After a Liver Rejection Episode: Caring for Your Child

Liver rejection causes inflammation (irritation and swelling) in the liver cells and bile ducts. Because your child had a rejection episode, the team changed the anti-rejection medicines. The care team may have added new medicines or changed the doses of the medicines your child has been taking. The liver inflammation will go away. The best way to keep your child's liver healthy is to give the prescribed medicines exactly as directed. When a child has many episodes of rejection, it can cause scarring in the liver.

Medicines

• Give medicines to your child on time and as directed. If your child is on prednisone, the dose will be slowly lowered based on results from blood work.

• Store medicines as the transplant team instructed. Some may need to be refrigerated.

• Gently shake liquid medicines before giving them.

• Check with your transplant team before starting any new medicines, including prescription medicines and medicines you can buy in the store without a prescription (over-the-counter medicines).

• Ask the transplant team before giving any vitamins or herbal supplements.

• On a day your child is having a blood test, do not give the morning dose of anti-rejection medicines (such as tacrolimus, mycophenolate, or sirolimus) until after the blood test.

• Your child will need blood tests more often. The test results will help your transplant team decide if a change in medicine dose is needed.

Staying healthy

• Check your child's blood pressure and temperature as directed by the transplant team.

• Give your child a healthy diet, and follow any specific recommendations from the transplant team.

• Talk with the transplant team about the right amount of exercise for your child and any restrictions on sports or physical activity.

• Apply sunscreen whenever your child goes outside. Some medicines used to prevent rejection can make skin more sensitive to the sun.

Preventing infections

• To prevent infections, make sure your family members wash their hands well and often.

• Your child should not receive live vaccines. Discuss any vaccines ahead of time with the transplant team.

Your child:

• has a fever of 100.5°F (38.1°C) or higher

• has blood pressure readings that are higher or lower than the range the transplant team told you was normal

• has blood sugars that are higher or lower than the range the transplant team told you was normal

• vomits or feels nauseated

• has diarrhea

• has belly pain

• has swelling of any part of the body

• develops itching, a rash, sores, or blisters

• develops yellowish eyes or skin

• has a change in the color of poop or pee, or blood in the poop or pee

• is crankier or more tired than usual

• is behaving differently than usual

• can't take the transplant medicines, or you are unable to get them

Your child:

• has trouble breathing

• seems confused or agitated, or can't speak clearly

• appears dehydrated; signs include dizziness, drowsiness, a dry or sticky mouth, sunken eyes, crying with little or no tears, or peeing less often (or having fewer wet diapers)

• has a seizure

Are there side effects from steroids? Yes, sometimes steroids like prednisone can cause high blood sugar or high blood pressure. You may need to keep track at home of your child's blood pressure and/or blood sugar while your child is on prednisone.

Is it OK for my child to travel? Yes, it's OK to travel. Be sure to take these precautions:

• Pack enough medicine for the whole trip, plus a few extra doses.

• Any medicines that need refrigeration should be kept in a cooler with frozen ice packs.

• Do not leave your child's medicines in a hot car.

• Make sure there is a refrigerator in any hotel rooms you stay in.