Liver transplant - Recovery

Once your liver transplant is complete, you will be moved to an intensive care unit (ICU).

A ventilator will assist you with your breathing. A tube will be inserted through your nose and into your stomach to provide you with nutrients and fluid. These tubes can normally be removed after a few days.

After the transplant, you are likely to be in some pain. You will therefore be given pain relief as required.

Most people are well enough to move out of the intensive care unit (ICU) and into a hospital ward within a few days of having a liver transplant. They can leave hospital within two to three weeks.

Recovering from a liver transplant can be a long, slow process. Aim to gradually build up your health and fitness. It may take three to six months before you are ready to return to work and resume normal activities.

Immunosuppressants

After a liver transplant, one of the biggest risks is that your immune system will not recognise the new liver and begin to attack it. This is known as rejection.

Read more about rejection and liver transplant complications.

To prevent rejection, you will be required to take medicines that suppress your immune system. These medicines are called immunosuppressants.

As the risk of rejection is highest in the first three months after a transplant, it is likely that you will initially be given a relatively high dose of immunosuppressants.

Your dose will then be reduced to a level thought high enough to prevent your immune system rejecting your new liver, but low enough to minimise unpleasant side effects.

To assess how well the immunosuppressants are working, it is likely that you will be given regular blood tests when you first start taking them.

Achieving the balance between preventing rejection and minimising side effects can be challenging. It may take several months before the optimal dose for you is achieved.

Types of immunosuppressants

Two main types of immunosuppressants are used to treat people after a liver transplant:

• calcineurin inhibitors
• corticosteroids

Each type of medication is discussed in more detail below.

Calcineurin inhibitors

Calcineurin inhibitors work by blocking the effects of a protein called calcineurin, which is responsible for activating a type of white blood cell known as T cells. The immune system uses T cells to fight infection.

Blocking the effects of calcineurin should mean that your immune system will not send T cells to attack the tissue of your new liver.

The two most widely used calcineurin inhibitors are ciclosporin and tacrolimus, which can be given either in tablet or capsule form, or as an injection.

Common side effects of ciclosporin and tacrolimus include:

• high blood pressure
• tremor (uncontrollable shaking or trembling)

For a complete list of side effects and interactions with other medicines, see the Medicines information section on ciclosporin and tacrolimus.

Although these side effects may be troublesome, you should never stop or reduce the recommended dose of immunosuppressants because it could lead to your liver being rejected.

Always check with your pharmacist or GP before you begin taking any other medication.

Corticosteroids

Corticosteroids can penetrate the wall of immune system cells. Once inside the cells, corticosteroids can "switch off" the genes responsible for releasing many of the chemicals that the immune system would otherwise use to attack your new liver.

A widely used corticosteroid in liver transplant patients is prednisolone.

Common side effects of prednisolone include:

• mood swings
• muscle weakness
• weight gain

For a complete list of side effects, see the Medicines information section on prednisolone.

The long-term use of corticosteroids can also lead to more serious side effects. Read more information about the side effects of corticosteroids.

Around 1 in 20 people have serious mental health symptoms while taking prednisolone, such as:

• thinking about suicide
• having hallucinations (seeing or hearing things that are not real)
• feeling very confused and having problems thinking clearly
• having strange, unusual and frightening thoughts

If you experience any of these symptoms, contact your GP or a member of your care team immediately. If this is not possible, telephone your local out-of-hours service or, in England, NHS 111 for advice.