When you arrive at the hospital — Many tests (blood tests, electrocardiogram and chest x-ray) will be done the day of the surgery. A physician will perform a history and physical. Please bring a complete list of all your medications. Although you are at the hospital, ready for surgery, the transplant is not guaranteed until after the hospital has seen the donated liver and the surgeon has determined that it is safe to proceed.

Surgery prep — This occurs the same day of surgery. It includes consenting to the surgery and intravenous (IV) line placement.

The surgery — Once in the operating room, an anesthesiologist needs to place a number of tubes, lines, and monitors so you can be safely managed for this big operation. The next thing you will remember is waking up in the Intensive Care Unit. The surgery lasts anywhere from 6 to 12 hours (average). When you have recovered sufficiently, you will be transferred out of intensive care.

The incision for liver transplantation is quite large — it goes across your abdomen and may extend up toward your chest. Once the incision is made, the surgeon will proceed with removing your old liver (leaving behind parts of the major blood vessels and bile ducts to attach to the new liver). While the new liver is being sewn in, you may be placed on veno-veno bypass to allow blood to flow around the site where the surgeons are working while returning a normal amount of blood back to the heart. During the surgery, you will receive transfusions of blood products and have blood sent for frequent monitoring of clotting factors, blood counts, and body chemistries. The gallbladder is also removed at the time of liver transplant so that it will not cause problems later, since performing another surgery in that location later would be difficult.

At the completion of transplant, you will be taken to the Intensive Care Unit (ICU). You will be kept on a breathing machine (ventilator) for a day or so and will be followed very closely by the staff there. The average length of stay in the ICU is two days, after which you will be transferred to the medical floor/ transplant unit.

The Hospital Stay and the Clinic Follow-Up

Recovery in the hospital

• Typically, you will be in the hospital for 7 to 10 days, but this could be longer and will depend upon your postoperative course.
• Expect some restrictions (walking, food, visitors), but it will be important for you to get out of bed and moving soon after your surgery.
  • You will be able to see visitors as soon as you are on the transplant floor (visitation policies while on the ICU floor vary by facility).
  • Nutrition recommendations will be different for each individual; you will meet with a dietitian so that you are well informed of the diet that best suits your unique needs.
• Routine tests and labs will be done daily to monitor your progress.
• You will be ready to leave the hospital when you are walking, eating, comfortable with/and understand your medications and aftercare plan, and have your support person(s) able to care for you.

Interim recovery (clinic followup while you are residing at VA transplant center lodging)

Once you are out of the hospital, the transplant team will assume all aspects of your medical care. They can be reached 24 hours a day.

• Your medical provider will probably see you once a week, but this can vary as your recovery progresses.
• For the first two to three months, you will get your blood tested twice a week, but if there is a need for more, your transplant coordinator will notify you. Your blood tests will indicate to your medical provider if medication adjustments are needed. They also show how your body is responding to your new liver (even before you notice how your body is responding).
• For patients transplanted with hepatitis C infection, when you are stable, the team will recommend treatment to cure the hepatitis C.
• Following a liver transplant, some people develop conditions such as diabetes or irregular chemical levels. They need to receive treatments to address these problems. All liver transplant recipients will be treated with medication that stops the body from rejecting its new liver.
• You will begin physical therapy, which is a major factor in your recovery. Prior to the transplant, your body was extremely sick, emaciated, and out of shape. Physical therapy will assist you in regaining your strength for quicker recovery.

Recovery at home

Instructions are given from the liver transplant team to you, your personal support person, and your primary medical care provider. They include which lab tests to complete and how often. You will receive recommendations about your visits with your referring or primary medical care provider. You and your support person will have a solid understanding of the medications you will need to take. In fact, you may feel like a medication expert because you will be just as responsible for your health care as your medical providers are. You are part of your own treatment team! Do not, however, adjust medications without the knowledge of the transplant team.