If you need to contact the transplant unit before you arrive (night or day), call 612-273-3000 . Ask for the Solid Organ Transplant Unit.

If you are having a deceased donor transplant
If you are having a living donor transplant
The transplant operation
Possible surgical complications
The Intensive Care Unit (ICU)
The Transplant Unit
How long will you have to be in the hospital?

If you are having a deceased donor transplant
If you will receive a liver from a deceased donor, you will get a call from a doctor at the University of Minnesota Medical Center. Calls like this often come at night, so be sure to answer your phone.

The doctor will ask you to come to the hospital as quickly (and safely) as possible. Please be sure to:

• Get the doctor’s name and phone number.
• Ask the doctor if you should stop any of your medicines. If you take insulin for diabetes, ask what to do about your insulin.
• Stop all foods and liquids. If you have taken insulin, you may eat hard candy or drink glucose fluids (juice, regular soda pop) to prevent low blood sugar.

Once your arrive at the hospital, please stop at the Admissions Department. They will know you are coming and will direct you to the Transplant Unit. Once you are admitted, we will prepare you for surgery.

• You will have a chest X-ray, ECG, blood tests and urine tests.
• You may need enemas to clean out your intestines.
• You will be told how to take a shower using special soap.
• The doctor in charge of your anesthesia (anesthesiologist) will do a brief exam.
• We may insert an IV (intravenous) line to give you fluids and medicines.

Your family can stay with you until it is time to go to the operating room. We will then direct them to the waiting area on the third floor. After your surgery, the doctors will meet them there.

If you are having a living donor transplant
If you will receive a liver from a living donor, we will give you a date for your surgery.
The day before surgery: You will come to the Transplant Center for a physical exam. This will include blood tests, chest X-rays and an ECG. We will also teach you how to get ready for the surgery.

The day of surgery:

• Please arrive at 5:30 a.m.
• Go to the Same Day Admission Unit (3C) at the University of Minnesota Medical Center.
• We will give you elastic stockings (to prevent blood clots in your legs) and a hospital gown. Please remove dentures, glasses, nail polish, lipstick, makeup, jewelry and hairpins. Leave your valuables at home, with Security or with your family for safekeeping.
• We will insert an IV (intravenous) line. This allows us to give you fluids and medicines during the surgery. The doctor in charge of your anesthesia medicine (the  anesthesiologist) will also come to see you.

Your family can stay with you until it is time to go to the operating room. We will then direct them to the waiting area on the third floor. After your surgery, the doctors will meet them there.

The transplant operation
A liver transplant is very complex. The average surgery takes six to 10 hours to complete. The surgeons must isolate the major blood vessels and bile duct of your liver and attach the “new” liver to the same vessels. They will remove the old liver and gallbladder.

The surgery is long because removing the diseased liver can be difficult. If you have had other surgeries, you may have scar tissue that causes tissues to stick together. Also, poor clotting can cause bleeding. You may receive blood products (a blood transfusion) to make up for this loss. Your incision will be in the upper abdomen, just under the rib cage.

While most patients come in with a swollen spleen, this is rarely removed during the surgery. The spleen may get smaller in the weeks after the transplant. Your spleen helps to maintain a good blood flow through your new liver. It is only removed when it causes problems or when your liver donor has a different blood type.

After your new liver is in place, your surgeons will watch for signs that it is healthy and has a good blood supply. One of the surgeons may update your family at this time about possible surgical complications:

• Bleeding: Bleeding is a major concern during and right after surgery. A blood transfusion will be given if needed. You may need to go back to surgery to correct further bleeding.
• Breathing problems: The liver, lungs and diaphragm are located close to each other. For this reason, fluid build-up as well as short-term swelling in the new liver can make it hard to breathe deeply. You will receive medicine to help prevent pain and to keep you relaxed. You will need the help of a breathing machine (respirator) until you can breathe on your own.
• Infection: The drugs used to prevent rejection may limit the body’s ability to fight infection. We will give you antibiotic (germ-fighting) medicine before and after surgery. (Most people take this for the rest of their lives.) We will test you often for early signs of infection.
  Obstruction (blocked vessels): Your blood vessels or bile ducts may become blocked right after surgery. This may slow the flow of blood or bile to and from your new liver. We will do an ultrasound after surgery to check the blood flow.
• Kidney damage: You may have kidney problems after your surgery. These may be short-term or lifelong and have a number of possible causes. Sometimes liver disease can affect the kidneys. At other times, anti-rejection drugs may affect kidney function. For some people, the blood flow from the kidneys is disrupted during surgery, causing the kidneys to function poorly for several days. (In this case, kidney function will often improve over time.) Some people need dialysis for a time after surgery.

We will watch your urine output and do blood tests to check your kidneys. You may have a tube in your bladder (a urinary catheter) for several days until your fluids and kidneys are stable.

The Intensive Care Unit (ICU)
After you leave the operating room, you will be taken to the adult Intensive Care Unit on 4D. You will stay there until you are stable and able to breathe on your own. Visiting hours are limited. Please ask your nurse for more information.

You may be slow to wake up after surgery. We may give you medicine to control pain and help you relax. You will find that many tubes were placed in your body during surgery.

• Endotrachial (breathing) tube: You will have a tube in your throat to help you breathe. It may be uncomfortable, but we will give you medicine to help you relax. You cannot talk while the tube is in your mouth. The doctors will remove the tube as soon as you can breathe on your own.
• Biliary stent (tube): This tube is placed in your bile duct at the time of surgery. It allows bile to flow freely while the stitches in your bile duct heal. Your surgeon will decide when to remove the stent. There are two kinds of biliary stents:
  – An external stent comes out the front of the abdomen. It drains bile into a small plastic
  bag. The bile often looks golden or dark green.
  – An internal stent is placed inside your body at the site where your new bile duct connects with your old one. It allows the tissue to heal without scarring and blocking bile flow.
• Jackson-Pratt (JP) tubes: These help drain the extra fluid and blood from the surgical area in your abdomen. They are attached to soft plastic bulbs that provide gentle suction. You may be sent home with one of these drainage tubes. We will tell you how to care for it. We will remove the tube during one of your follow-up visits.
• Chest tube: In rare cases, a tube may be placed in your lungs to help drain fluid. This is temporary.
  Foley catheter (urinary tube): This tube will be in your bladder for a number of days until your fluids and kidneys are stable. It allows the nurses to check your urine output.
• Intravenous (IV) lines: You will have many IV lines, including a “central line.” This tube is placed in a large vein near the heart. We use it to give medicines, fluids and blood transfusions. It is also used to take blood samples and check fluid pressures in the body. You may have this until the day you leave the hospital.
• Nasogastric (NG) tube: This helps keep your stomach empty so you don’t get nauseated (feel sick to your stomach). During surgery, the tube is placed in the nose and goes down into your stomach. It will stay in place until you can pass gas and have bowel  movements. You cannot eat when you have an NG tube.
• Compression sleeves: These sleeves surround your lower legs. They will inflate and deflate every so often. This helps blood flow and prevents blood clots. Once you can get up and walk, you will not need them.

The Transplant Unit
Once you are stable and your breathing tube has been removed, we will move you to the Transplant Unit. You may be in a single or double room. We will draw blood tests daily, usually through your central line. You may also have X-rays and a liver biopsy to make sure your liver is working well.

While you are on the Transplant Unit, you will learn about your medicines and how to take care of yourself at home. You will need to go to two different classes. Your nurse will schedule these for you. You will also receive a handbook for patients. This provides general information and a place to write your lab results.

Your nurse will work closely with you as you learn. By the time you go home you will know how to take your medicines, record your lab values, check your blood pressure and more. Once you go home, you will need to keep track of your lab values and report them to the transplant office for the rest of your life.

How long will you have to be in the hospital?
Expect to be in the hospital for at least two weeks. Some people stay as long as two months. Once you have attended the self-care classes and know how to care for yourself, you will leave the hospital.

If you were very sick before your transplant, you may move to a short-term care facility or rehab (rehabilitation) unit until you are strong enough to go home. You may still have a JP tube or stent. You may still have staples in your incision.

If you did not attend classes before leaving the hospital, please call the Patient Learning Center at 612-273-4894 to schedule them. It is helpful to bring someone with you to class.