Medications To Avoid After Liver Transplant


Liver Transplant Survival Rates

Medication after transplant | UCLA Liver Transplant Services

Your chances of a successful liver transplant and long-term survival depend on your particular situation.

In general, about 75% of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 75 will live for five years and 25 will die within five years.

People who receive a liver from a living donor often have better short-term survival rates than those who receive a deceased-donor liver. But comparing long-term results is difficult because people who have a living donor usually have a shorter wait for a transplant and aren’t as sick as those who receive a deceased-donor liver.

Survival rates among liver transplant recipients also vary among U.S. transplant centers and can be found online at the Scientific Registry of Transplant Recipients.

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After Liver Transplant: Medications

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When performing liver transplant surgery, the patients life changes, because they have a new opportunity, which is accompanied by new challenges. One of them is represented by the medications you must take to keep the transplanted organ working properly.

The following article will help you understand more about this topic, as it is based on a discussion conducted by Dr. Pedro Rivas -president and founder of Fundahígado América-, with the specialists in the field, the doctors: Mia Schmiedeskamp-Rahe -professor of clinical assistance at the Faculty of Pharmacy at the University of Illinois Chicago, United States- and David Choi -pharmacologist and professor at the same university-.

The conversation of the three health specialists seeks to clarify all doubts about which are the drugs that should be given to post-transplant patients, the justification for their consumption and duration of treatment. As well as the recommended doses and their side effects.

Starting from the premise, liver diseases are characterized by a history of long treatments which involve the consumption of various drugs and whose life expectancy in many cases is transplantation. It is important to point out that once the surgery has been performed, the patient must follow new care: control exams and medicine intake.

Drugs That Protect Your Digestive System

Because some medications you take can cause stomach ulcers, you may need to take other medication to help protect your digestive system. These drugs will be prescribed by you transplant team, when necessary.

Antacids/Anti-Ulcer MedicationsRanitidine , Famotidine , and Omeprazole , are medications used to prevent and sometimes treat stomach ulcers.

  • It is important to follow instructions about meals and other medications when taking any of these drugs.
  • Your transplant team will decide the right medication, dosage, and length of treatment time for you.
  • Do not take these drugs with other medications unless your transplant team has told you to do so.

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Implantation And Caval Techniques

The suprahepatic vena cava is anastomosed first, followed by the infrahepatic cava.

Prior to completion of the latter, the liver is flushed free of preservation solution by infusion of chilled Ringer lactate solution. Alternatively, this may be performed after the portal vein anastomosis is completed, using portal blood . The recipient portal vein is decannulated and anastomosed to the recipient portal vein. After reperfusion, the caval clamps are opened, restoring normal flow. After a quick hemostatic check, the hepatic artery is anastomosed in an end-to-end fashion. The author has routinely used the common hepatic artery at the level of the gastroduodenal to avoid a steal phenomenon.

To confirm adequacy of the vascular reconstructions, flow is then measured with an ultrasonic or electromagnetic flow meter. If flow is inadequate, the inflow, outflow, and anastomoses are examined to determine the reason and to correct the problem.

Piggyback technique

Cholangiography is performed to confirm a technically sound biliary reconstruction and may be performed through the T-tube or via the cystic duct. With this completed, closing the abdomen after leaving 3 closed suction drains above and below the liver concludes the operation.

How Can I Prevent Organ Rejection

Orthotopic Liver Transplantation

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 systems 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 systems 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.

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Medical Complications After Liver Transplant

After 1 year posttransplant, nonhepatic-related causes of death include malignancy , cardiovascular disease , infection , and renal failure , whereas liver allograft failure accounts for less than one-third of deaths .2 Metabolic syndrome is uncommon in patients with end-stage liver disease before transplant , but it increases dramatically after OLT, with 44% to 58% of patients affected and is associated with an important increase in cardiovascular morbidity.3-6 Many centers defer the management of metabolic syndrome and medical complications to primary care physicians.7Table 1 summarizes the most common metabolic complications after OLT, and these complications are discussed in greater detail later in this article.

Causes of death at 1 year posttransplant among liver transplant recipients with a mean follow-up of 10 years. OLT = orthotopic liver transplant.

Am J Transplant

Will I Need To Take Medications After A Liver Transplant

Following a liver transplant, you will need to take immunosuppressants for the rest of your life. These can help prevent your body from attacking and damaging the new liver.

Medications doctors can prescribe to help reduce the chance of your body rejecting the new liver can include:

  • cyclosporine or tacrolimus FK 506
  • prednisone or methylprednisolone
  • mycophenolate mofetil MMF

In the case of severe rejection, doctors may prescribe OKT3.

Because there can be a wide range of side effects from these immunosuppressants, such as high blood pressure, depression, and headaches, you may also need to take other medications to help manage these side effects.

Following a liver transplant, some things youll need to avoid include:

  • live vaccines
  • close physical contact with people who have infectious diseases
  • alcohol, cigarettes, and recreational drugs
  • unpasteurized milk products, and raw or undercooked eggs, meats, and seafood
  • water from lakes or rivers
  • walking barefoot outside, which can allow soil microorganisms to get into your body
  • pregnancy within the first year post-transplant

While traveling after a liver transplant is typically fine, talk with your transplant team before traveling, especially to developing countries. They can talk with you about how to minimize potential risks.

Its also important to always wear a medical bracelet or necklace after your transplant so that emergency healthcare professionals will know that you have a transplant.

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Wear Sunscreen And Be Careful In The Sun

Cancers, especially skin cancers, are more common in patients who have had a liver transplant. Avoid staying out in the sun for long periods, and wear factor 50 sunblock, long-sleeved shirts and a hat if you are in the sun. If you are invited for screening tests its strongly recommended that you attend.

What Should I Avoid Eating After My Liver Transplant

Living With Your Transplant – Transplant Medication Information & Management

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
  • meats, particularly pork and poultry
  • fish and other seafood

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Intensive Care Unit Care

Following LT, the function of the new liver is monitored closely in an intensive care unit setting. Elevations of liver enzymes, notoriously transaminases , early on are reflective of preservation injury . On occasion, these enzyme levels rise sharply. If they are higher than 2000, the overall viability function of the liver should be monitored carefully to assess the need for retransplantation.

Usually, the liver enzyme levels normalize very quickly, typically within a week of transplantation. The bilirubin level follows a similar pattern of early rise and delayed clearing. However, if the preservation injury is severe, this elevation can persist for 2-3 weeks and can be accompanied by a significant rise in alkaline phosphatase levels.

Platelet counts usually decrease in the first week after LT and recover during the second week. This may be caused by platelet sequestration in the liver and spleen due to preservation injury. Once the liver has recovered, as manifested by the return of bilirubin levels to normal, the platelet count increases.

Recovery in a typical patient is rapid, as is discharge to the floor, usually within 2-3 days. However, if the graft has suffered severe preservation injury, return to normality may lag. Treatment is mostly supportive, with the goal of maintaining stable hemodynamics while the liver recovers. In extreme cases, termed primary graft nonfunction, the new liver never recovers and urgent retransplantation is required.

Medications After A Transplant

After an organ transplant, you will need to take immunosuppressant drugs. These drugs help prevent your immune system from attacking the donor organ. Typically, they must be taken for the lifetime of your transplanted organ.

You will take other medications to help the anti-rejection drugs do their job or control their side effects. And you may need to take medications for other health conditions.

Organ rejection is a constant threat. Keeping the immune system from attacking your transplanted organ requires constant vigilance. So, it’s likely that your transplant team will make adjustments to your anti-rejection drug regimen.

After your transplant, it’s vital that you:

  • Keep all your doctor appointments
  • Undergo every recommended lab test
  • Take all your prescription drugs

It’s also important to find a good pharmacist who can help you:

  • Understand your medications
  • Understand how the medicine works
  • Learn about side effects and interactions

Although rejection is a scary word, it doesn’t necessarily mean that you will lose your donor organ. Most of the time, a rejection can be reversed if your doctor detects its early signs.

The symptoms of rejection — and the medical tests used to detect rejection — vary by the type of your organ transplant. So, it’s important to familiarize yourself with the early symptoms of rejection that are specific to your transplant.

  • Switch to a new drug
  • Add another drug
  • Take a larger or smaller dose of your medications
  • Hair growth or hair loss

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Common Questions About Life After Liver Transplant

Here are some common questions about life after liver transplant. Ask your transplant team if you have more.

  • Can I drink alcohol after liver transplant?

If you had a liver transplant because of alcohol-related liver disease, youll have committed to life-long abstinence from alcohol. A donor liver is likely to be more easily damaged by alcohol than your own liver. So even if you didnt have a liver transplant for this reason, you should still take care to only drink a little, if you decide to drink at all.

  • When can I have sex after liver transplant?

You can have sex again as soon as your wound has healed and you feel ready.

  • Can I have a baby after liver transplant?

Many women have successful pregnancies after a liver transplant. Its best to seek advice before you get pregnant.

Some medicines, such as mycophenolate, have been linked to problems with pregnancy when taken by the mother or father. So it is important to have safely changed to a different medicine first.

When you get pregnant you will need extra monitoring and specialist care.

  • Can I contact my donors family to thank them?

Yes, you can write a letter, which can go to your transplant centre, which will pass it on. Or the Donor Family Care Service team can do this for you.

  • Can I claim benefits?

Tips For Caring For A Liver Transplant Recipient

Foods to avoid after Liver Transplant

If you know someone having a liver transplant, you may wonder how you can support them. Some practical ways to offer assistance include:

  • helping ensure that they follow their postsurgery medication schedule, which can include putting pills in a dispenser, setting alarms, or contacting them with reminders
  • keeping track of and transporting them to required medical appointments and tests
  • encouraging lifestyle changes recommended by doctors
  • helping prepare balanced, nutritious meals
  • offering a listening ear for the range of emotions they may experience

2016 data report , there is an 89% chance of living 1 year past a liver transplant and a 75% survival rate after 5 years.

The biggest risks following a liver transplant include rejection of the new liver and infection. Approximately 60-70% of liver transplant recipients will develop rejection at some point after the surgery, but major medical advances now offer ways to help manage potential rejections.

Other complications can include:

  • damage to the bile ducts
  • side effects related to the medications the recipient takes to prevent rejection of the new liver

You need medical monitoring and medication after a liver transplant, and you may not feel healthier for up to a year.

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Ial Liver Recipient Procedures

While the number of LTs has grown exponentially, the number of organ donors has not kept pace with the growing number of candidates. This widening gap between supply and demand has led to higher mortality rates among candidates on the waiting list. In attempts to narrow this gap, transplantation centers have broadened their donor selection criteria and have begun to use innovative surgical techniques such as reduced-size LT, split LT, and living-donor LT.

Reduced-size LT was introduced in the mid 1980s to provide size-matched grafts for pediatric patients. In reduced-size LT, a cadaveric liver procured using standard techniques is resected on the back table to create a smaller graft. The liver allograft can be tailored based on the recipient’s body size. Right lobe grafts, left lobe grafts, or left lateral segment grafts can be created. The rest of the liver is discarded.

Choosing A Transplant Center

If your doctor recommends a liver transplant, you may be referred to a transplant center. You’re also free to select a transplant center on your own or choose a center from your insurance company’s list of preferred providers.

When you’re considering transplant centers, you may want to:

  • Learn about the number and type of transplants the center performs each year.
  • Ask about the transplant center’s liver transplant survival rates.
  • Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients.
  • Understand the costs that will be incurred before, during and after your transplant. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments.
  • Consider additional services provided by the transplant center, such as coordinating support groups, assisting with travel arrangements, helping with local housing for your recovery period and offering referrals to other resources.
  • Assess the center’s commitment to keeping up with the latest transplant technology and techniques, which indicates that the program is growing.

After you’ve selected a transplant center, you’ll need an evaluation to determine whether you meet the center’s eligibility requirements. Each transplant center has its own eligibility criteria. If you aren’t accepted at one transplant center, you may undergo evaluation at another center.

Your evaluation may also include:

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Related To Immunosuppressive Medications:

These potent drugs have a lot of side effects and potential long-term complications. These side effects will be monitored at your clinic visits, and your providers will make every attempt to control or decrease medication side effects. Most patients, however, will develop one or more complications, which then need to be managed.

Diabetes, kidney problems, high blood pressure, and high cholesterol are some of the more serious side effects. Some of the more annoying side effects include hair loss, insomnia, diarrhea, nausea, headaches, swelling, and neuropathy .

Do not take any new medications without talking with the transplant center or a physician trained in transplant. Many medications can interact with each other and cause elevated levels of immunosuppression, which may lead to serious toxicity. Even antibiotics, herbal remedies, ibuprofen, and grapefruit can do this!

Food And Medication Interaction

Post Transplant Liver Medications – Stacy Animisis
Food and Drink

Tacrolimus is affected by grapefruit, grapefruit juices and a similar fruit that looks and smells like a grapefruit known as pomelo. These can cause your tacrolimus levels to be too high and damage your body. It is very important to avoid grapefruit and pomelo and all related products. Grapefruit items include drinks such as sodas and juices such as Sunny Delight® and Simply Orange® . It is always good to read packages and labels and avoid these products. It is very important to review other possible food interactions with your healthcare team.

Other Medicines

Tacrolimus can be affected by many medicines including vitamins, supplements, prescription medicines, natural remedies and essential oils. It is important to always talk to your transplant team before starting a new medicine even ones given to you by a local doctor or naturopath.

There is a group of medicines used for pain called NSAIDS . They include ibuprofen also known as Motrin®/Advil®, naproxen, also known as Aleve®, and ketorolac, also known as Toradol®. It is important to avoid these medicines as they increase the chance of kidney damage with tacrolimus. The best choice is to always take acetaminophen also known as Tylenol® for pain and contact your transplant team for other options.

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Aim For A Healthy Weight

Weight gain is common after a transplant, especially in the first year. This is often a side effect of the medications, but it can also be because your diet is less restrictive. Or because you have a better appetite due to improving health. However, too much weight gain places a strain on your heart and blood vessels so its important to eat healthily and stay active as much as possible.

Being a healthier weight can help to lower your chances of having problems with your recovery. You should lose weight by increasing the amount of exercise you do and taking extra care with your diet. Speak to your transplant team for more advice on losing weight.

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