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Living With Your Liver Transplant

Once the recipient has had a liver transplant, it is imperative that he/she looks after this new liver. Advice on all aspects of lifestyle and living are therefore very important. These measures may ensure that their liver functions fully and properly and that as a result the recipient leads a healthy and full life.

Some of the most important aspects of daily living are discussed below:

1. Diet

By definition patients who have had a liver transplant have previously had severe liver failure. They will most likely have been unwell for a lengthy period of time preceding their transplant. Therefore there may be many nutritional problems that have built up over this time. Examples of this include deficiencies in vitamins, minerals and calories resulting in weight loss and other problems. It is therefore likely that the recipient will be advised by a dietician after the transplant.

Generally there are very few restrictions to dietary intake, though a healthy diet which is balanced and nutritious will be recommended. A healthy diet may entail a reduction in fat and sugar and should be high in fibre. The dietician may be able to help the recipient in creating a diet or meal plan.

It is recommended by some specialists that recipients should avoid eating food containing listeria for the first 3 months after transplantation. Listeria is a bacterial infection that may cause significant complications for recipients as they will be taking anti-rejection medication at this time. Typically foods containing listeria can include raw eggs, soft cheeses, seafood, mayonnaise, live yogurt, pate and unpasteurised milk.

It is thought that liver disease increases the likelihood of patients developing osteoporosis (thinning of the bones). This is caused by a decrease in absorption of Vitamin D. This essential vitamin is required for normal bone mass development. As a result, patients with liver disease may be at higher risk of developing bone fractures. To counteract this risk, recipients will be advised to increase their calcium and Vitamin D dietary intake. Examples of foods containing a good source of calcium include milk, cheese and canned sardines/salmon.

2. Alcohol

Drinking alcohol is not recommended for the first few months after transplantation. In those patients who have had alcohol related liver disease leading to liver transplantation, it is imperative that total abstinence from alcohol be advised. In short, these patients should not drink any alcohol. However, in other liver patients, over the longer term it is essential that they drink alcohol sensibly and in moderation. Binge drinking will always be discouraged. Many countries have national guidelines for alcohol intake and these should not be exceeded.

3. Smoking

Most individuals are aware that smoking is detrimental to all aspects of health. This is especially so for patients who have received a liver transplant as they will be taking anti-rejection medication. These drugs reduce the efficiency of the immune system. Smoking is responsible for many infections, delayed recovery from infections and the development of cancers. Therefore transplant patients are particularly susceptible to the harmful effects of smoking.

In addition to the above points it is also thought that smoking delays wound healing. As liver transplantation is a major operation requiring a large incision, immediate post operative recovery can also be delayed.

Smoking will therefore always be discouraged and smoking cessation advice should be available from your doctor.

4. Exercise

Exercise is an important issue for everyone. This is especially so for victims of chronic liver disease. The likelihood is that after such an illness, the patient will be weak, will have lost weight and will have a degree of muscle wasting. It is therefore with a proper diet and a gradual resumption of exercise only that these changes can be reversed.

Exercise can also benefit the transplant patient in several other ways. It is known to reduce stress and anxiety symptoms, help achieve a normal sleep pattern, increase energy levels through the day and improve digestive function. Improved digestion will help liver transplant patients further by allowing a better dietary intake.

However, it must be remembered by all individuals who have not exercised recently, that their ability to exercise and general fitness levels will be much lower than they’re perhaps previously used to. Therefore, it is important that they start a gradual exercise plan, before slowly and carefully building up. This will reduce the likelihood of exercise induced injuries and strains.

As a rough guide, do not lift more than 6-7kg (15lbs) in weight or participate in sit-ups for 2 months. Avoid swimming for approximately 3 months.

5. Driving

It is generally recommended that recipients of liver transplantation wait 3 months before starting to drive again. However, this is a rough approximation as countries will have very different laws governing who can drive and when. In the UK for example, all aspects of licensing as regards driving are regulated by the DVLA. Drivers in the UK must notify the DVLA of their illness and operation. Insurance companies should also be notified.

6. Return to Work

The issues regarding work can vary greatly with the type of work you do, which country you live in and what type of benefits are available to you. As a generalisation, most recipients are advised to have around 6 months off work. Clearly it will be important to notify your employer regarding your health status and intended time off work.

Those will light duties or desk jobs may wish to return sooner whereas those with heavier or manual jobs may take longer.

7. Sex

There are no time constraints for sexual activity after transplantation. Most patients will resume sexual activity when they feel comfortable and confident enough. This may take a few weeks or several months and very much depends on the individual patient and also their partners. Other factors which may hinder sexual activity include the drugs that recipients will be taking such as anti-rejection medication. These can reduce sexual desire as well as sexual function.

However, if engaging in casual sex, it is strongly advised that adequate protection is used to prevent contraction of sexually transmitted infections. Examples include hepatitis B and C, HIV, syphilis, chlamydia and gonorrhoea.

It also strongly advised that all female recipients of child bearing age use adequate contraception for at least 1 year before conceiving.

8. Skin Care

As with many aspects of this page, this advice applies to everyone but is particularly relevant to transplant patients. It is vital that all recipients protect their skin from excessive sun exposure. The anti-rejection drugs that recipients take increases the risk of them developing skin or lip cancer compared to the general population. This is because taking these immunosuppressants interferes with the body’s ability to fight the development of abnormal cells which may lead to cancer. Recipients are therefore urged to heed the following advice;

  • avoid the midday sun (i.e. 10am-3pm) as the harmful ultraviolet radiation will be at it’s strongest then,
  • cover up as much of your skin as possible by wearing long sleeved clothing and trousers, as well as a wide brimmed hat when outdoors.
  • use high factor sun block lotions and lip balm when outdoors. Always remember to re-apply regularly, especially if swimming.

9. Hair Care

The condition of your hair can also be affected both by liver disease and by medication such as steroid drugs. Hair may become brittle and fragile. Scalp hair loss also becomes more likely. Hair dyes, bleaches and other hair chemicals can increase the damage to hair at this time. It is therefore recommended that recipients wait until they are on lower doses of steroids or until they manage to stop the steroids completely before using these hair products. Good hair care is therefore strongly advised by for example using conditioners.

Conversely, transplant patients may find that they begin to develop excess facial and body hair. This again can be as a result of medication. Hair removal creams may be useful but further advice can be sought from your doctor. Patients must never reduce or stop their medication without consulting a doctor.

10. Eye Care

Regular 6 monthly eye tests are recommended for liver transplant patients. This should involve screening for cataracts and glaucoma as these conditions can occur with medication. Visual acuity can also change during the first 6 months after transplantation surgery.


11. Dental Care

Recipients are usually advised to inform their dentist about their liver disease and especially about transplantation. It is also advisable for recipients to have a 6 monthly dental assessment. Antibiotics are routinely given to transplant patients before and during any dental surgery such as tooth extractions.

12. Sleep Pattern

Recipients of liver transplants frequent have some degree of sleep disturbance. This may be an inability to drift off to sleep (initial insomnia) or they may wake up regularly through the night. The causes for this may include being in hospital on a noisy hospital ward and the stresses and anxieties which inevitably are present with transplant surgery. However, once patients go home, a normal and regular sleep cycle tends to return within a few weeks. Sleeping tablets are usually not required.

13. Anxiety and Depression

The complexities and seriousness of both liver failure and transplantation surgery are discussed elsewhere in this guide. But not surprisingly, emotional and psychological symptoms can develop as a result. Patients may worry about their health, finding a liver donor, the surgery itself, the lengthy recovery process, the possibility of complications and death, the impact on their families and financial prospects.

Anxiety and depressive symptoms are therefore common amongst this group of individuals. They are advised to discuss any of these issues with their doctor, transplant co-ordinator or counsellor.


14. Pregnancy

Women who have liver transplantation can go on to have children. But they are usually advised to wait at least 1 year after surgery before they start trying to conceive. Adequate contraception must therefore be used. However, the combined oral contraceptive pill is usually not advised in this instance. For further information regarding this, women are advised to discuss this with their hepatologist or obstetrician.

15. Other Women’s Health Issues

Immunosuppressant medication can increase the risk of developing cancer. This occurs as these drugs reduce the efficiency of the immune system, thereby allowing abnormal cells which otherwise may have been destroyed, the chance to develop into cancers. Women are therefore asked to have regular cervical smears (Pap smears) and carry out regular breast self-examination. Any masses or other symptoms must be reported immediately to a doctor.

16. Vaccinations

Vaccines are given to people of all ages from birth to old age. Some are part of national immunisation schedules whilst others are given for travel or occupational reasons. However, after liver transplantation, live vaccines should not be given or accepted by patients. Attenuated (or killed) vaccines are permitted. The following are some examples of those vaccines which are and are not permitted.

Permitted (attenuated/killed) vaccines

  • Inactivated polio (Salk)
  • Influenza (flu vacc)
  • Polysaccharide Typhoid (Typhum Vi)
  • Pneumococcal
  • Tetanus

Not permitted (Live) vaccines

  • BCG
  • MMR
  • Oral typhoid
  • Polio (Sabin)
  • Smallpox
  • Yellow fever

17. Travel

Before traveling to a malaria zone, transplant patients will need to discuss anti-malaria drugs with their hepatologist. Malaria can be a very serious infection if contracted by immunocompromised patients. Every effort should therefore be taken by recipients to avoid catching this infection.

Similarly, common sense must be exercised in trying to avoid contracting other infections such as Hepatitis A from contaminated food and water in certain countries. The risk of sexually acquired infections is also greater in certain countries.

Please also read the section on skin care and vaccinations if considering going abroad. Finally, before traveling, it is vital that liver transplant patients arrange adequate travel insurance in case of emergencies.

Resources on Liver Transplant Surgery

Treatment Locations for Liver Transplants

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From Surgery abroad with Globe Health Tours.