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Sunday, January 27, 2008

How to live with your new liver

You have received a successful liver transplant after considerable wait, drained financial resources, extremely hard work of the transplant team, sacrifice of a cadaver donor or a live related donor who gave the liver as well with tremendous emotional support of the family and friends. This gift of life must be cherished and taken care of well. Of paramount importance is to take your prescribed medications on time and without fail. Get in touch with the transplant team if you have any fever, pain, problems with the water works, loss of appetite or any other symptom that is unusual. Consumption of alcohol is strictly prohibited.

Cadaver Liver after implant in a recepient Gradual increase in physical activity is recommended after discharge. After 3 to 6 months one can start physically demanding sports activity other than contact sports. One can commence normal sexual activity after 3 months. For women regularization of periods will take place 4 to 6 months after transplant. Pregnancy is not recommended for minimum of 2 years after transplant. Breast feeding while on immunosuppressive medicines is considered safe except when on Mycofenolate Mofetil. If you are not already immune to hepatitis immunization should begin during or immediately after the transplant. At the end of six months HBSAb titer must be checked to ensure immunity. Some of the medications that you take can induce diabetes, hypertension and hyperlipidemia. Regular monitoring of blood sugar, blood pressure and lipid level in the blood should be carried out as advised by your doctor.

Follow up:
Following tests are ordered on fortnightly or monthly basis- AST,ALT, Bilurubin, PT, CBC, urea and creatinine along with drug level of cyclosporine or tacrolimus, as the case may be.

The duration between the blood tests are gradually increased to a bare minimum of 6 monthly tests for long term follow up.

Annual ritual of follow up involves the following examination- examination by the transplant team, bone mineral density study, thorough assessment of kidney function including 24 hour protein excretion, hepatitis and other viral markers, cancer screening, lipid profile, TMT and other cardiac assessment in chosen few.

In long term follow up, close monitoring of the side effects of immunosuppressive medicines becomes important. Dietary advice to prevent or control hypertension, diabetes and weight gain is part of the follow up.

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