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On the day of the transplant it is very important for patients to listen to, understand and follow the indications given by the hospital. It is vital that they try to remain calm and reach the hospital as soon as possible and accompanied by someone they trust. Patients who cannot travel to hospital by their own means can request an ambulance by calling 112.
The duty hepatologist will call each patient and give them the necessary instructions whenever a liver comes available. Patients may be called at any time, 24 hours a day, 365 days a year; transplants cannot be programmed in advance. Once at the hospital, patients undergo a physical examination and any diagnostic tests the doctor deems appropriate (blood tests, ultrasound, etc.) to rule out the presence of any medical problems that could interfere with the operation and/or patient’s recovery.
The length of a liver transplant varies greatly, ranging between 7 and 10 hours. The surgeons will inform the patient’s family about the operation once it is finished, but never during surgery.
Unfortunately, transplants have to be postponed if the surgeon discovers that the donor liver is unsuitable for transplant while removing it from the donor. In such cases, the patient is discharged and he will stay in the waiting list until the donation a new organ.
Post-liver transplantation management
Intensive Care Unit (ICU)
Patients are transferred to the intensive care unit (ICU) upon finishing the liver transplant. The patient’s family can visit them in the ICU, in line with the visiting hours and clinical recommendations indicated to them at the time of admission.
Patients will be sedated and breathing through a tube when they leave the operating room. They will also have various catheters attached to them, which are used to administer medicines, and drains next to the surgical wound. The breathing tube is withdrawn after 24–48 hours, so long as the patient is well enough. Oral feeding usually starts 48–72 hours after the transplant, again, depending on the patient’s condition.
Patients start to perform some simple respiratory physiotherapy and general mobility exercises while still in the ICU in order to reduce the risk of certain complications, e.g., pneumonia, muscle atrophy or vascular conditions.
In the absence of complications, patients are expected to stay in the ICU from 2 to 7 days. They are then transferred to an in-patient unit.
Relatives can accompany patients all day long in the in-patient unit, so long as they follow the rules and recommendations they received at the time of admission. At this point the patient will still be wearing a drain, probe and/or catheter; these will be removed when appropriate.
Patients will continue to complete the physiotherapy exercises they learnt in the ICU. Throughout the hospitalisation period, the physiotherapist will provide tools that allow the patient to progressively increase their mobility and ensure maximum independence when they are discharged.
Frequent blood tests will also be carried out while the patient is admitted to hospital to check the state of their liver, assess medication levels and subsequently adjust doses, if necessary. Patients usually spend 10–20 days in the in-patient unit in function of the appearance of any complications and the need for medication dose adjustments.
Just before being discharge, health professionals provide the recommendations to follow at home.