This section explains your dietary choices after a liver transplant. Following your liver transplant, your immune system becomes weakened (immunocompromised) due to the immunosuppression medication that you are required to take.
This information has been provided by the Kings Liver Dietitians Team
Post Liver Transplant Dietary Advice
This section explains your dietary choices after a liver transplant. Following your liver transplant, your immune system becomes weakened (immunocompromised) due to the immunosuppression medication that you are required to take. This medication includes Tacrolimus (Prograf/Advagraf®), Sirolimus, Mycophenolate and Prednisolone.
There are some foods you need to avoid for life, as they interact with your medications. These are listed under Fruit and drug interactions here.
Due to the immunosuppression, you are at greater risk of developing infections from the bacteria or fungus found in some foods. This section gives advice on food safety to reduce the risk of developing a foodborne infection. Symptoms of food poisoning include nausea, vomiting, fever, cramps and diarrhoea.
The immunosuppressant medications can cause taste changes but this usually settles within 6-12 weeks.
Dietary advice for when you are in hospital
A high-protein and high-energy diet is recommended for the first 8-12 weeks after transplant surgery to aid recovery and for wound healing. Some people find weight gain is easier after a liver transplant. After the initial phase of recovery, you may need to reduce the calorie content of your diet to avoid excessive weight gain.
During your hospital stay there are extra snacks available from your nurse and ward host, including:
- Fresh milk
- Full fat yoghurts, custards & trifles
- Cheese & crackers
- Cakes & biscuits
- Sandwiches (including egg, cheese, ham & tuna)
Foods and snacks can be brought in by your family but at your own risk. The wards do not have a microwave to reheat food but can provide limited fridge space. If you have food items brought in, please ensure that the items are clearly labelled with your name and expiry date. Out of date items will be thrown away.
If your appetite is poor or you have lost weight unintentionally
Below are some tips if you have a poor appetite or you have lost weight unintentionally:
- Eat little and often, even if you can only manage small amounts by having smaller meals and snacks in between meals.
- High-energy snacks can include yoghurt, cheese and crackers, cake, biscuits, fruit with custard or cream, ice cream, rice pudding, nuts and seeds.
- If you are finding it difficult to eat, nutritious drinks are a good way to consume calories and protein. For example, full cream milk and nutritional supplement drinks such as Fortisip Compact® or Fortijuce®.
- Try not to fill up on non-nutritious fluids such as water, squashes and fizzy drinks. Avoid drinking too much with a meal.
- Avoid lower energy meals such as salads or tinned soup.
If there are no improvements in your intake or appetite and you are underweight or continue to lose weight, please ask to be referred to a dietitian.
Fruit & Drug Interactions
The following foods can interact with your anti-rejection medications and need to be avoided for life:
- Grapefruit
- Grapefruit juice (including mixed fruit juices with grapefruit added)
- Pomegranate and pomegranate juice
- Pomelo
- Seville oranges and marmalade (jaffa or sweet oranges and orange juice are fine)
- Large amounts of lime juice (a squeeze of lime juice in a drink or in cooking is fine)
- Large quantities of bergamot products or dried citrus fruit peel. For example, limit Earl Grey tea to no more than two cups a day
Food safety
We suggest that you follow the below guidelines for 6 to 12 months after your liver transplant or after any episode of rejection to reduce the risk of developing a food born infection:
Meat & poultry
- Raw or undercooked meat and poultry, e.g. meat which is still pink – rare steak
- Smoked or cured meat, e.g. salami or Parma ham
- Deli counter meats
- Unpasteurised paté
- Rotisserie chicken
- Meat from a barbeque unless cooked in settings where you know it has been cooked well enough for consumption
Safer alternatives
- Well-cooked meat and poultry - juices should run clear and no pink showing
- Cooked, cold, sliced meats from a packet
- Smoked or cured meat if cooked and piping hot
- Tinned or jar meat/paste
Fish & shellfish
- Avoid smoked salmon unless eaten directly from a freshly opened packet
- Raw or lightly cooked shellfish (lifelong avoidance)
- Sushi made with raw fish
Safer alternatives
- Vacuum packed fish eaten straight from a new packet
- Well-cooked shellfish, e.g. prawn curry
- Well-cooked fresh, frozen or tinned fish
Milk & yoghurt
- Unpasteurised milk or yoghurt (can be found in some markets and from farms or on the internet)
- Live or probiotic supplements such as Yakult© or Actimel®
Safer alternatives
- Pasteurised milk and yoghurt – those found in supermarkets will be pasteurised
- Live or Probiotic yogurts are likely fine as they are not very high in (good) bacteria
Cheese
- Soft, ripened cheeses such as brie, camembert, some goat cheeses and blue veined cheese such as stilton
- Soft goats and sheep cheeses
- Cheese made with unpasteurised or raw milk
Safer alternatives
- Pasteurised cheeses – check labels (most hard cheeses will be fine)
Eggs
- Raw or undercooked eggs without the Lion stamp or eggs from outside of Britain
- Raw egg products in restaurants – mayonnaise, tiramisu, mousse, egg nog
Safer alternatives
- Lion stamped British eggs can be eaten with runny yolks as long as they are within date
- Raw egg products that are made at home and eaten within 24 hours
Salad
- Salad from deli counters or salad bars
Safer alternatives
- Freshly prepared salad
Ice cream
- Soft ice cream such as Mr Whippy©/McFlurry©
- Homemade ice cream
- Milkshakes from ice cream makers such as McDonalds or Burger King milkshakes
Safer alternatives
- Hard or individually wrapped ice creams
Miscellaneous
- Honey - it is recommended that only cooked honey is eaten. All honey including shop bought is not heated to a suitable temperature to be classified as pasteurised and therefore may contain an unsafe microbe.
Hepatitis E
Hepatitis E poses much more of a threat to the health of pregnant women and those who are immunosuppressed, and in rare cases can be fatal. One of the routes of transmission is thought to be undercooked pork. It is therefore recommended that extra care is taken to ensure pork and pork products (for example, sausages) are thoroughly cooked through and that juices run clear – this advice should be followed lifelong.
Rates of Hepatitis E infection are increasing in the UK. Those who are immunosuppressed are at higher risk of contracting Hepatitis E and of having a chronic form of the disease. Most Hepatitis E infections clear up within around four weeks of infection.
Food preparation advice
- Eat foods within ‘use by’ dates
- Store foods according to the instructions
- Wash fruit and vegetables before eating
- Keep fridge temperature below 5 degrees Celsius and the freezer below 18 degrees Celsius
- Defrost food in the fridge, not at room temperature - ensure it is thoroughly defrosted before using and do not refreeze
- Keep raw meat and fish in the bottom of the fridge to avoid cross contamination with other foods
- Keep foods wrapped up or in storage containers
- Have separate chopping boards for meat/fish and vegetables fruit. Replace chopping boards regularly when they become worn, as bacteria can harbour in the cracks.
- Keep fridge-freezer and cooking surfaces clean
- Keep pets away from food
- Ensure chopping and cooking surfaces are clean
Cooking & reheating advice
- Ensure food is cooked to a minimum temperature of 70 degrees Celsius, including food that is being reheated. A food thermometer is recommended.
- Cool any leftovers as quickly as possible and refrigerate once at room temperature
- Do not reheat food more than once
- Discard leftovers within 48 hours
- It is recommended that rice is cooked fresh each time it is eaten
Tips on eating out
- If possible, check the food hygiene rating of the place you are going to
- Check food is well-cooked and hot on arrival
- Avoid buffets and carveries
- Avoid cold foods or salads
- Avoid in-house made mayonnaise, Caesar salad dressing, hollandaise sauce and sweets such as tiramisu, some ice creams and mousses.
- Barbecues can be a common source of food poisoning. Ensure food is thoroughly cooked.
Healthy eating advice
- Regular meals (breakfast, lunch, dinner)
- Use low-fat alternatives, for example semi-skimmed milk, low-fat margarines, low-fat yoghurts, low-fat mayonnaise.
- Avoid high-fat takeaways, for example fish and chips or creamy curry. Only have these occasionally.
- Grill, bake or steam instead of frying.
- Cut down on the amount of oil you use in your cooking.
- Cut off visible fat and skin on meat.
- Choose plain biscuits and cakes instead of chocolate or cream varieties.
- Cut down on pies and pastries.
- Use sugar-free, no-added-sugar or low-calorie squash and fizzy drinks.
- Try using artificial sweeteners in drinks instead of sugar.
- Cut down on sugary sweets.
Please let your nurse or dietitian know if you have any other dietary restrictions or food allergies.
Further Information
If you are concerned about your diet and nutrition in relation to liver disease, ask to see a dietitian during your hospital stay. Or you can ask your doctor, nurse or transplant co-ordinator to refer you to the dietetic clinic. You can be referred to see a local dietitian if preferred.
If you have any questions about any of the information you have read here, please contact the Liver Dietitians on 020 3299 1812 or 020 3299 9000, extension 31489.