• Alcohol:

After transplantation, you should not use alcoholic liquids or foods, even in very small amounts. Since the liver is responsible for breaking down the alcohol, it will destroy liver tissue and lead to withdrawal symptoms.

• Sun exposure:

Transplantation increases skin’s sensitivity to sunlight and increases the risk of skin cancers, as the risk of skin cancer in a transplanted person is sixty-five times higher than non-transplanted one. But if diagnosed early, most of these cancers are well treated. Always check your skin and report any new skin lesions to your medical team.

Prolonged exposure of people with blonde hair and fair skin to sunlight, increases the risk of freckle on the skin, so be sure to use sunscreen with SPF above 30 after transplantation. It is best to cover the body with clothing, use a masked hat and sunglasses, and avoid exposing to extreme sunlight.

Avoid outdoor activities during the maximum sunlight hours (between 10 a.m. and 4 p.m.). Skin tanning is prohibited for transplanted patients.

• Travel:

After the initial recovery, you can travel, although it is recommended not to travel long distances in the first six months, especially if you are away from your healthcare center and transplant team. Be sure to have new tests before the trip and let the transplant team know the results. Make sure to keep your medicine safe and take enough amount with you.

• Periodic visits and examinations:

You will need to visit transplant center on a regular, pre-arranged schedule, but if you face a problem or need a doctor in your hometown, you can consult with a pediatrician, internal medicine, gastroenterologist, or liver transplant surgeon. But keep in touch with your transplant team.

• Vaccine:

Most adults usually have had a complete vaccination before transplantation, but children who have a liver transplant may not yet have completed their vaccination program and will need to complete it after transplantation. Patients are at high risk of infection in the first six months after transplantation and cannot be vaccinated. After this time, also the patient body’s ability to produce antibodies is reduced due to the use of immunosuppressive drugs, so transplanted patients will not be able to be vaccinated with live or attenuated virus for the rest of their lives and can only be vaccinated with killed virus.

• • Tetanus: This vaccine can be injected both before and after transplantation. In adults, the vaccine should be renewed every ten years.
  • Diphtheria: This vaccine can be injected like tetanus before and after transplantation and is repeated with tetanus vaccine every ten years.
  • Influenza: The vaccine is given annually and is usually recommended for transplanted patients, especially the elderly and children. Because the flu virus can cause very serious illnesses, the best time to get the flu shot is in late September and early October.
  • Hepatitis B: If the patient does not have hepatitis B and has not been vaccinated before transplantation, it is best to get vaccinated after transplantation. Note that the vaccine is given in three stages.

Note: Vaccines that are contraindicated for transplant patients are yellow fever, tuberculosis, oral polio vaccine, chickenpox, measles, rubella and mumps.

In general, vaccines containing weakened live viruses should be avoided. You should even avoid contact with the body fluids of people who have recently been vaccinated with the oral polio vaccine, because this live virus can be released into the body fluids up to eight weeks after vaccination, but being away from a child who has recently vaccinated with DT is not necessary.

If necessary, the polio vaccine can be used with a passive virus rather than a live virus, which is an injectable form of the vaccine. It is best to get vaccinated with any killed virus, six months after transplantation.

Influenza vaccines are contraindicated in patients with severe egg allergies.

• Oral and dental care:

Some of gums and mouth problems, such as sores, can be caused by medications or opportunistic infections. It is best to avoid any dental treatment until six months after transplantation, but it is necessary to do dental examinations every six to twelve months.

Be sure to see your dentist if you have toothache, swelling, or bleeding gums.

Brush twice a day and use dental floss.

Use antibiotics before any dental activity to prevent infection under dentist supervision.

• Eye care:

Eyes may damage after transplantation for variety of reasons as in, drug complications, infections, and the effects of post-transplant diabetes. It is recommended to examine your eyes annually.

If you have any of the following symptoms, consult your transplant team:

• • Eye pain
  • Blurred vision
  • Flashes in the eyes
  • Light sensitivity
  • Seeing dark spots in the visual field
  • Dryness and redness of the eyes

• Screening for prostate disease:

The prostate is a natural gland in male genitourinary system. Many of men, especially in old ages, have problems with their prostate. One of the most important and common of these diseases is prostate cancer.

The most important risk factors for prostate cancer are old age and family history.

It is recommended that men over the age of fifty, undergo a special laboratory test (named PSA) annually in addition to physical examination for prostate cancer.

• Bone density test:

Osteoporosis is one of the most common complications in liver transplant patients. Osteoporosis can make your bones soft and brittle. Taking prednisolone, tacrolimus, or cyclosporine can cause osteoporosis. In addition, some underlying conditions, such as primary sclerosing cholangitis, can be effective in causing or exacerbating it.

The following actions can reduce your osteoporosis:

• • Adequate and appropriate use of foods containing calcium and vitamin D.
  • Doing physical activity, especially walking
  • Avoiding smoking and alcohol
  • Performing bone density test, periodically under supervision of doctor

• Smoking:

If you used to smoke before transplantation, it should stop now, because smoking, whether directly or indirectly, can increase the risk of heart problems and respiratory infections.

• Hair color:

Due to the presence of substances such as oxidants in chemical hair dyes, these substances can have adverse effects on transplant patients, and it is best not to use these substances in the first six months after transplantation. Also, according to recent researches, chemical dyes in commercial hair dyes, affect the structure of the hair and causing it to become flaky and branched, in addition to, creating fragility, dryness and excessive hair loss. Although this may occur in ordinary people, it has more side effects in transplanted individuals, due to the use of immunosuppressive drugs.

Therefore, transplanted patients should avoid dyeing, curling and discoloring their hair, especially in the first months. Also, just as transplanted individuals separate their personal belongings from others, it is recommended to separate their health and beauty supplies and avoid using shared ones.

Extra hair growth in transplanted patients is sometimes more than usual. To remove this excess hair, using laser is safer than wax, razor or bleach, because using a razor can injure the skin, and using wax can cause inflammation and scratches on the skin.

• Returning of primary disease:
  • In some patients with liver transplants, recurrence of the primary disease is seen. Removing a diseased liver is part of transplant surgery, but it doesn’t always cure the underlying cause.
  • Recurrence of primary disease in transplanted patients may occur due to the underlying cause of hepatitis B and C, liver cancer, autoimmune hepatitis, or primary sclerosing cholangitis.
  • Therefore, in patients with hepatitis B diagnosis, in addition to the antibody titer and the correct use of drugs, it is recommended that hepatitis B antibody injections be given according to the time prescribed by the doctor and continue using antiviral drugs forever (Biovudine, Adefovir, Tenofovir). These patients should have their hepatitis B virus count checked at the requested time (every six months).
  • Patients with hepatitis C should repeat the virus count test every six months and have an annual biopsy to check the transplanted liver.
  • Patients who had liver cancer or have been transplanted based on this diagnosis, should have their blood tested for alpha-fetoprotein every three months in the first year and then every year, and perform abdominal pelvic color CT scans every six months in the first year.
  • Patients diagnosed with autoimmune hepatitis should continue taking prednisolone to prevent recurrence of the primary disease, as prescribed by their doctor. The drug should not be discontinued in these patients.
  • Patients with primary sclerosing cholangitis along with inflammatory bowel disease should have an annual colonoscopy with a biopsy to assess the course of their bowel disease.

• Diabetes after transplantation

As mentioned, some patients will have high blood sugar due to the transplant medication side effects. Patients who have had diabetes before transplantation will have their diabetes worsened after surgery. It is important to have a personal blood sugar control device. Depending on the severity of the diabetes, it may be necessary to check the blood sugar four to five times a day. Most patients need high doses of insulin, but if they follow a proper diet and avoid weight gain, their need for insulin will gradually decrease, especially as transplant medication decreases over time, which will improve the condition. These patients should minimize their sugar and sweet intake, monitoring HbA1C, fasting blood sugar and two hours after meal blood sugar by an endocrinologist. In addition, their eyes should be examined every three to six months.

• Quarantine:

Contrary to many people’s beliefs, there is no need to separate transplanted individuals from others, but close contact with people who have an active infection, especially children with measles, smallpox, or those who have respiratory infection, should be avoided.