A liver transplant surgery replaces the affected or diseased liver of a person with a whole or partial healthy liver from a donor. A variety of causes can render a liver damaged and non-functional, such as alcoholic liver disease, chronic hepatitis infection, genetic diseases, and others. All the causes result in cirrhosis which ultimately leads to liver failure if left untreated.
The recipients of liver transplants have higher chances of weight gain and metabolic syndrome. The risks may arise due to improvement in diet, immuno suppression, and reduced stress with an enhanced catabolic state. This post highlights the causes of weight gain risks after liver transplant and measures to minimize weight gain.
The common causes of Weight Gain
Weight gain in liver transplant recipients occurs due to various reasons such as improvement in diet, immunosuppression, and reduced stress along with improvement in the catabolic rate. The maximum amount of weight gain occurs in the first six months after the liver transplant surgery in Turkey. Usually, the patient will gain about 5 Kg weight during the first year. There are chances for the patient to gain 10 kg within 3 after surgery.
More than 30 percent of people become obese and may develop metabolic syndrome. If there is pre-existing metabolic syndrome, the case may worsen or the patients might develop de novo metabolic syndrome.
The drug calcineurin inhibitors (CNI) used by the clinicians to suppress the immune system increase hypertension and dyslipidemia (uncontrolled levels of cholesterol and various other lipids in the bloodstream) in the patients after the transplant. The cortico steroids used to reduce inflammation boost the components of metabolic syndrome. The metabolic syndrome is a collection of metabolic reactions which increase the risk of stroke, diabetes, and heart disease. The immunosuppressors and modulators may result in fluid retention and lead to weight gain.
A team of surgeons demonstrated that 50% of patients who had liver transplantation for non-alcoholic steatohepatitis experienced post-surgery weight gain with BMI above 35 kg/m2. A lot of patients try to maintain weight through diet and exercise but a lot a struggle due to post-surgical temptation and with overeating as a coping mechanism. Lifestyle changes and support from family are critical to maintaining weight after liver transplantation.
Bariatric surgery has shown some effect in the long-term for morbid obesity and also improves metabolic syndrome. But bariatric surgery is no option for everyone who has got a liver transplant. It also increases the risk of complications in patients and also affects recovery from liver transplant surgery.
Weight Gain Management
The management of post-transplant obesity and metabolic syndrome involves making lifestyle changes. Proper diet along with regular exercise is the right way to go about it.
Diet and Nutrition
It is quite common for a patient to experience loss of appetite post-surgery. It is nothing to be alarmed about. Over time the patient’s appetite starts to show slow progress. It is important for the patient to be on a high protein diet which will boost healing and liver regeneration. In case of need, the healthcare team will gauge the patient’s situation and food habits and suggest the incorporation of certain supplements in the diet.
Instruction prepares and consumes food
- Extreme care should be taken while preparing the food to make sure it is hygienic. Meat in particular should be cooked well to kill microbial contamination and inactivate any toxins.
- The utensils and kitchen should be disinfected before and after preparing the meal.
- The drinking water shouldn’t drink as it is, but it should either be boiled or filtered.
- The patient should avoid consuming large meals in a single go instead of space out the meals. The meals should be small and frequent.
- Staying hydrated throughout the day by taking a lot of liquid is also equally important.
- Patients who have the complication of high blood pressure/hypertension should restrict the intake of salt.
- On the whole, a balanced, low-carb, high protein diet is the right way to have food.
- A calcium-rich diet is inevitable for improving the strength of bones. Include calcium-rich foods such as skimmed milk, cheese, soya, eggs, chicken, and fish in the diet.
- The patient can resume their normal diet once the doctor and the healthcare team have reviewed the progress and analyzed the health of the new liver.
Foods to avoid
- The patient should say a big no to junk, unprocessed, deep-fried, and oily food as it tends to have high calories and trans fat.
- The patient should also refrain from consuming foods that have been left outside overnight.
- Avoid having uncooked food such as raw eggs, or mayonnaise. The patients are at high risk of getting salmonellosis and various other food poisoning diseases.
- Say no to partially cooked food, raw meat, and cod meat.
- If the patients have a high blood sugar level, the patient should cut sugar intake
Activity and Exercises
- The patient shouldn’t perform any intense workouts and lift after the surgery but it is also equally important to stay active.
- The patients can keep themselves active after discharge with day-to-day activities such as climbing up the stairs, walking around the home, less-intense strengthening exercises.
- Focus on simple and conscious breathing exercises. The breathing exercise expands the lungs, opens the air passage, enhances circulation, and expels sputum out easily.
- Work closely with a physiotherapist and start with simple exercises and raise the bar to mild exercise to promote healing and for faster recovery.
The recovery period after liver transplant surgery is highly crucial for the patient. Only when the necessary changes are made in lifestyle after the surgery, the patient can enjoy a healthy life.