The immunosuppressants you take after transplant make your immune system weaker. A weak immune system can make it easier for you to get sick from viruses that are usually harmless.
Your transplant team will routinely check your urine and blood for:
- cytomegalovirus (CMV)
- Epstein Barr Virus (EBV).
Cytomegalovirus (CMV)
CMV is a common virus that may cause more problems in patients with weak immune systems.
Many people are CMV positive (they have the virus but may not show symptoms). If the person who donated your liver was CMV positive, it will be present in the new organ. You may already be CMV positive and not know it.
To stop CMV from causing an infection, you will have to take antiviral medicines for about three months after transplant. These antiviral medicines are called ganciclovir or valganciclovir. Ganciclovir is given through your PICC or CVL line. Valganciclovir is taken by mouth.
You will likely become CMV positive at some point after transplant. For most patients, this is not a problem. However, some patients develop CMV infection and will have to take antiviral medicines more often and for longer until the infection is under control.
Epstein Barr virus (EBV)
This is the virus that can give you mononucleosis (mono). If the person who donated your liver was EBV positive, it will be present in the new organ. Many people are EBV positive and you may be positive too. We will treat it in the same way as CMV (see above).
As with CMV, you will likely become EBV positive at some point after transplant. For most patients this is not a problem. However, some patients develop an EBV infection (like mono). EBV can also cause post-transplant lymphoproliferative disease (PTLD). We will watch carefully for any signs of this and help you understand what signs and symptoms to watch for.
Chickenpox (varicella)
Always tell your transplant team if:
- you come in to contact with chicken pox in the first six months after transplant
- you have been told that you do not have antibodies against chicken pox.
The transplant team can write a letter for your school asking other parents to contact the school if their child develops chickenpox.
If you did not have chickenpox or receive a chickenpox vaccine before your transplant, and you come in contact with someone with chickenpox, you may need an injection of a medicine called VariZIG® (varicella zoster immunoglobulin). This will help protect you from a full chickenpox infection.
The chicken pox virus is dormant in the body but can become active when the immune system is weak. If you develop a chickenpox infection, you may have to go to hospital for up to a week to get an antiviral medicine called acyclovir. You will usually feel ok during this time.
Shingles (herpes zoster)
Shingles is a painful rash caused by the same virus that causes chickenpox. The rash usually appears in a band or strip on one side of the body or face and turns into a cluster of small, fluid-filled blisters. If you think you have been in close physical contact with a person who has shingles, please tell your transplant team.
If you think that you are developing shingles, call your transplant team right away so that you can get treatment as soon as possible.
What to do if you get sick at home after a transplant
There are a number of things you can do at home to prevent health problems or deal with them if they occur. Sometimes, however, you will need to tell your transplant team how you feel so you can get treatment as soon as possible.
When to contact the transplant team
Contact your transplant team if you:
- have a temperature higher than 38°C (contact the transplant team immediately if your PICC or CVL line is still in place)
- have flu-like symptoms such as chills, nausea, tiredness, headache, dizziness and body aches and pains
- feel pain or burning when you urinate (pee)
- feel pain or more swelling than usual in your feet, calves or legs
- experience chest pain or shortness of breath
- cough up blood
- are vomiting and unable to keep fluids and medicines down
- have vomit that looks like ground coffee
- pass a stool that is black
- are passing more stool than usual
- have bad diarrhea.
