Diet and your liver – Transplant patients

People do need more calories and protein to help recover post-transplant. So from what I was saying about people having lost muscle when they are ill, obviously, post-transplant you have a brand new transplanted liver, but you still have some of the problems existing, ie the muscle loss and weight loss. So initially, we’d be giving people high protein advice to help with healing, to help with muscle recovery, and longer term muscle gain. So while the body is healing, you don’t tend to put on weight and muscle, because those proteins are diverted to provide the building blocks for new tissues.

Once the healing process is completed, that can be weeks in people that are better nourished, but it can be a couple of months in people that have got a poorer protein status. Once that healing is completed, that protein can be diverted to muscle to start to get some muscle gain. Also steroids do promote the deposition of fat, so you’re more likely to gain fat, and they hinder muscle gain. So it’s about getting the balance right of calories and protein. So it would be higher calorie and higher protein advice for most patients post-transplant. The duration of that depends on the degree of weight loss pre-transplant.

And again, we tailor that advice to people and say that they would usually be continuing with their supplement drinks, if they were on them. But as their appetite increases, their healing is finished, and they start to gain weight, we would be giving them advice to tail down those supplement drinks, so they’re reducing. Because longer term post-transplant it’s very important to maintain a healthy lifestyle, because you can gain weight. Steroids do set the scene for increased appetite. And so you can get into a habit of eating more.

And because it takes longer to get back to your usual activity level when you’ve had a chronic disease and not used to being as active, and you’ve had surgery, it takes you a while to recover from. Sometimes your eating recovers quicker than the exercise and burning off. So we’ve got to be careful about weight gain. So we’re quite keen to give people the tools to be able to reduce the supplements and the extra calories and protein as their weight improves. And longer term, it’s healthy lifestyle management, as we talked about earlier.

The only exceptions, perhaps, would be that somebody who has been transplanted for fatty liver may not need additional calories, because they’re quite well nourished, but they do need the additional proteins to promote healing and recovery of the muscle. And again, it’s very important in those patients that we give them quite specific advice, that they know when to tail down the protein supplements. And again, longer term, it’s healthy lifestyle management to help prevent the recurrence of the accumulation of fat in the liver.

Anybody avoiding fats, or reducing fats to manage the biliary diseases, once that the bilirubin have been level and the jaundice starts to subside post-transplant, they can re-introduce fats and eat a normal, healthy diet, once they’ve recovered from any weight loss. Those are a key aspects of recovering weight and managing weight. The other aspect of dietary management post-transplant is the consideration of food safety. Obviously, people are immunosuppressed. Their immune systems are not functioning as per a normal healthy individual because of the medication. So we give food safety advice to any food related illness.

So that storage of food in the fridge, so cooked foods, always go above rule, so you don’t get raw juices contaminating that they could drip on cooked foods below. So in the fridge, cooked above raw. People also have got to make sure that unpasteurised foods and cheeses, mayonnaises are made with pasteurised products, not unpasteurised, because of the risk of illness from salmonella. Also, we would make sure that people were having well cooked eggs and poultry. Again, to avoid the risk of salmonella. So we would give that food safety advice. We also give caution to avoid taking probiotics early in the post-transplant period. But longer term, they can be reintroduced under the guidance of the medical and dietetic team.