Intestinal Perforations

Bowel injuries from cautery burns may become evident during the first postoperative week. Leukocytosis and abdominal distention should always raise the possibility of an occult perforation.22 Leaks from bowel anastomotic suture lines or from de novo perforations in areas not subjected to extensive dissection may also occur. Early diagnosis is essential to prevent recurring infected collections. When the abdominal cavity is heavily contaminated with bowel contents and peritonitis is well established, planned returns to the OR are useful for regular peritoneal washing and prevention of the persistence of infected collections.

Early Outpatient Care

The routine length of hospitalization after liver transplantation is approximately three weeks. After discharge the patients are monitored frequently to allow the clinician to recognize the early signs and symptoms of rejection and infection. After the first month to six weeks, follow-up is weekly and then ultimately monthly.

Long-term Function, Outcome, Growth and Developmental Results, Follow-up and Rehabilitation

Following the first year after transplant, laboratories are obtained quarterly and children are examined twice yearly to monitor growth and look for signs of chronic graft dysfunction. Cyclosporine and tacrolimus doses are weaned to approximately 50% of the initial values after the first year following transplant. At

Table 13C1.2. Recommended immunization schedule for liver transplant recipients

Begin the following schedule 6 months after the transplant

Hepatitis B----------------------------------- Month 7, Month 9, Month 12

DTP------------------------------------------ Resume standard schedule

H. influenza type b -------------------------- Resume standard schedule

Polio ----------------------------------------- Resume standard schedule

Patient and sibs must receive IPV*

Measles, Mumps, Rubella ------------------- Month 7 if not previously protected, confirm vaccine response with titers

Varicella-------------------------------------- Month 7 if not previously protected, confirm vaccine response with titers **

Pneumovax---------------------------------- Required for patients with splenectomy or asplenia***

Hepatitis A --------------------------------------Newly recommended vaccine for immuno-

compromised patients including organ transplant recipients

Influenza------------------------------------- Yearly

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