver learn why your new liver is not working right.
  
  
• Doppler ultrasound: A Doppler ultrasound is a test to check the blood flow through the main artery in your liver.
  
  
• Electrocardiogram: This test helps caregivers look for damage or problems in different areas of your heart after surgery.
  
  
• 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, sugars, and proteins. They also may have electrolytes in them needed to prevent abnormal heartbeats after surgery.
  
  
• Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers 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:

• Antimicrobial medicines: Along with the antibiotics you are getting, you may also need antifungal and antiviral medicines. Antifungal medicine may be needed to help kill fungus that can cause infection and illness. Antiviral medicine may help fight an infection caused by a germ called a virus after your transplant.
  
  
• Antirejection medicine: Your body tries to attack your new organ like it would attack an infection. These medicines are given to help your body accept your new organ and to keep your body from rejecting it. You may need to take this medicine for the rest of your life.
  
  
• Steroid medicine: Steroid medicine may be given to stop your body from rejecting your new liver. Steroid medicine can also help decrease inflammation, which is redness, pain, and swelling.
  
  
• Pain medicines: Your caregiver may give you medicine to decrease your pain. Tell your caregiver if your pain does not get better after taking your medicine. Do not wait until the pain is very bad to ask for your pain medicine. The medicine may not work as well at controlling your pain if you wait too long to take it.
  
  
• Proton pump inhibitor medicine: This medicine helps decrease the amount of acid that your stomach makes to prevent an ulcer.

Preventing deep vein thrombosis:

Deep vein thrombosis (DVT) is a condition where blood clots form inside your blood vessels. This can easily happen after having surgery. Ask your caregiver for more information about deep vein thrombosis. The following can help prevent clots from forming inside your veins:

• Compression stockings: Your caregiver may have you wear compression stockings. These are tight elastic stockings that put pressure on your legs after your surgery. The pressure is highest in the toe area and decreases as it goes toward your thighs. Wearing pressure stockings helps push blood back up to your heart and keeps clots from forming.
  
  

Diet:

• Once you are breathing on your own and bowel sounds are heard, you may be able to eat. Your caregiver will listen to your stomach for bowel sounds using 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. Some examples of soft foods are ice cream, applesauce, or custard. 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). TPN is also called hyperalimentation. It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). 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.

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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.