Medical Oncologist
CION Cancer Clinics
Intensive Care and the First Week After a Liver Transplant | CION Cancer Clinics
Most people wake up in intensive care with tubes and drips, and spend the first week getting the new liver working, the tubes out, and themselves eating and walking again. Daily blood tests and bedside scans check the new liver, the joined blood vessels, the kidneys and early signs of infection or rejection. This page walks through that week for patients and the family waiting outside. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- What happens in the first week after a liver transplant?
- What does a typical first week look like?
- What is the team checking for in the first week?
- What do the words on the ICU chart mean?
- What families worry about in the ICU, and what is actually true
- How can family help during the first week?
- What this page cannot tell you
- Common questions about the first week after transplant
The short answer
What happens in the first week after a liver transplant?
Most people wake up in intensive care, often still on a breathing machine for a short while, with several tubes and drips in place. Over the next few days the team removes those tubes one by one, gets you sitting, eating and walking, and checks every day that the new liver has started working.
Why the first days are watched so closely
The new liver has to take over the work your own liver stopped doing. Blood tests show within hours whether it is making bile, clearing waste and helping the blood to clot. The team also watches the joined blood vessels, the kidneys, the lungs and early signs of infection or rejection.
Who this page is written for
This page is for people who had a transplant because of liver cancer on a background of cirrhosis, and for the son, daughter or spouse sitting in the waiting area. The first week is broadly similar whether the liver came from a living donor or a deceased donor. If you are the donor, your own recovery is different and is covered on what happens to the donor.
Every transplant centre runs its own routine. Your centre's written plan always comes before anything you read here.Day by day
What does a typical first week look like?
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The first night, in intensive care
You may still have a breathing tube when you arrive. Many people have it removed within the first day once they are awake and breathing well. Nurses check blood pressure, urine and drains around the clock.
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The next day or two
Blood is taken often. A bedside Doppler ultrasound, a scan that shows blood flow, checks the new liver's vessels. A physiotherapist sits you up and gets you breathing deeply and coughing to keep the lungs clear.
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Moving to the transplant ward
When you are stable, breathing on your own and need fewer drips, you move to a high-dependency or transplant ward. Some people move within a couple of days. Others need longer, and that alone is not a bad sign.
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Eating and walking again
Sips of fluid usually come first, then soft food. Walking starts early, first to a chair, then in the corridor, because lying still raises the risk of chest infection and clots.
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Tubes come out, tablets begin
The urinary catheter, neck line and drains are removed as each one stops being needed. You start the anti-rejection tablets you will take for life, and the nurses begin teaching you their names and timings.
Not sure whether this applies to you?
Ask an oncologistBehind the blood tests
What is the team checking for in the first week?
Each daily round runs through the same short list. Most of these problems, when they happen, are found early because of it.
Is the new liver working?
Falling bilirubin, improving clotting and a clearer head are the signs the team wants. Rarely a new liver is slow to start, and the team will explain what that means if it happens.
Are the joins holding?
The surgeons joined an artery, veins and the bile duct. Ultrasound and the drain fluid show whether blood is flowing freely and whether any bile or blood is leaking.
Are the kidneys and lungs coping?
A long operation, fluid shifts and some anti-rejection medicines can strain the kidneys for a while. Breathing exercises protect the lungs.
Any infection or rejection?
Your immune system is being deliberately damped, so fever, wound redness or a rise in liver enzymes is taken seriously and tested straight away.
How each is checked
- Blood cultures and swabs if there is a fever
- Medicine levels in the blood each morning
- Sometimes a liver biopsy if rejection is suspected
At the bedside
What do the words on the ICU chart mean?
- Ventilator
- The breathing machine. Coming off it is called extubation, and it usually happens once you are awake enough to breathe safely on your own.
- Central line
- A drip in a large vein in the neck, used for medicines and frequent blood samples so your arms are not pricked every time.
- Abdominal drains
- Thin tubes from the wound that let fluid out. The colour and amount tell the team whether there is bleeding or a bile leak.
- Doppler ultrasound
- A scan at the bedside that shows blood moving through the new liver's artery and veins. It is quick and painless.
- Liver function tests (LFTs)
- The daily blood panel, including bilirubin, a yellow waste pigment, and the enzymes that rise when the liver is under stress.
- Trough level
- The lowest amount of an anti-rejection medicine in the blood, measured just before the next tablet. The dose is adjusted to keep it in range.
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Commonly believed
What families worry about in the ICU, and what is actually true
"He is still on the machine, so something has gone wrong."
Not necessarily. Some people need the ventilator a little longer after a long operation, a lot of blood products or a weak state beforehand. The team will tell you plainly if there is a specific concern.
"After a liver operation she should avoid protein."
The opposite is true. A healing body and a new liver need protein. Cutting dal, eggs, milk or meat slows wound healing and muscle recovery. Follow the transplant dietitian, not family advice.
"More visitors will lift his spirits."
Every visitor is a possible source of infection while immunity is low. One or two familiar people, with clean hands and masks, help more than a crowded doorway.
"A raised liver test means the transplant has failed."
Numbers move up and down in the first week for many reasons, including the medicines themselves. The team looks at the trend across several days, not one result.
For the family
How can family help during the first week?
Pick one person to speak to the doctors and pass updates to everyone else. ICU teams give the clearest information when they are not repeating it to a different relative every hour. Write questions down for the daily update.
Practical things that genuinely help
Do not bring any home remedy, tonic or herbal powder into the hospital. Some interfere with anti-rejection tablets. Ask before bringing food from home.
Look after the people waiting
Families travelling from a district often sleep and eat poorly for days. Take turns. If a living donor is also recovering, that person needs their own care and should not be running errands. Ask the transplant coordinator or social worker for support early.
This page does not apply to a donor's recovery, or to a transplant done for a reason other than liver cancer, where some details differ.Being straight with you
What this page cannot tell you
It cannot tell you how your own recovery will go. The pace of the first week depends on how unwell you were before the operation, how the new liver starts, and whether any complication appears. Two people in neighbouring beds can have very different weeks.
It cannot read your results
A single blood value or a line on an ultrasound report means little out of context. The transplant hepatologist and surgeon at your transplant centre are the people to ask. They see every result together.
Where CION fits
Liver transplants take place at licensed transplant centres. CION's surgical oncologists and tumour board help assess whether transplant suits the cancer, coordinate with the transplant team, and plan cancer follow-up afterwards, including the scans that look for the cancer coming back. Your team will tell you where the operation takes place. Read the transplant operation for what happens before you reach intensive care.
Questions we are asked
Common questions about the first week after transplant
How long will I be in the ICU after a liver transplant?
It varies. Many people move out of intensive care within the first few days, once they are breathing on their own and stable. Some need longer because they were very unwell before the operation or a complication needs watching. A longer stay does not by itself mean the transplant is failing.
Will I be in a lot of pain?
The wound is large, so some pain is expected. It is controlled with medicines through a drip or a pump at first, then tablets. Tell the nurse if pain stops you breathing deeply, coughing or walking, because those matter for recovery. Ask before taking any painkiller from outside, as some are not safe for a new liver.
When can I eat and drink normally?
Sips usually start within the first day or two, then soft food as the bowel wakes up. The transplant dietitian will guide you. Protein is needed for healing, so do not cut it. Food from home is often restricted early on because of infection risk, so check with the ward first.
Why are so many blood tests taken every day?
They show whether the new liver is working, whether the kidneys are coping, and whether the anti-rejection medicine is at the right level. The dose is often changed daily based on these results. Frequent testing is routine, not a sign that something is wrong.
Can family visit me in the ICU?
Usually yes, but with strict limits on numbers and timings, hand washing and often masks. Children and anyone with a cough, cold or fever should stay away. Each centre sets its own rules. A short visit from one familiar face often helps more than a long crowded one.
Is confusion after the operation normal?
Some people are muddled or see things that are not there for a few days after major surgery in intensive care, especially older patients. It usually settles. Tell the nurses about any change, because confusion can also be a sign of infection, medicine levels or liver function, and they will check.
When will I go home?
Not in the first week for most people. Discharge comes when the liver tests are settling, you are eating and walking, your medicine levels are stable and you can manage your own tablets. Families from outside Hyderabad are often asked to stay nearby for early clinic checks.
Does the first week tell us if the cancer is gone?
No. The first week is about the new liver and recovery. The removed liver is examined in the laboratory, and that report helps the team plan cancer follow-up. Scans to watch for the cancer coming back start later. Read about cancer coming back after a transplant.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- NIDDK — Liver Transplant - NIDDK
- MedlinePlus — Liver Transplantation
- NHS Blood and Transplant — Liver - Organ transplantation - NHS Blood and Transplant
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
The Transplant Operation: What Actually HappensThe step before intensive care, explained plainly.Immunosuppression for Life: What It Means Day to DayThe tablets that start this week and continue for life.Infection Risk After Transplant and How to Reduce ItWhy hygiene and visitor limits matter so much early on.Rejection: Signs and What Is DoneWhat the team means when it mentions rejection.
Talk to us
Is a transplant being discussed for your liver cancer?
CION's tumour board can review the scans and reports and explain whether transplant suits the cancer, and how follow-up would work. One helpline serves every CION centre.