Great news! Both Mr. McGrath and Mr. Murphy came through their surgeries well. Mr. Murphy recovered very quickly and has already been discharged. Mr. McGrath hasn’t had any post-operative complications, though he’s still pretty weak. He’s making good progress, and I think he’ll be able to go home in the next few days.

Post-Operative Issues
Before he goes home, I want to make sure that the McGraths know what to expect during the next few months. They were so concerned about getting through the surgery and the first couple of weeks, that I’m not convinced they have a good understanding of what Mr. McGrath is facing and what he must do to keep his new liver healthy. Before he’s discharged, I plan to sit down with both of them and cover several post-op issues.

First, Mr. McGrath will need to take care of himself, so he can heal properly. It’s important for patients to understand how a transplant will affect their lifestyles. They need to know what they can and can’t do, when they can return to work, etc. They also need information on diet and exercise, and the medical care they’ll need post-transplant.

As with any transplant, there’s always the risk of rejection. Our immune systems are designed to attack cells our body’s think are foreign. Even though a transplanted organ will help a patient, the patient’s immune system often thinks the organ is foreign and so attacks it. Mr. McGrath must be able to recognize the signs of rejection, so he can alert me if he believes he’s experiencing symptoms of rejection.

He’ll also be on immunosuppressant medication. These medications help reduce the risk of rejection. There are, however, quite a few side effects that Mr. McGrath will need to be aware of. I want him to understand what to expect and how to deal with any side effects.

Finally, as you know, the liver transplant did not cure Mr. McGrath’s Hepatitis C. He’ll need treatment for the Hep C to keep his new liver healthy. We need to make sure he understands what that treatment will be.

Next Steps
In addition to relaying this information to the McGraths in person, I think it’s important to give them something – a document – they can take home with them. I want you to put together a report that covers the major post-operative issues. Specifically it should include information on:

• Immunosuppressant medications
  • Short-term or Induction phase
  • Long-term or Maintenance phase
  • Possible side effects and how to handle them
  
  
• Rejection, specifically:
  • The definition of rejection
  • Signs of rejection
  • Anti-rejection phase of immunosuppressant medication
  
  
• Lifestyle issues (i.e., returning to work, limits on activity, emotional adjustment, etc.)


• Diet and exercise


• Follow-up medical care and checkups


• Post-transplant treatment for Hepatitis C

Thanks,

Dr. Laura Schaffer
Attending Physician
Divison of Hepatology
Lincoln Regional Medical Center