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Because liver transplant recipients are immunocompromised, they should receive no live virus vaccinations, such asMMR and varicella vaccines. Should a post-transplant patient have a varicella exposure, he or she must receive treatment within 96 hours of exposure (preferably 72 hours).
Immunizations children awaiting a liver transplant should receive:
Immunizations that liver transplant recipients should receive:
No vaccine should be administered at the time of presumed rejection episodes with attendant increased immunosuppression.
Most liver transplant recipients resume a regular diet within a week of surgery.
Some medications significantly alter the levels of immunosuppressant medications taken by transplant recipients, especially tacrolimus and cyclosporine.
The following medications increase the effective level of tacrolimus:
Drugs which decrease levels include the anti-seizure medications in general and most of the anti-tuberculosis medications.
If you must prescribe any of these medications, please closely monitor the child's tacrolimus trough levels.
It is safe for liver transplant patients to receive acetaminophen and ibuprofen in weight-appropriate doses following the recommended intervals.
Most children receive basilixumab for induction therapy immediately after transplant while in the hospital.Following induction, medication will likely include:
Some children require supplements of bicarbonate and magnesium due to losses associated with tacrolimus.
Generally, there are no physical restrictions after the transplant. If the child is involved in contact sports, he or she should not participate for six weeks.
For the first six weeks after transplant, we ask the liver transplant patient to stay away from any crowded areas such as malls, grocery stores, school, church, movie theaters (just to name a few).
We ask the family to limit their contacts with sick children and adults.
Patients should always avoid bright sunlight and use sun-protecting lotions.
Meticulous general care is extremely important for our liver transplant patients. Being proactive in the search for potential complications is the key.
Because of the risk of post-transplant lymphoproliferative disease (PTLD), careful examination of lymph nodes at each visit is important.
Because of their constant immunosuppressive state and thus risk for melanoma, careful dermatological examination is important.
Renal dysfunction secondary to chronic tacrolimus or cyclosporine use has been a concern in long-term survivors. Therefore, BUN and creatinine levels must be monitored, and patients should have yearly determination of urine protein and creatinine. Nephrotoxic medications should be used sparingly.
For patients waiting for a liver transplant:
We ask you to keep us informed of any changes in medical condition, any admissions to the hospital, any acute or chronic infections and any psychosocial concerns. All of these may affect the patient's listing and will help us identify the best opportunity for successful transplantation.
For liver transplant recipients:
We would like to be notified of any significant illness, jaundice, fever (>100.5 degrees), abdominal pain, lymphadenopathy, and excessive diarrhea/vomiting or compliance issues, hospitalizations or recurrent problems.
Hours: Monday-Friday, 8:30 a.m. to 5p.m.
Phone: 888-CH-LIVER or locally 617-35-LIVER (617-355-4837)
If it is an urgent matter during off-hours or weekends, please page the GI fellow at 617-355-6363. They will contact a member of the Liver Transplant Service.
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