After the transplant operation

First, you'll be in intensive care

After surgery, you will be transferred to the RPA Hospital Intensive Care Unit. The average stay in the Intensive Care Unit (ICU) is two to three days. When you first wake up, you may be a little drowsy, as the anaesthetic drugs take a while to wear off. You may not be able to talk as there will be a breathing tube in your mouth. This will be removed when you are able to breath without support.

There will be an ICU nurse monitoring you constantly and the intensivists, transplant medical team and transplant surgical team will be routinely seeing you.

Whilst in ICU:

• your pain levels will be monitored
• you will also have a number of lines (tubes) in place that will be removed over the following days
• intravenous lines in your neck and arms for fluid, monitoring and pain relief
• nasogastric tube to allow for feeding (with increasing oral intake over time)
• abdominal drains to remove post-operative fluid from the abdomen
• urinary catheter draining your bladder
• calf compressors to your lower legs to reduce the risk of venous thrombosis

Family will be allowed to visit once you are settled in intensive care.

The amount of time you spend in the Intensive Care Unit will depend on your recovery progress and whether there are any complications.

Then, you will be moved to the Transplant Ward

After a stay in the Intensive Care Unit, you will be transferred to the RPA Hospital Transplant Ward. The average stay in hospital ward is one to four weeks, but may be extended due to complications.

You will be cared for on the ward by specialised transplant nurses, supported by the Nursing Unit Manager and Clinical Nurse Educator. The Transplant Team, including the Surgical and Medical Doctors will make regular ward rounds. A team of allied health supports including social workers, dieticians and physiotherapists will also assist your recovery.

The team will encourage and support you as you focus on:

• mobility, chest physiotherapy and breathing exercises to reduce the risk of pneumonia
• food intake
• wound management
• monitoring bloods
• increase your activity becoming more independent
• regular rounds by the medical and surgical transplant teams

Family and friends are encouraged to visit and their help and support plays an important role in your recovery. From time to time, if there are concerns about infection risk the hospital may restrict the number of visitors that may attend.

Discharge

Your stay may be extended due to complications but at the time of discharge you should be well enough to do most things, like showering and dressing yourself. You will be advised of an expected discharge date to allow sufficient time to prepare for your discharge. For patients living outside the Sydney region you will be expected to stay close to the hospital for 1-2 weeks or until your doctor agrees you may go home.

Before discharge you will have education from:

• your liver transplant coordinator will explain the care you'll receive as an outpatient
• the pharmacist will explain the importance of your medications and when to take them
• the physiotherapist would have cleared you for independent mobility
• the dietitian will discuss dietary requirements and food safety
• social worker will supply any supports you may need
• surgical team will review your surgical wound and make a plan for any needed follow up

Most people, although well, take many months to get over the effects of the surgery and may not feel their normal selves again for several months.

Follow-up after discharge

Following discharge, the Liver Transplant Clinic (on Level 9 at RPA Hospital) will monitor your progress. In the first week following discharge, you will probably need to attend the clinic twice for follow-up appointments. Follow-up appointments will become less frequent as time progresses. One year after transplantation, most patients will attend the clinic every three months for a follow up appointment. However, lifelong follow up is necessary.

Risks associated with liver transplant surgery

The major risks of liver transplant surgery include:

• intraoperative bleeding
• primary non-function (rare condition when the new liver does not work)
• hepatic artery thrombosis (formation of blood clot in the artery to the liver which may result in the liver failing)
• kidney failure requiring temporary dialysis
• cardiac complications
• unexpected transmission of other diseases from the donor
• death (there is a 1 in 100 risk of dying during the transplant operation)

Long term risks after a transplant include:

• your body rejecting the new liver
• infection
• bile duct narrowing (strictures)
• your disease coming back

The transplant team will be an integral part of your transplant journey which will be lifelong.

We monitor you closely whilst you are an inpatient and you will have regular contact with the team as an outpatient. The clinical expertise and support offered will help reduce any risks that may arise.