Life after LDLT

Life after LDLT 

Recovery after LDLT and DDLT is not substantially different. Approximately two-thirds of all patients are brought out of anaesthesia at the end of surgery, just as for any regular operation. The remaining patients are awoken the following morning. This is a decision made by the anaesthetists depending on the patients condition and the complexities of the operation. Patients immediately feel the extra energy they have after the operation, and it is not unusual for them to say ‘I wish i had undergone the operation sooner’. Most patients are transferred back to the ward from the ICU within 3 days depending on how well their new liver is functioning. They begin feeding, sitting in a chair and even walking while still in ICU. The focus over the first few days is to observe the function of the new liver, ensure there is no bleeding or leakage of bile requiring reoperation, and confirm that the reconstructed hepatic artery (in particular) and the portal vein are providing adequate blood to the new liver. All unnecessary IV and arterial access is removed, as is the urinary catheter. Surprisingly most liver transplant recipients feel very little pain in comparison to the magnitude of the operation. Whatever pain they might experience is managed paracetamol with some additional narcotic medication.    

After returning to the ward, the focus is on nutrition and exercise to regain strength. The immunosuppression medication that was started in ICU is ramped up to the optimum level for an individual patient based on their liver function, drug levels in the blood, and side effects. The level of immunosuppression is balanced between preventing their body from rejecting the new liver and avoiding too great a degree of immunosuppression to cause serious infections.  

Once this is achieved, patients may be discharged, usually in 10-14 days after surgery.  

Unfortunately some patients do experience minor episodes of rejection or infection or other causes of graft dysfunction that may prolong their hospital stay. Major graft dysfunction or occlusions of blood supply to the liver affect a small minority of patients.  

In the case of LDLT, recipients are naturally very concerned regarding the health of their donor. Donors are usually discharged home within a week without complications.  

After discharge, recipients are on a number of infections - mostly immunosuppression, some antibiotics to prevent viral and fungal infections and nutritional supplements. Over the next 2-3 months these medicines are reduced in dose and number. Steroids in particular, as well as the antibiotics are withdrawn. One or two immunosuppressive drugs along with calcium supplements to strengthen bones are continued. Immunosuppression in particular must be continues life long although the dose of the medication is sometimes very minimal.  

One of the complications that can cause a lot of trouble in the early months after operation is a narrowing of the bile ducts, which affects 15-20% of patients. This is usually managed by endoscopy, but can sometimes take a little while to treat. This complication is particularly disappointing to patients as it occurs just when they feel they are fully recovered from the operation, but begin to experience itching, sometimes fevers and abnormal liver tests.  

Transplant recipients need to take certain precautions after return home 

• Take their Tacrolimus dose at regular times daily, with an hour if fasting before and after the dose.  

• Do not drink grapefruit juice as it affects Tacrolimus absorption 

• Wear a mask while outside the home for the first 3 months after surgery.  

• Avoid going to enclosed crowded places for the first 3 months after surgery to avoid respiratory infections in particular (theatres and wedding halls for example). 

• Maintain basic levels of personal hygiene 

• Avoid eating uncooked, unpeeled food unless thoroughly washed 

• Avoid street food, especially for the first 3-6 months 

• Drink safe water 

• Avoid direct sunlight for the first 3 months while on high doses of Tacrolimus. Or protect yourself from sunlight with clothing 

• Stop smoking and chewing tobacco or paan 

• Abstain from alcohol   

Patients rarely develop liver related problems of any significance after liver transplant. The most common causes of illness after transplant are cardiovascular diseases, and less commonly kidney dysfunction and some cancers. Screening for these diseases, a healthy diet and exercise are vital post transplant. If they follow basic rules, patients usually live a healthy, long and fulfilling life post transplant.