In the first three to six months after your transplant, you will likely make a lot of trips back to the hospital. This is not easy, but it is very important to have follow-up visits to make sure you and your new liver are healthy.
You might visit the hospital several days a week (even on weekends) in the first few weeks after your transplant.
Common tests and visits once you leave the hospital
- You will make regular visits to the transplant clinic for different tests (see below).
- You may receive IV medicines through your PICC at the hospital, or you may receive them at home (for example ganciclovir).
- A home care nurse will visit you at home to check your PICC, do dressing and cap changes and possibly give you medicine through the IV.
- Your PICC line will be taken out anytime between six weeks and three months after surgery. Ask your team when yours can come out.
Transplant clinic visits
At a typical clinic visit you will have blood drawn for testing and then be seen by different members of your transplant team, including your nurse, doctor or nurse practitioner. You may also be seen by a dietitian, social worker, physiotherapist, pharmacist or an adolescent medicine specialist as needed.
They will all ask you questions and check different things to make sure you are healthy.
The table below shows how often* you need to come for clinic visits.
| If your transplant was… | You will come to the clinic |
|---|---|
| 0 to 1 month ago | Once or twice a week |
| 1 to 2 months ago | Once every one to two weeks |
| 3 to 6 months ago | At least once every one to two months |
| 6 to 12 months ago | At least once every two to three months |
| Over 1 year ago | At least once every four to six months |
| Over 2 years ago | Once a year |
*These are guidelines only. Your visits may change depending on how you are doing.
Blood work after transplant
How often you have blood work depends on when you had your transplant surgery. Have a look at the table below for more information.
| If your transplant was… | You will have blood work… |
|---|---|
| 0 to 4 weeks ago | One or two times a week |
| 1 to 3 months ago | At least twice a week |
| Every 1-2 weeks | At least once a week |
| 3 to 6 months ago | Every 2-4 weeks |
| 6 to 12 months ago | Every 4-8 weeks |
| Over a year ago | Every 3 months |
If your team is concerned about any blood test results, they will ask you to have blood work more frequently.
Ultrasound
Your blood work will include liver function tests to see how well your transplanted liver is working. The team will follow these tests closely. If the tests show an increase in liver enzymes, your transplant team may do an ultrasound scan.
Liver biopsy
If your team sees signs in the blood work that your liver enzymes are increasing, they may do a biopsy of the liver.
Liver biopsies are performed when your transplant team suspects that you may be experiencing liver transplant rejection or an infection in the transplanted liver.
What happens during and after the biopsy?
A biopsy involves using a needle to go in through your abdomen (belly) and take out a tiny piece of your new liver so it can be studied under a microscope. You will receive medicine to help you relax, known as sedation, and/or have a local anaesthetic to numb the area so you won’t feel any pain when the needle goes in.
If you need a biopsy, you will usually have it as a day patient in the interventional radiology (IGT) clinic. Being a day patient means that you will usually not need to stay overnight in the hospital.
After the biopsy, you will have to lie flat on your back in hospital for four hours to help prevent any bleeding. You will have your blood counts checked (especially your hemoglobin) four hours after the biopsy to make sure there is no sign of bleeding.
What happens if the biopsy results are abnormal?
If your biopsy shows that you have signs of rejection in your liver, you may be admitted to hospital (as a day patient or sometimes overnight) to receive medicines to treat the rejection. Alternatively, the team might give you extra medicine to take at home.
If you need a liver biopsy, the team will explain it to you in detail.
Other tests
Later on after your transplant you will have a set of tests and appointments that are part of the normal follow-up. These tests include:
- liver ultrasound (three months after transplant and then one year after transplant)
- GFR - a kidney filtration test one year after your transplant that tells your transplant team how your kidneys are working.
All this follow-up might seem like a lot, but regular blood tests and check-ups are the only way we can know that you and your transplanted liver are healthy. If your body is rejecting your liver, you will probably not have any symptoms for a long time. Similarly, if you have an infection, your team will often find signs in the blood before you start to have symptoms.
