liver transplant

RN1982 · Sep 9, 2008

My fiance is being evaluated for liver transplant. What I would like to know is what to expect (providing we get a liver) in the SICU and post op. Yes, they are giving us education, but I would like to hear from the nurses who care for this type of patient-the real story. I don't do med surg/critical care, so any help is appreciated!

Post op, he'll be recovered in the ICU. He'll have a PA catheter, be vented, have an arterial line and a central line. As far as drips, he'll be on dopamine(renal dose), amicar, insulin, maybe some levophed depending on his blood pressure. He will most likely receiving blood products in and out of OR. I've had liver transplant patients require 60 units of PRBCs total plus FFP, cryo and platelets. Depending on how he does out of OR he will probably remain on the vent for the first day. I've had patients come from OR to the ICU and within three days are extubated, PA cath out and on their way to a general practice unit. He will need to keep up with all of his medications as far as his anti-rejection meds go when he is discharged. I find that a lot of patients lose their organs because they do not follow their anti-rejection medication regimen.

Dottie78 · Sep 9, 2008

Redshiloh, that is great your fiancee is being evaluated for a liver transplant! I hope that he'll be eligible to be placed on the transplant list and everything goes well for him. :wink2:

As far as recovery and what to expect, everyone is different. I don't know what condition your fiancee is in, or why he needs the transplant, but my mother-in-law just had a liver transplant a little over 3 weeks ago, and is still in the hospital recovering. She is no longer in ICU, but still hasn't been able to get up and walk due to some complications after her surgery. I don't want to scare you, because everyone reacts differently, and my mother-in-law was VERY sick before she got the transplant, and has Hepatitis C, so I think her recovery is going to be a very long process.

But do keep in mind that this is a major surgery and your fiancee will require blood products, will be put on a vent and have an arterial line after the surgery. Depending on how he does, he'll only be on the vent for a couple days.

I'm sure he'll do fine!

Pedi-Gree, BSN, RN · Sep 9, 2008

First of all, be prepared for the extent of the incision. It's going to be transverse from the right subcostal midaxillary line all the way to the left subcostal midaxillary line along the bottom of the ribcage, and may extend either superior or inferior to the sternum depending on the size of his native liver and the size of the donor liver. With kids we often see them with two art lines, one radial and one right femoral so that we can monitor blood flow through the liver for the first couple of days. I'm not sure if that's the practice for adults. There will be at least one drain for the continuing ascites; it might be a JP or it could be a pigtail, or even a sump drain. The blood products will be almost continuous at least initially. There will be a variety of options for immunosuppression and other drugs depending on the degree of immune response expected and the donor's condition. For example, if the match isn't perfect, he may need ATGAM to really suppress him, and the dose will be adjusted based on his daily lymphocyte count. He'll be on steroids for some period of time and the side effects of those are well-known. Be prepared! If the donor is positive for CMV or EBV and your fiance isn't, he'll need ganciclovir for several weeks. He'll also need candida prohylaxis for awhile and magnesium supplementation for quite some time.

Post discharge, he'll have frequent blood work to monitor his immune response, his drug levels and his liver and renal function, the frequency of which will decrease over time. He will need to monitor his bone density because steroids and calcineurin inhibitors like tacrolimus and cyclosporine cause osteopenia. He's trading a terminal condition for a chronic one and some people can't handle the forever part of it. The susceptibility for infection does wane somewhat over time and the amount of immunosuppression will be tapered to the minimum as soon as possible but there will be drugs for life.

Please keep us informed about his progress.

Neveranurseagain, RN · Sep 10, 2008

Let your fiance know that he may suffer from "survivors guilt." My husband was an organ donor, and the man who recieved his kidney has expressed concern over the fact that my husband died and left 2 children. But I remind him he had nothing to do with my husbands death, and I feel honored that he was able to help other people through the gift of his organs.

Pedi-Gree, BSN, RN · Sep 10, 2008

awsmom8, as a family member of an organ recipient I want to thank you from the bottom of my heart for your courage and compassion at a time when your whole world was collapsing. It takes a great deal of intestinal fortitude to stuff down the grief, confusion and fear that the type of events leading to organ donation bring with them to make such a selfless choice. When I speak with families who are waiting for The Call, they often ask about the emotional impact of transplantation and mention feeling selfishly bereft at the notion that someone will die in order to allow their loved one to live. But as you say, it isn't exactly that they're wishing for it to happen, or causing it in any way. It will happen regardless, because it just does. And people like you make the choice you did. Thank you again. It's not much, but it's all I have.

redshiloh · Sep 10, 2008

Thanks for the help!

Are there a lot of meds for immunosuppression? He gets unhappy about taking meds (he does take them, just does not like it)

Pedi-Gree, BSN, RN · Sep 10, 2008

There will be a first, but as time passes they'll diminish. Usually by the end of the first year, they're down to twice a day. One man I know who is now many years post transplant takes cyclosporine and labetalol twice daily, Vitamin D and a calcium supplement once a day and Fosamax once a week. It's a routine.

Best wishes for a speedy, perfect-match, uncomplicated transplant.