Living with a Liver Transplant

In this section:

• What is organ rejection?
• What are the signs and symptoms of organ rejection?
• How can I prevent organ rejection?
• What are the side effects of immunosuppressants?
• How do I help care for my new liver?
• What should I eat after my liver transplant?
• What should I avoid eating after my liver transplant?

After a liver transplant, you will need to see your doctor often to make sure your new liver is working properly. You will have regular blood tests to check for signs of organ rejection and other problems that may damage your new liver.

What is organ rejection?

Organ rejection occurs when your immune system sees your transplanted liver as “foreign” and tries to destroy it. You have the highest chance of organ rejection in the first 3 to 6 months after your transplant.⁵

What are the signs and symptoms of organ rejection?

Abnormal liver blood test results may be the first sign of organ rejection. Rejection does not always cause symptoms you may notice. When symptoms of rejection are present, they may include

• feeling tired
• pain or tenderness in your abdomen
• fever
• yellowing of the skin and the whites of your eyes
• dark-colored urine
• light-colored stools

You should talk with your doctor right away if you have symptoms of organ rejection. Your doctor will often perform a liver biopsy to see if your body is rejecting the new liver.

How can I prevent organ rejection?

To help keep your body from rejecting the new liver, you will need to take medicines called immunosuppressants. These medicines prevent and treat organ rejection by reducing your immune system’s response to your new liver. You may have to take two or more immunosuppressants. You will need to take these medicines for the rest of your life.

Rejection can occur any time the immunosuppressive medicines fail to control your immune system’s response to your new liver. If your transplanted liver fails as a result of rejection, your transplant team will decide whether another transplant is possible.

What are the side effects of immunosuppressants?

Immunosuppressants can have many serious side effects. You can get infections more easily because these medicines weaken your immune system. Other possible side effects include

• brittle bones
• diabetes
• high blood pressure
• high levels of cholesterol and triglycerides in the blood
• kidney damage
• weight gain

Long-term use of these medicines can increase your chance of developing cancers of the skin and other areas of your body.

Prescription medicines, over-the-counter medicines, vitamins, and dietary supplements can affect how well immunosuppressants work. Tell your doctor if you are prescribed any new medicines. Talk with your doctor before using over-the-counter medicines, vitamins, dietary supplements, or any complementary or alternative medicines or medical practices.

How do I help care for my new liver?

Do the following to help take care of your new liver.

• Take medicines exactly as your doctor tells you to take them.
• Talk with your doctor before taking any other medicines, including prescription and over-the-counter medicines, vitamins, and dietary supplements.
• Keep all medical appointments and scheduled blood draws.
• Stay away from people who are sick.
• Tell your doctor when you are sick.
• Learn to recognize the symptoms of rejection.
• Have cancer screenings as recommended by your doctor.
• Keep up to date with vaccinations; however, “live” vaccines should not be used.
• Talk to your doctor, both before and after your liver transplant, about the use of contraceptives and the risks and outcomes of pregnancy.

Learn how to recognize the symptoms of infection. Symptoms of infection may include:

• fever
• chills
• a stuffy nose
• sore throat
• cough
• diarrhea
• vomiting

Talk with your doctor right away if you have symptoms of infection.

Make healthy choices and protect yourself.

• Eat healthy foods, exercise, and don’t smoke cigarettes
• Don’t drink alcoholic beverages or use alcohol in cooking if you have a history of alcohol use disorder.
• Protect yourself from soil exposure by wearing shoes, socks, long-sleeve shirts, and long pants.
• Avoid pets such as rodents, reptiles, and birds.
• Protect yourself against organisms that can transmit diseases, such as ticks and mosquitoes, by
  • using insect repellent
  • wearing shoes, socks, long-sleeve shirts, and long pants
  • not going outdoors at times when organisms are most likely to be active, such as at dawn and dusk
• If you are planning on traveling, especially to developing countries, talk with your transplant team at least 2 months before leaving to determine the best ways to reduce travel-related risks.

What should I eat after my liver transplant?

You should eat a healthy, well-balanced diet after your liver transplant to help you recover and keep you healthy. A dietitian or nutritionist can help you create a healthy eating plan that meets your nutrition and diet needs.

What should I avoid eating after my liver transplant?

Grapefruit and grapefruit juice can affect how well some immunosuppressants work. To help prevent problems with some of these medicines, avoid eating grapefruit and drinking grapefruit juice.

If you have a history of alcohol use disorder, do not drink alcoholic beverages or use alcohol in cooking.

You should avoid consuming the following:

• water from lakes and rivers
• unpasteurized milk products
• raw or undercooked
  • eggs
  • meats, particularly pork and poultry
  • fish and other seafood

Your dietitian or nutritionist may recommend that you limit your intake of

• salt
• cholesterol
• fat
• sugar

References