Lifestyle Changes for Liver Transplant Recovery

A liver transplant is a surgery that replaces the damaged liver with a healthy one from a donor. Some people with liver cancer may benefit from a liver transplant. A transplant can be especially helpful when the cancer is advanced or the liver is not healthy enough for the cancer to be removed via surgery. In these cases, a liver transplant can cure the cancer and also lower the chances of it coming back.

Getting a liver transplant is just the beginning of your journey to better health. To keep your new liver healthy, there are important steps you’ll need to follow. These will help protect your liver and give you the best chance at a strong recovery and long-term health.

Avoiding alcohol and smoking entirely

After a liver transplant, it’s very important to avoid alcohol completely. Drinking alcohol can seriously harm your new liver and raise your risk for several types of cancer, including those of the stomach, throat, and mouth.

It’s also important not to smoke. Smoking can damage your new liver by affecting its blood flow and how well it works. It can also slow down healing, increase your chances of having a heart attack or stroke, and raise your risk for cancers like lung, throat and liver cancer. Avoiding alcohol and smoking will help protect your new liver and support your overall health. Ideally, quitting these unhealthy habits before the transplant will be most beneficial.

Having a healthy diet

Eating a nutritious, balanced diet is extremely important after a transplant. This keeps your new liver healthy and reduces your risk of rejection and complications.

Some foods you should include in your diet:

• Fruits and vegetables (at least five servings per day), which are rich in vitamins, minerals, antioxidants and dietary fiber
• Whole grain foods that are high in fiber, such as cereals and bread, which aid digestion, regulate blood sugar levels and promote gut health
• Lean meat, poultry and fish, which are high in protein that’s needed for wound-healing and recovery
• Low-fat, pasteurized dairy products, which can help maintain calcium levels in your body and protect your bones

Foods to avoid:

• Food and drink items high in sugar, salt, cholesterol and saturated fats, which can increase the risk of heart disease, promote inflammation that potentially harms your liver and affect your recovery. Examples include red and processed meat
• Grapefruits, pomelos and pomegranates, which can interact negatively with your anti-rejection medication (immunosuppressants)

After your liver transplant, you’ll need to take medications that weaken your immune system to prevent your body from rejecting the new liver. However, these medications can also make it easier for you to get sick from germs in food. That’s why it’s important to follow food safety guidelines and avoid certain foods that may carry harmful bacteria like Listeria, Vibrio and Salmonella. Some of the foods you should stay away from include:

• Unpasteurized dairy products, such as milk and cheeses
• Raw or undercooked eggs, meats, fish and seafood
• Shellfish
• Unwashed fruits and vegetables, including salads
• Deli meats

Your dietitian and transplant team will help create a personalized healthy-eating plan that caters to your needs and lifestyle after a liver transplant. If you’re unsure about what you can and cannot eat, be sure to follow their advice.

Keeping physically active through regular exercise

Staying active is important for your overall health. Regular exercise can help you keep a healthy weight, strengthen your immune system, and lower your risk of diabetes and heart disease. However, after your liver transplant, it’s important to take it slow at first and ease into activity to avoid injury or problems with wound healing.

In the first few weeks after surgery, stick to light activities like short walks. These can help improve blood flow and gently rebuild your strength. As you start to feel stronger, you can slowly increase the length and intensity of your exercise.

If your recovery is going well, you may be able to add moderate activities—like jogging, swimming, or biking—into your daily routine around 6 to 8 weeks after surgery. However, you should avoid rough contact sports such as rugby or martial arts, as they can put your new liver at risk of injury.

If you're unsure about what types of exercise are safe, talk to your doctor or transplant care team. In some cases, they may recommend working with a physical therapist for a short time to help you safely regain strength and stamina.

Maintaining a healthy weight

It’s common to gain weight after a transplant, and there are a few reasons for this:

• Some medications, like steroids (e.g., prednisolone), can cause weight gain
• You may be less active during recovery
• Your appetite often improves as you start feeling better

While it’s important to rebuild strength and regain healthy muscle after surgery to support healing and lower your risk of infections, gaining too much weight can be harmful. It can raise your chances of developing high blood pressure, diabetes, and high cholesterol, which can lead to heart disease, strokes, and other problems with your blood vessels.

If you’re concerned about your weight or need support, don’t hesitate to talk to your transplant team—they’re here to help you stay on track.

Being careful with sun exposure

Liver transplant recipients have a higher risk of developing skin cancer. This is because of immunosuppressive medications.

To lower your risk of skin cancer, it’s important to limit how much time you spend in direct sunlight. Some key precautions you should take include:

• Avoid being exposed to the sun for prolonged periods of time, such as during the midday sun (between 10 am and 3 pm) when the sun’s rays are strongest
• Use a sunscreen with a sun protection factor (SPF) of 50 on exposed areas of your skin, especially your face, neck and hands
• Put on a long-sleeved shirt and a hat when you’re out and about to protect your skin

Please check with your transplant team if you notice unusual spots on your skin or any of the following changes:

• New moles
• Moles that have changed color
• Moles that are taking shape outside their borders
• Unusual spots on your skin

It is also highly recommended that you see a dermatologist annually for a complete skin exam.

Avoiding infection

While your immunosuppressant medications help prevent your body from rejecting your new liver, they also make it easier for you to catch infections like COVID-19, shingles and the flu. That’s why it’s important to protect yourself as much as possible.

Try to avoid close contact with people who are sick, wear a mask in crowded places, and stay up to date on your vaccines—just remember, you should only get vaccines that are inactive or “killed”. It’s also important to wash your hands regularly and keep your home clean.

By following these simple steps and listening to your healthcare team’s advice, you can lower your risk of getting sick and support a smooth recovery.