Monitoring your diet and fluid intake after a liver transplant

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After your transplant, your main goal is to make healthy food choices and drink enough fluids every day. A healthy diet is low in salt, sugar and fat and high in calcium and fibre.

Following healthy eating guidelines will help you control your cholesterol and sugar levels as well as your blood pressure and make sure you have a healthy weight and strong bones.

Some of the immunosuppressants (anti-rejection medicines) you take after your transplant surgery can affect your immune system, your appetite and your body’s ability to store the right level of nutrients to keep your cells working properly. Some may also have side effects such as an increased risk of high blood pressure.

Eating the right foods and drinking the right amount of fluids will help you help you control some of the medication side effects and help you keep a healthy body weight. Safe handling of food will help you minimize the risk of food borne illnesses and also make a big difference to your quality of life with your organ.

Teen girls eating apples and carrots

How will my diet change when I have a liver transplant?

A liver transplant is a major operation. Your body will need proper nutrition and enough calories and protein to heal and fight infections after the surgery.

The transplant team will try to have you eat in the first week after the transplant, but this depends on how quickly you recover from your surgery. You will start on clear fluids and then move to a full fluid diet before taking regular food again.

There is no special “liver transplant diet”. Your transplant team will do frequent blood tests after your transplant to monitor your nutritional status (the nutrients in your blood resulting from your diet or any medication side effects). Based on the blood test results, your team will tell you what foods, fluids, or supplements you need to take. If you have any questions, your dietitian will be very happy to answer them.

Special diets to manage your weight, cholesterol or blood pressure

If your transplant team has any concern about your weight, cholesterol or blood pressure, you will need to follow some dietary guidelines to maintain a healthy body weight​ or follow a special cholesterol-lowering diet or low-sodium diet.

Support to help you get enough nutrients and calories

If you feel sick, full or bloated or have a poor appetite after your transplant, you might not be able to eat enough calories. In these cases, you may need to be fed in a different way, for example through:

  • a feeding tube that goes through your nose into your stomach (nasogastric tube, or NG tube)
  • a feeding tube that goes directly into your stomach (a gastrostomy tube, or G tube)
  • an IV that goes into a vein in your arm or the back of your hand (parenteral nutrition, or PN)
  • nutrient or calorie supplement drinks, if you are able to drink.

These options are called nutrition support and are normally only needed for a short time until you are able to eat enough calories.

Sometimes after liver transplant surgery, you may experience a condition called chylous ascites. This occurs when the lymphatic vessels of the abdomen, which transport a substance called chyle (blood cells and partly digested fat), leak the chyle into the abdomen. This can cause your abdomen to feel full and prevent it from digesting fat normally.

If you have chylous ascites, your transplant team will put you on a treatment that involves a very low-fat diet and special fat modified formula and/or a period of nutrition through an IV. You may also require a special fat supplement such as walnut oil to met your essential fat needs. Because you can also lose vitamins if you have chylous ascites, your vitamin levels will be checked in blood work during your follow-up clinic visits. Depending on the blood work results and your nutrient intake, you may need to be take vitamin or mineral supplements.

Iron deficiency and anemia

You need iron to help your body make a substance in your red blood cells called hemoglobin, which carries oxygen. Low iron in your blood can make you feel tired and cause anemia. Anemia is sometimes seen after a liver transplant due to a combination of low iron intake, blood loss during surgery, medications and any kidney problems.

After transplant, your blood work will include tests for iron deficiency anemia. To reduce the risk of anemia, it is important to include ir​on-rich foods​ in your diet. In some cases, an iron supplement may be prescribed for a short period of time to help increase your body’s iron stores.

Diets to adjust to changes in your electrolyte levels

Electrolytes are substances in the body that control how the cells work. They include sodium, potassium, phosphate and magnesium.

Some of the medications that you take may raise or lower the levels of some electrolytes in your blood. If this happens, you must balance the electrolyte levels by eating different foods. For example, if your potassium levels are high, you will need to follow a low-potassium diet. In some cases, you may also need to take medications to help lower your potassium levels.

If your blood has low levels of magnesium or phosphate, you may need to take an electrolyte supplement (pill or liquid) if a high-magnesium diet or high-phosphorus diet are not enough.

Your transplant team will monitor your recovery and tell you if you need to change your diet or take supplements and for how long. The changes might only be for the first three to six months after surgery, but they can sometimes last longer.

Vitamins and minerals to keep your bones healthy

Some medications, and sometimes the disease you had before your transplant, can affect your bones. It is essential to have enough calcium and vitamin D every day to keep your bones strong and healthy. If you do not eat enough foods with calcium and vitamin D, your transplant team may recommend a calcium or vitamin D supplement.

Adjusting to anti-rejection medications

When you first receive your liver, you will need to take certain medications to stop your body rejecting the transplant. These are called immunosuppressant or anti-rejection medications. They work by stopping the immune system from working normally so your body does not reject the new liver.

Some immunosuppressants medications can raise blood sugar levels, which can lead to glucose intolerance or diabetes. Your transplant team will check your blood sugar levels regularly. If your sugar levels are high and diabetes develops, you may need to take insulin, a hormone that helps to keep blood sugar levels normal. Diabetes after transplant generally lasts only a short time.

Whether or not you have diabetes, still take time to learn how to read nutrition fact tables and food labels to follow a healthy diet and identify products that are lower in sugar (less than 8 g of added sugar per serving).

Safe handling of food is important for everyone, but it is especially important when you are taking anti-rejection medications. When your body is less able to fight infections and defend itself against bacteria, you are at a higher risk for getting sick from contaminated food.

Person filling a glass with water

Drinking enough fluids to flush out your system

After your transplant, it will be very important that you stay well hydrated. The medication you take can be hard on your kidneys, so it is very important to drink enough fluids, especially water, to flush the harmful parts of the medications out of your body. Your doctor, nurse or dietitian will discuss how much fluid you should take each day to keep your kidneys healthy.

You will have to drink more fluids than usual if you:

  • are sweating a lot, for instance in hot and humid weather
  • lose fluids while sick, for instance if you are vomiting or have diarrhea.

Special diets after a transplant

Below is the full list of special diets after a liver transplant. Remember, you will not need to follow all these diets, only those that your transplant team recommends for you. Every transplant patient is different – your transplant team will decide which diet or diets you need to follow based on your own needs and the side effects that you experience from your medications. Your team will also work with you to help you manage any possible food allergies.

Click on the diets below to get more information about them.

Can I ever eat my favourite food again?

The good news is that you can! Remember, though, that moderation and variety are key. Speak to your dietitian to help you choose healthy foods.

Last updated: November 30th 2017