Transplant Surgery: Post Liver Transplant Instructions
You have had a liver transplant. Transplantation requires a lifelong commitment from you. To lessen complications and to have a smoother recovery, it is vital that you carefully follow the instructions your Transplant Team gives you. This handout reviews a number of topics that will help you get through your post-transplant recovery and beyond. Keep this and use it as a resource at home.
Remember, your Transplant Team will continue to provide you with support and medical follow-up after you have been discharged from the hospital.
Topics in this handout include:
1) Your Medications After Transplant
1a.Immunosuppressants
1b. Medications to Prevent Infections
1c. Antacids
2) Immune System
3) Organ Rejection
4) Sun Sensitivity
5) Infection
6) Blood Pressure and Temperature
7) Incision Care
8) Resuming Life Activities
9) Smoking and Alcohol Use
10) Physical Activity
11) Healthy Eating and Nutrition
12) Sexual Activity
13) Ureteral Stents
14) Post-Transplant Office Visits and Follow-up Care
15). Diabetes
16) Other Post Transplant Medication
16a. Blood Pressure Medications (Antihypertensives)
16b. Water Pill (Diuretics)
16c. Clot Prevention
16d. Insulin
16e. Pain Relief Medications
16f. Hepatitis B Medications
16g. Hepatitis C Medications
16h. Colony Stimulating Factors
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Liver Transplant Team Phone Number: 212-263-8133
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1. Medications after Transplant
The best way to keep your new organ(s) healthy is to take your medications every day. It may feel overwhelming at first but in time you will become comfortable with your routine.
We will give you a medication sheet before you leave the hospital. This tool will help you stay on track with your medication routine. Use it to keep track of all your medications and when you need to take each one.
It is very important that you learn the names of your medications. Also, you need to know the reasons for taking them, the dose you take, and the side effects you may have.
Please follow these important tips:
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Always bring your medication sheet to your follow up appointments. If we need to adjust your medications, we will make those changes on your medication sheet.
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Always take your medications at the same time every day.
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Do not skip a dose. If you miss a dose, call your Transplant Team.
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Do not stop taking your medications for any reason without checking with your Transplant Team.
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Call your Transplant Team if you have any possible side effects from your medications (vomiting, diarrhea, etc.).
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Do not take medications other than those prescribed by your Transplant Team. This includes over the counter (OTC) medications, herbal medications or those prescribed by other doctors. Always check with your Transplant Team.
Important note: Not taking medications as prescribed is the most common reason for transplant rejection or failure. For this reason, be very careful when taking your medications.
Call your Transplant Team with any questions or concerns, no matter how small they seem.
The following is a list of common post-transplant medications by category. Check off the medications that you are taking as you review these medications with your Transplant Team.
If you experience any of the side effects listed under each medication category, call your Transplant Team.
1a. Immunosuppressants
Immunosuppressants or anti-rejection medications are very important and you need to take them for life. They protect your new organ so that it can function well. There can be side effects with these medications. However, keep in mind that most patients do not have many of these side effects. If you feel you are having side effects, do not stop taking or adjust any medication until you speak to your transplant doctor or nurse coordinator.
_____Tacrolimus (Prograf®, Astagraf XL®, Envarsus XR®)
_____ Cyclosporine (Neoral®, Gengraf®)
Purpose: To suppress your immune system (the body system that fights infections). This prevents rejection of your transplant by your body.
Remember: Always take your tacrolimus or cyclosporine dose at the same time each day. However, if it is a day that you need to have blood work done, do not take your tacrolimus or cyclosporine until AFTER your blood is drawn.
Important note: You can take this medication with or without food but you must be consistent! If you have a small meal with your morning medications do so every day. This may help prevent an upset stomach.
_____ Mycophenolate Mofetil (Cellcept®)
_____ Mycophenolic Acid (Myfortic®)
Purpose: To suppress your immune system (the body system that fights infections). This prevents rejection of your transplant by your body.
Important note: This medication causes birth defects. For this reason, you should not get pregnant while taking mycophenolate. All pregnancies must be planned with your Transplant Team.
_____ Prednisone
Purpose: To suppress your immune system (the body system that fights infections). This prevents rejection of your transplant by your body.
Remember: Your doctor will gradually lower your dose of prednisone. Always take with food to reduce stomach upset or irritation.
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Possible side effects:
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Swelling of the face, hands, or ankles
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Increased appetite
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Increased blood sugar.
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Muscle weakness.
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Stomach irritation.
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Easy bruising and slow healing of wounds.
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Mood changes.
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Cosmetic changes (acne, increased hair growth)
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Skin irritation and sensitivity to sun.
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Changes in your vision
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1b. Medications to Prevent Infections
You will be prescribed medication to prevent infections. This is because your immune system is weakened by the immunosuppressants or anti-rejection medications you take (listed above) to protect your new organ. It is very important to take these medications to exactly as directed.
_____ Valgancyclovir (Valcyte®)
_____ Acyclovir (Zovirax®)
Purpose: To prevent viral infections such as herpes and cytomegalovirus (CMV)
_____ Sulfamethoxazole-trimethoprim (Bactrim® or Septra®)
_____ Dapsone
_____ Atovaquone (Mepron®)
_____Inhaled Pentamidine
Purpose: To prevent a certain type of lung infection (Pneumocystis Pneumonia - PJP).
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Possible side effects:
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Rash
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Nausea, vomiting, loss of appetite
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Skin irritation and sensitivity to the sun
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High potassium levels with Bactrim®
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_____ Nystatin (Liquid Suspension)
Purpose: To prevent yeast or fungal infections in your mouth. Swish the liquid in your mouth and swallow the liquid. Do not eat or drink for 15 minutes after taking.
_____ Fluconazole (Diflucan®)
Purpose: To prevent or treat fungal infections.
1c. Antacids
_____ Esomeprazole (Nexium®)
_____ Omeprazole (Prilosec®)
_____ Pantoprazole (Protonix®)
_____ Famotidine (Pepcid®)
Purpose: To reduce your stomach’s production of acid. Also, to protect your stomach from irritation and ulcers.
Remember: This medication works best when you take it 30 minutes before a meal. Take on an empty stomach before breakfast. Your Transplant Team may instruct you to take this medication before dinner as well.
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Possible side effects:
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Headache
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Feeling dizzy
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Diarrhea
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2. Immune System
Your immune system’s job is to help protect your health by attacking foreign substances in your body. Unfortunately, your immune system cannot tell the difference between harmful foreign substances (bacteria and viruses) and transplanted organs. Your immune system sees a transplanted organ as a foreign substance that needs to be attacked.
To protect your transplanted organ from being attacked by your immune system, you must take medications. These medications are used to suppress, or weaken, your body’s immune response. These are called immunosuppressants or anti-rejection medications.
3. Organ Rejection
Organ Rejection is one of the most common complications for patients with a transplanted organ. This occurs when your immune system recognizes the transplanted organ as a foreign object and tries to protect you by attacking it.
Almost every patient experiences organ rejection at one time or another. Keep in mind that if you do suffer an episode of rejection, it does not mean that you are going to lose your newly transplanted organ! It does mean that you will need to have your medication adjusted.
We will prescribe medications called Immunosuppressants for you. These will prevent your body from rejecting your new organ. Without these drugs, your immune system - the body’s main line of defense- will try to attack and reject your new organ. The immune-suppressive drugs work to prevent rejection. This way it will not be attacked.
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The most common symptoms of organ rejection include:
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Fever over 101° F (38.3°C)
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Flu-like symptoms: chills, aches, headache, dizziness, nausea, vomiting
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Itchiness
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Shortness of breath or fatigue
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Abdominal (belly) tenderness or pain
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Swelling at the transplant site
Call your Transplant Team if you have any of these symptoms.
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Other signs of rejection will not be obvious. They can only be detected through blood tests. This is why your blood is frequently drawn both during your hospital stay and on your follow-up clinic visits.
Biopsy
A biopsy is a procedure sometimes needed to know if there is organ rejection. A doctor takes a sample of tissue from the transplanted organ. This takes place in the hospital either as an inpatient or in the radiology department. The doctor will take a tissue sample directly from your transplanted organ using a needle. The needle is inserted through the skin of your abdomen.
A mild organ rejection episode can be managed by making changes in your medication. If you are having a moderate episode of organ rejection, you will need to stay in the hospital for a few days. The Transplant Team will observe you while they adjust the doses of your immunosuppressive drugs. You may need a stronger immunosuppressive drug. As soon as the organ rejection is controlled, you will be able to return home.
4. Sun Sensitivity
Your skin is more sensitive to the sun due to the immunosuppressant medications you are taking. Even if your skin does not usually burn, you should always apply sunscreen (UVA and UVB coverage, SPF 30 or higher) before going out. Do this all year long. It helps prevent skin cancer. Use protective clothing, sunglasses and a hat. Do not use tanning booths. Examine skin every month for any changes.
5. Infection
Infection happens when a foreign organism enters your body, reproduces, and causes your immune system to fight it. The foreign organism can be bacteria, a virus or fungus.
Why Are You at Higher Risk for Infections?
You are at risk for different infections because you are taking medications called Immunosuppressants. These medications suppress or weaken your immune system and lower your body’s ability to fight infection. Infections can be caused by bacteria, viruses, and fungi. Because you are at higher risk, we will also prescribe medications to help prevent infections.
The following are common symptoms of infection to look out for:
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Fever
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Chills
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Flushed skin
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Increased fatigue
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Swelling
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Pain
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Redness around the incision or drain
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Incision (surgery wound) feels warm to the touch
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New drainage from the incision
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Foul smell from the incision
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Cloudy urine
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Urine with a foul smell
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Burning when you urinate (pee)
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Sore throat
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Cough
If you have any of the symptoms listed above, call your Transplant Team right away.
Safety Measures You Can Take to Help Prevent Infection
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Take all your medications as prescribed.
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Take good care of your incision. Follow the instructions your nurse gave you.
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Eat a healthy diet. A registered dietitian (RD) will meet with you before discharge. They will help you create a food plan that is right for you.
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The RD will also review food safety basic rules which include:
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Wash your hands before and after handling food.
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Wash your hands after you use the restroom.
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Wash your hands after playing with pets.
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Wash your hands before doing any wound or drain care.
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Wash fruits and vegetables well. You can even use a drop of soap.
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Do not have any grapefruit or grapefruit juice. Do not have any pomegranate or pomegranate juice.
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Avoid eating raw or undercooked foods. These include: eggs, raw fish, raw shellfish or raw meat.
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Keep hot foods hot and cold foods cold. Throw food out when in doubt.
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Avoid foods from street vendors, salad bars and buffets.
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Get plenty of rest. We will give you activity guidelines before your discharge.
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Maintain good personal hygiene. Shower (do not bathe) at least once a day. Shower more often if your wound is draining or if you are sweating.
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Avoid pools, hot tubs, or bathing in a bathtub until incision is completely healed. Your doctor will tell you when you can do these activities again.
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If you cut or scrape your skin, clean the area with soap and warm water. Apply a Band-Aid to keep the area clean and dry.
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Avoid people who are sick (with a cold, the chicken pox, the flu, etc.).
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Avoid cleaning bird cages, cat litter and areas with dog feces. These have a lot of bacteria and fungi.
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Avoid gardening for the first 6 months after transplant.
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Avoid yard work with compost piles and vegetative leaves. These carry fungi.
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Wear disposable gloves when gardening. Wash hands thoroughly when done.
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Avoid sources of stagnant (still) water. Some examples are: denture cup, flower vases, soap dishes, swimming ponds. These are all places where bacteria grow.
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If you have well water: Boil water for 5 minutes for drinking or cooking.
6. Blood Pressure and Temperature at Home
When you return home from the hospital, you will need to take your blood pressure and temperature every day. Before discharge, we will teach you how to use a thermometer to take your temperature and an automatic blood pressure cuff to check your blood pressure. Keep a log of all your blood pressure and temperature readings. Bring this log with you to your follow up visits at the transplant clinic.
Temperature
It is important to take an oral temperature (by mouth) every day in the morning and when you feel you may have a fever. A higher temperature can be a symptom of either rejection of your transplanted organ or some type of infection. Both organ rejection and infection are easier to treat when recognized early.
Since you are receiving Immunosuppressants, you may not get high fevers. If your temperature is between 100.2°F (37.9°C) and 100.9°F (38.3°C), take it again in two hours. If the repeat temperature stays between 100.2°F (37.9°C) and 100.9°F (38.3°C), call your transplant team.
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Call your Transplant Team RIGHT AWAY
**DO NOT WAIT TO TAKE A SECOND TEMPERATURE READING
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Steps for taking your temperature by mouth:
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Wash thermometer well with soap and water.
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Be sure not to drink anything hot or cold within 5 minutes of taking your temperature.
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Turn thermometer on and place it under your tongue. Close your lips to hold the thermometer in place. Avoid talking or biting down.
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Leave thermometer in place in order to obtain an accurate reading. Wait until it beeps.
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Remove the thermometer.
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Read the thermometer.
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Wash thermometer well with soap and water after each use.
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Record temperature in the notebook we gave you. Be sure to bring this log with you at your follow up visit.
*DO NOT share your thermometer with anyone else*
Blood Pressure
High Blood Pressure (hypertension) can be a side effect of your new medications. It can also be a sign of fluid retention. You may be discharged from the hospital with medications that help control your blood pressure.
You will need to take your blood pressure twice a day. Take it once in the morning and once in the evening. Follow the directions given at discharge on how to check your blood pressure using the automatic blood pressure cuff. Keep a record of the results.
You will also need to take your blood pressure if:
Steps for taking your blood pressure:
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Sit comfortably at a table with both feet on the floor. Do not cross your legs or feet.
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Place your arm on the table, with your palm facing up. Your arm should be at the level of your heart.
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Wrap the cuff around your upper arm, just above your elbow. Wrap the cuff directly on your skin. Not over clothing. Most cuffs will show you where the blood vessel in the middle of the arm at the inner side of the elbow (the brachial artery) should line up with the cuff.
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Press the start button. The cuff will tighten (inflate) then loosen once the reading is done.
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Write down the numbers for each blood pressure reading.
Tips to get the most accurate blood pressure reading:
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Wait at least 30 minutes after eating, exercising, or smoking.
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Don't drink coffee, tea, soda, or other caffeinated drinks before checking your blood pressure.
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Rest for at least 5 minutes before you begin.
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Make sure there are no distractions. This includes TV, cell phones, and other electronics.
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Wait to have conversations with others until after you measure you blood pressure.
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If you need to re-take your blood pressure in one sitting, wait at least one minute between readings.
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When to Call your Transplant Team
Call the office if and speak to a member of your transplant team if:
Call the office RIGHT AWAY if:
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Tips to help keep your blood pressure under control:
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Eat a low-salt diet
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Lose extra weight
**The registered dietitian (RD) on your Transplant team will help you with a diet plan before discharge.
7. Incision Care
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YOU MUST shower with soap and warm water every day.
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Lather the incision(s) with a pure soap (such as Ivory) and let the warm water run over them.
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DO NOT take baths, use hot tubs, or swim right after your operation and until cleared to do so by your surgeon.
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DO NOT put lotions, powders or oils on your incision.
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Look at your incision every day for signs of infection. If you feel you have an infection, contact the Transplant Team.
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Steri-strips applied to the incision will begin to peel and will fall off.
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If you go home with staples in place, they will be removed in the transplant clinic. This happens about a month after your transplant.
8. Resuming Life Activities
When you return home, you should go back to your normal activities. The key is moderation. At first, you will not have as much energy as you did before surgery. It takes time for your body to heal and get used to the new medications. Be sure to nap and to space out activities.
Try to return to your normal routine as much as possible. It is recommended you take precautions to prevent illnesses (such COVID or flu). Use a mask and wash your hands often. However, you should avoid anyone who is sick or not feeling well. You should not visit anyone who is sick and they should not visit you. Avoid large crowds.
School and Work
You should be able to return to work or school within 3 to 4 months. Your Transplant Team will help decide what is best for you.
Driving
Consult with your Transplant Team before driving. You will not be able to drive for about 1 to 2 months after your transplant. Consult with your Transplant Team before driving.
If you are thinking about driving, ask yourself the following questions:
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Am I well enough or strong enough to drive?
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Am I experiencing any side effects from the medications that would interfere with my driving, for example blurred vision or tremors?
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Am I experiencing any discomfort from my surgical incision?
Using caution and restraint in this early post-operative period will help you and others stay safe on the road. Always wear your seat belt. You may use a small pillow or towel to pad your incision area if needed.
Travel
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Consult with your Transplant Team before traveling.
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You are not allowed to travel internationally for the first year after your transplant.
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You may need to see an infectious disease travel doctor for additional vaccines and medications. This depends on where you are traveling.
9. Smoking and Alcohol Use
Smoking and Other Nicotine Products
Smoking is bad for your health. It can lead to heart disease, lung disease and cancer.
It is recommended that all post-transplant patients quit smoking and/or using any nicotine products (including e-cigarettes, vapes). Because you are taking immunosuppressants, cigarettes and other nicotine products increase your risk of getting cancer. You should make every effort to quit. If you smoke, consult with your Transplant Team for help quitting.
You can also contact the NYU Langone Tobacco Cessation Program:
Alcohol and Illicit Drug (Street Drug) Use
You ARE NOT allowed to drink alcoholic beverages or use illegal drugs after your transplant. Alcohol is broken down by the liver and can damage the liver. Street drugs are toxic and destroy the liver.
10. Physical Activity
Exercise
Exercise will be an important part of your life. It will help you return to your regular activities and maintain your overall health. Exercise improves muscle tone as well as heart and lung function. It also helps to reduce stress and keep a healthy body weight.
Recommendations for Initial Home Exercise Plan
Lifting Restrictions
Do not lift anything heavier than 10 pounds for 8 to 10 weeks after surgery. For this reason, you must avoid heavy resistance training in exercise. As time passes, you may slowly go back to normal lifting. But you must wait until you have been cleared by the Transplant Team before you can work out with heavy weights or resistance equipment.
Physical Therapy
Not all transplant patients will need physical therapy after surgery. If needed, your Transplant Team will arrange physical therapy for you after discharge. Outpatient physical therapy is available at the Rusk Institute and at other outpatient facilities.
11. Healthy Eating and Nutrition
Healthy eating after a liver transplant is important. It helps you recover faster and helps you have your best long-term health.
In the first few months after transplant, you need to eat enough protein and calories. This will help you heal, replace muscle tissue and gain back any weight you may have lost before your transplant. At first, you may find it hard to eat enough. Your dietitian will help you make the healthy food choices you need. It is important that you learn how to handle, cook and store food safely. This prevents foodborne illness. You will also need to control your blood sugar.
Short-term goals for healthy eating:
Long-term goals for healthy eating:
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Keep a healthy body weight
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Keep cholesterol, triglycerides, blood pressure and blood sugar at healthy levels. (Your doctor will tell you the levels that are right for you.)
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Build and maintain strong bones
These long-term healthy eating goals are designed to prevent or treat certain chronic diseases. These diseases include diabetes or high blood pressure. They can also help you better handle other health issues that may develop later on.
Nutrition Tips
Grapefruit and Grapefruit Juice, Pomegranate and Pomegranate Juice
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Grapefruit and pomegranate can interact with many medications, including your immunosuppressant medications. Pomelos, tangelos and Seville oranges are similar to grapefruits and also interact with these medications. These fruits can cause the level of some medications in your blood to rise too high. This can happen even if these fruits and your medications are taken at different times.
Salt
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If you had high blood pressure before your transplant, you should continue to follow a low salt diet. Even if you did not already have high blood pressure, limiting salt helps prevent common side effects of your organ rejection medications. These include high blood pressure and your body holding on to fluid.
Protein (Short-Term)
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In the first 4 to 6 weeks after your transplant, you need to eat more protein. This helps you heal from surgery. Good sources of protein include lean meat, fish, chicken, legumes like beans and lentils, eggs, tofu and peanut butter. Low fat dairy products such as milk, yogurt and cheese are also good sources.
Protein (Long-Term)
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We recommend a healthy, balanced diet. We do not suggest following any high protein diets or continue high protein supplements long-term, unless you are under the direction of your dietitian or doctor.
Sugars
Some medications you need to take after your transplant (Prednisone, Cyclosporine, and Prograf) can raise your blood sugar. If your blood sugar gets high, you may need to cut back on eating and drinking concentrated sweets such as candy and soda. When your blood sugar levels are high for a long time, you can get diabetes. If you already had diabetes and took insulin before your transplant, you may need to change your dose of insulin. This is because the medications taken after your transplant may change how much insulin you need to take.
Important things to note:
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“Reduced Fat” and “Fat Free” products often have more added sugar.
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Instead, choose “Sugar Free” products such as hard candy, gum, Jell-O, pudding, juices, sorbet, fruit ices or popsicles.
12. Sexual Activity
You may start normal sexual activity again as soon as you feel ready. Over time your sexual desire will return to what you consider normal. If it does not return within 3 months, speak with the Transplant Team. If you are not in a long-term, monogamous relationship, you must practice safe sex. This includes using a condom. This is very important. Your immune system is suppressed, and you are at higher risk for sexually transmitted infections (STIs).
Special note for people with a uterus:
All patients with a uterus or who were assigned female at birth should have yearly pelvic exams and Pap smears.
Patients who menstruate generally continue their menstrual cycle (period) after having a transplant. But, high doses of Prednisone may stop your menstrual flow. Talk with your Transplant Team about birth control methods. It is important to know that although people who menstruate may not have regular menstrual cycles (periods), it is still possible to become pregnant. For this reason, it is very important to use birth control (for example: condoms or a diaphragm). We do not recommend birth control pills for pregnancy prevention. If you are thinking about becoming pregnant, please know that all pregnancies must be planned with your Transplant Team. This is because your medications may need to be adjusted before becoming pregnant.
If you become pregnant before planning or speaking with your Transplant Team, call them right away.
Special note about fertility in men:
Men who were infertile before the transplant may now be fertile. This may be due to hormonal changes that can happen post-transplant.
13. Ureteral Stents
*NOTE: This section is ONLY for patients who had a kidney transplant in addition to their liver transplant.*
A ureteral stent is a soft plastic tube with holes in it. It is temporarily inserted into a ureter to help drain urine into the bladder. One end goes in the kidney and the other end goes in the bladder. A coil on each end holds the stent in place. The stent cannot be seen from outside the body and is not likely to interfere with your normal routine.
Your stent is placed at the time of surgery by your transplant surgeon.
While you have a stent:
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Some discomfort is normal. Certain movements may trigger pain or a feeling that you need to urinate (pee). You may also feel mild soreness or pressure before or during urination. These symptoms will go away a few days after the stent is removed.
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If you are prescribed medication to control pain or bladder spasms, or medication to prevent infection, take it as directed by your healthcare provider.
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As with any artificial device placed in the body, there is a risk of infection. The stent may have to be removed if this happens.
How long will you need a stent?
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When to call your healthcare provider
Contact the Transplant team right away if:
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The stent comes out of your urethra
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You have a fever of 100.4°F (38°C) or higher, chills, nausea, or vomiting
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Blood in your urine
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14. Post-Transplant Office Visits and Follow-up
Lab work and doctor visits are more frequent right after your transplant. At first, visits are weekly and then over time they will be less often.
As you become more stable, there will be fewer office visits later in your post-operation period. On some days, the doctors will only need to check your blood work. On these days, you will not see the doctor. You will only go to the lab between 7 am and 8 am for blood work. The coordinators will contact you if there are any problems or medication changes.
When you are discharged from the hospital, you will be seen in our outpatient clinic. It is located at 317 East 34th Street, 8th floor. Be sure to bring your medication list with you and any logs where you have written down your blood pressure readings, blood sugar testing, tube drainage and/or urine output.
Important Note about lab work:
Do NOT take your morning immunosuppressive medications before your lab work done in the morning. This is very important because it helps us get an accurate blood level and better manage your medications. You may take all other medication before your lab work is done. If you prefer to take all your medications at the same time, you can take them after your blood is drawn.
Primary Care
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You will continue to work with your Transplant Team but it is also very important that you maintain your relationship with your primary care doctor (family doctor).
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You should tell both your primary care doctor and the Transplant Team about any medical problems you may have.
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Make sure you check with your Transplant Team before taking any prescription or over the counter medication including herbs. Also, get your team’s approval before agreeing to any procedures recommended by other doctors. The medication or procedures may interfere with your ability to prevent organ rejection.
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Your primary care doctor or specialist will need to continue to renew prescriptions that they prescribed for you.
Dental Care
Eye Care
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It is important to have a yearly checkup with your eye doctor. This is because the immunosuppressant medication, Prednisone, may cause cataracts and changes in your vision.
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You may schedule your first post-operative (post-op) visit with the eye doctor once you are on your maintenance dose of Prednisone. Ask your coordinator when you should make that appointment.
Immunizations/Vaccinations (Shots)
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We recommend annual flu shots. It is important, however, that you receive the dead virus vaccine to avoid any risk of becoming infected.
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Ask your Transplant Coordinator about other vaccinations before receiving them.
Dermatologist (Skin Doctor)
Oncologist (Cancer Doctor)
Prescriptions
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Your Transplant Team may be able to help you find a pharmacy in your insurance plan that will deliver your monthly medications.
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Many medications interact with your ability to prevent organ rejection. For this reason, YOU MUST ALWAYS consult with a member of your Transplant Team before taking any medications prescribed by any doctor. YOU MUST NOTIFY the Transplant Team if your pharmacy changes your medication from a brand name to generic name drug or vice versa.
Support Groups
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We recommend that you continue with any support groups that you have been involved with before your transplant including private and group sessions (for example, Alcoholics Anonymous (AA) or Transplant Recipient International Organization (TRIO). If you would like more information, please ask your transplant social worker.
15. Diabetes after Transplant
High blood sugar can be a side effect of some of the medications that you are taking to help prevent rejection of your transplanted organ. You may develop high blood sugar after your transplant whether or not you had diabetes before the surgery. High blood sugar is often a temporary problem. It will improve as the dose of your medication is lowered over the next few months. However, it is important to treat this problem when it happens.
What You Can Do to Lower Your Blood Sugar:
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You may have to follow a special diet. A registered dietitian (RD) will review the diet with you before discharge.
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You may need to give yourself medication each day. This may be by insulin injection. Insulin is a substance that lowers your blood sugar when your body cannot do it alone.
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You will need to check your blood sugar 2 or 3 times a day. We will give you a special device (glucometer) for checking it. Your nurse coordinator will teach you how to use the device before discharge.
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You will need to keep a log of your blood glucose testing results. Bring this log with you to your follow up visits.
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You will need to know about the signs and symptoms of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). The reason for this is that blood sugar levels can vary.
High Blood Sugar
High blood sugar (hyperglycemia) is a common complication of diabetes. It happens when your diabetes is not controlled. High blood sugar may be brought on by eating a big meal, becoming sick or having an increase in your steroid (Prednisone) doses. It also will happen if you do not take your insulin or diabetes medications as prescribed.
Symptoms of high blood sugar include:
If you have these symptoms, check your blood sugar. The best way to treat high blood sugar is to follow the diet given to you by the dietitian.
Low Blood Sugar
Low blood sugar (hypoglycemia) can happen to anyone taking insulin or diabetes medications. It is usually easy to treat, but you need to know what to do BEFORE it happens.
Symptoms of low blood sugar include:
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Feeling shaky
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Becoming sweaty
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Feeling tired
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Feeling hungry
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Becoming cranky and confused
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Having a rapid heart beat
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Having blurred vision or headaches
If you have these symptoms or think your blood sugar is low, test it. If it is low, follow the treatment your diabetes doctor recommended.
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When to call your healthcare provider
Contact the Transplant team if:
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your sugar is very high when you check it.
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you have symptoms of low blood sugar but your blood sugar test shows a normal reading. These symptoms may be happening because of other problems or medication side effects.
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16. Other Post Transplant Medications
16a. Blood Pressure Medications (Anti-Hypertensives)
_____ Amlodipine (Norvasc®) _____ Nifedipine (Procardia®)
_____ Hydralazine (Apresoline®) _____ Labetalol (Normodyne®)
_____ Clonidine (Catapres®) _____ Metoprolol (Lopressor®)
_____ Carvedilol (Coreg®)
Purpose: To lower your blood pressure.
Important Note:
If you are taking any medication that comes in a capsule labeled “Long Acting (XL)” or “Sustained Release (SR),” do not break the capsule open or cut the tablet in half to reach your prescribed dose. Your Transplant Team needs to prescribe you a new capsule or tablet.
If you are having trouble swallowing the capsule or tablet, do not crush or break it. Call your Transplant Team for help with this issue.
16b. Water Pill (Diuretics)
_____ Furosemide (Lasix®)
Purpose: To reduce swelling caused by fluid build-up (edema).
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Possible side effects:
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Feeling dizzy
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Low blood pressure
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Muscle Cramps
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16c. Clot Prevention
_____ Aspirin
Purpose: To prevent blood clots from forming in your blood vessels, mainly in your new organ.
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Possible side effects:
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Stomach ulcer
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Bleeding
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Skin rash
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Ringing in your ears
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16d. Insulin
Fast-acting insulin injections:
_____ Insulin Aspart (Novolog®)
_____ Insulin Lispro (Humalog®)
Purpose: To lower your blood sugar before meals.
Note: Take 15 minutes before meals, as directed.
Long-acting insulin injections:
_____ Insulin Glargine (Lantus®)
_____ Insulin Determir (Levemir®)
Purpose: To lower your blood sugar over 24 hours.
16e. Pain Medications
_____ Acetaminophen (Tylenol)
_____ Oxycodone
_____ Tramadol (Ultram®)
Purpose: To control pain.
16f. Hepatitis B Medications
_____ Entecavir (Baraclude®)
_____ Tenofovir disoproxil fumarate (Viread®)
_____Tenofovir alafenamide (Vemlidy®)
Purpose: To lower your blood sugar before meals.
_____ HBIG (Hepatitis B Immunoglobulin) intravenous (IV) infusion
Purpose: To protect you from repeated Hepatitis B.
Important note: If the reason for your transplant was Hepatitis B, you will need monthly lab tests to find out when you will need this infusion. The Transplant Team will call you when it is time for you to have an infusion. This will take place either at home or in the hospital.
16g. Hepatitis C Medications
_____ Glecaprevir/pibrentasvir (Mayret®)
_____ Sofosbuvir/velpatasivr (Epclusa®)
Purpose: To treat hepatitis C virus.
Remember: You must take Mavyret® with food.
16h. Colony Stimulating Factors
_____ Filgrastim (Neupogen®) Injection
Purpose:To treat low white blood cell count (neutropenia).
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Possible side effects:
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Headache
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Fever
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Weakness
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Fatigue
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Bone pain
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Nausea, vomiting
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_____ Epoetin (Epogen®) Injection
_____ Darbepoetin (Aranesp®) Injection
Purpose:To treat low red blood cell count (anemia).
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Possible side effects:
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Headache
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High blood pressure
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Joint pain
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Liver Transplant Team Phone Numbers: (212) 263-8133
© 2023 NYU Langone Health. All rights reserved. Reviewed for health literacy. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.