High protein, high energy
Initially, following your transplant; your body needs more energy and protein for healing from the operation, this takes several months as the wounds inside are continuing to heal even after you have healed on the outside. You will therefore need to continue with your high energy, high protein diet while you heal.
If you are coming back to Addenbrooke’s for your follow up appointments with the doctors, a dietitian will also see you in that clinic to check how you are doing. You can ask to see a dietitian in this clinic at any time to answer any nutritional concerns or questions you may have.
Grapefruit, pomelo, Seville oranges and pomegranate
After a transplant you should avoid eating and drinking food containing grapefruit, Seville Oranges (used to make marmalade), pomelo and pomegranate because these foods interfere with the levels of the immunosuppressant medication. You
should also check food and drink which may contain these foods such as mixed fruit juices and marmalade.
Food hygiene advice
After your transplant you will have to take immunosuppressant medications for example Tacrolimus, Ciclosporin, Sirolimus, Mycophenolate Mofetil, Azathioprine, and Prednisolone. These reduce the activity of your immune system in order to help prevent your new liver being rejected.
The role of your immune system is to fight infections in your body. Because the activity of your immune function is lower than normal it means you are more likely to pick up infections. You are at risk of getting a food borne infection such as Listeria, E-coli and Salmonella. If you have Listeria you may not experience any symptoms or you may experience mild ‘flu like’ symptoms such as a temperature, headache, diarrhoea or a sore throat. A more serious infection can arise if the Listeria spreads in the body. If you follow the advice below, you will reduce the risk of getting a food borne infection.
Guidelines on specific foods and drinks to avoid to reduce your risk of food borne infections
The list of foods below are to be avoided by everyone initially after a transplant to minimise the risk of food borne infection. It is recommended that you avoid these foods while your immunosuppressant medication is at a high level.
Once you are on a maintenance dose of your immunosuppression medication, you can relax the restrictions as long as you are sensible. This is usually about six months after your transplant. It is important to avoid undercooked pork and undercooked shellfish for ever.
If you are ever put back on to a higher dose of immunosuppressant medication, for example with to treat rejection, you should restrict these foods again until your maintenance dose is restarted.
|
Types of food to avoid |
Alternative choices | |
|---|---|---|
| Milk and yogurts |
Types of food to avoid Unpasteurised milk and yogurts, for example milk sold on local farms, some goat and sheep milk. |
Alternative choices Pasteurised milk and yogurt, tinned milk, UHT milk, dried milk. |
|
Types of food to avoid Please note: all cow’s milk sold in the supermarket is pasteurised. All yoghurt is pasteurised unless the label states otherwise. |
Alternative choices Please note: all cow’s milk sold in the supermarket is pasteurised. All yoghurt is pasteurised unless the label states otherwise. | |
| Cheeses |
Types of food to avoid Soft mould-ripened cheeses such as Brie, Camembert, Dolcelatte, Roquefort, Cambozola, Danish blue. Soft sheep and goats cheeses. Cheese made with unpasteurised milk. |
Alternative choices
Hard cheeses such as Cheddar, Red Leicester Edam, Parmesan(cut off any visible rind) and Stilton Processed cheese, for example Philadelphia, Dairylea and Kraft. Cottage cheese. Feta if it is pasteurised. |
|
Types of food to avoid Please note: cheese made with unpasteurised milk will be labelled as ‘made with raw milk’ or ‘made with unpasteurised milk’ |
Alternative choices Please note: cheese made with unpasteurised milk will be labelled as ‘made with raw milk’ or ‘made with unpasteurised milk’ | |
| Eggs |
Types of food to avoid Raw eggs or undercooked eggs that do not have the lion stamp (these eggs must be well-cooked). |
Alternative choices
Well-cooked/hard boiled eggs without the lion stamp. Hen eggs with the lion stamp can be eaten raw/runny/undercooked. |
| Fish |
Types of food to avoid Raw fish such as sushi. Raw or lightly cooked shellfish, oysters and caviar. Avoid smoked salmon unless eaten directly from a freshly opened packet. |
Alternative choices
Well-cooked fresh, frozen or tinned fish. Well-cooked shellfish, for example prawn curry. |
| Meat |
Types of food to avoid Raw or undercooked meats, including rare meats for example steak tartare. Smoked/cured meat, for example salami, unless well-cooked. All deli counter meat, for example cooked ham sliced from the bone, unless you cook it well again at home. Rotisserie chicken. |
Alternative choices
All well-cooked meat, including fresh, frozen, and tinned meat. Cooked meat in a sealed packet from the fridge, for example cooked sliced ham. Smoked and deli counter meat if cooked and piping hot. |
| Pate |
Types of food to avoid Unpasteurised meat and vegetable pate/paste (requiring refrigeration). |
Alternative choices Tinned or bottled meat and vegetable pate/paste. |
| Fruits and vegetables |
Types of food to avoid Unwashed Fruit and vegetables. Salads from the deli/salad bar, such as coleslaw and potato salad. |
Alternative choices
Washed fruit, vegetables and salad. Tinned, dried and stewed fruit. Cooked fresh, frozen, tinned vegetables. Coleslaw and potato salad from a sealed packet kept in the fridge. |
| Ice cream |
Types of food to avoid Soft ice-cream for example Mr Whippy, McFlurry. Slush puppy or other similar iced drinks from a machine. Milkshakes from a soft ice-cream style machine, for example McDonald's and Burger King milkshakes. |
Alternative choices Ice cream and ice lollies stored in the freezer. |
Guidelines on how to look after your food and drinks to help reduce your risk of infection
Shopping
- Check the ‘use-by’ date to make sure they are still current.
- After shopping for fresh foods put them in the fridge or freezer as soon as possible.
Food preparation
- Wash your hands properly.
- Protect cuts and wounds before handling food.
- Wash and dry utensils (for example knives), work surfaces, such as chopping boards between preparing cooked and raw foods to avoid cross-contamination.
- Wash all fresh fruits and vegetables before preparation.
Cooking
- Thaw meat and poultry in the fridge, not at room temperature.
- Cook meat, poultry and shellfish thoroughly.
- When reheating food ensure that it is piping hot.
- Never reheat food more than once.
- When using the microwave follow the cooking and standing times.
Storing food
- Check the temperatures of the fridge and freezer regularly, ensuring the fridge is less than 5oC and the freezer is less than -18oC.
- Never refreeze thawed food.
- Cover all foods in the fridge.
- Store the cooked food at the top of the fridge and the raw goods at the bottom.
Eating out and abroad
- When eating out or having a takeaway, ensure the food is well cooked. If possible avoid buffets.
- Try to ensure that you only go to reputable restaurants/eateries and avoid food sold on streets or markets. Choose places with a food hygiene rating of 4 or 5.
- It is recommended to avoid buffets and carveries for the first 6 months after liver transplant, as the food is sat out for long periods and not well temperature controlled. If it is not possible then it is recommended to eat the food as soon at the buffet/carvery is laid out.
- Take extra care when abroad, as food hygiene may be poorer.
- Ensure BBQ’d meat is thoroughly cooked and not left for long periods between cooking and eating. Ensure clean tongs are used to pick up cooked meat, not the same tongs used to put raw meat onto the BBQ.
If you have any queries, please do not hesitate to contact your dietitian.
Dept of Nutrition and Dietetics, Liver Transplant Dietitians - 01223 216655
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