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WHAT YOU NEED TO KNOW:
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.
HOW TO PREPARE:
Before your surgery:
While you wait for your donor liver:
- Do not drink alcohol for at least 6 months before your transplant. Ask your caregiver for help if you do not think you can stop on your own.
- Your caregiver may order medicines for you to take while you wait for your transplant. If you have viral hepatitis, you may need immune globulin or antiviral medicines. These medicines may help decrease the amount of virus in your body before surgery. Ask your caregiver for information about medicines you may need before your transplant.
- You may need liver support before your transplant to decrease the level of toxins (waste) in your blood. Liver support may include plasma exchange to remove your plasma and replace it with donor plasma. Plasma is a yellowish liquid that makes up your blood. You may also need hemodialysis before your transplant. Hemodialysis uses a filter to pull toxins out of your blood that your body cannot remove on its own.
- If you have liver cancer, you may need treatment to slow tumor growth before your transplant. Ask your caregiver for more information about treatments for liver cancer.
- You may need to have a CT scan or MRI. You may also need an abdominal ultrasound, Doppler ultrasound, and a chest x-ray. These tests are done to check for cancer or any blockages in the blood flow to your liver. Blood tests will be done to check the function of your liver and other organs. You may also need an upper endoscopy to check for bleeding in your esophagus. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test .
- Write down the correct date, time, and location of your surgery.
- Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
- Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
- Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
- You may need a blood transfusion if you lose a large amount of blood during surgery. 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. You may ask a family member or friend with the same blood type to donate blood for you. Ask your caregiver for more information about blood transfusions.
The day of surgery:
- You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
- What to bring: You may want to bring items such as a toothbrush and bathrobe.
- Blood and urine tests: You may need blood and urine tests done the day of surgery to check your organ function. The tests may also be done to check for infection, or any recent alcohol or drug use.
- An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.
- 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 antibiotics through your IV before your surgery. Antibiotics help prevent infection from bacteria.
- 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 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 fluids.
WHAT WILL HAPPEN:
What will happen:
- You will receive anesthesia to keep you asleep, and free from pain during your 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. The blood vessels attached to your liver will be cut and closed to stop any bleeding. The blood flow to your liver will be stopped during surgery.
- Your liver will be removed, and the donor liver will replace it. Your caregiver will sew the blood vessels of the donor liver to your blood vessels. Blood will then be allowed 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 a bandage. The bandages will help keep your wounds clean and dry, and help prevent infection.
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 endotracheal (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 wound often for healing and for any problems. Caregivers will also give you pain medicine.
CONTACT YOUR HEALTHCARE PROVIDER IF:
- You get sick with a cold or the flu.
- You have a fever.
- You are diabetic and your blood sugar levels are not where your caregiver says they should be.
- You have new headaches or shakiness.
- You have new pain or tenderness in your upper abdomen.
- Your legs begin to swell.
- You have questions or concerns about your surgery or condition.
Seek Care Immediately if
- You are urinating less than usual, or not at all.
- You feel very confused or have a seizure.
- You feel very weak or get tired easily.
- You have a decreased appetite for food and are losing weight.
- You have black, tarry bowel movements, or you vomit blood.
- You have new, or worsening yellowing of your skin or the whites of your eyes.
- You have severe pain in your upper abdomen.
- Your abdomen becomes swollen.
- 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.
Care AgreementYou 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.
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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.