At the hospital

Your child will stay in Intensive Care for a few days (4 to 5 days), and then be admitted to the Pediatric Surgery floor for about 3 weeks.

The duration of hospitalization may vary, depending on the child’s state of health.
 

Yes, you can stay with your child, whether in intensive Care or Pediatric Surgery.

Yes, after you have informed the nursing team. But the child must wear a mask. Masks are available for you in the unit. You can also go for a walk with them around the hospital.

Yes, they are actually encouraged. However, if any family members show signs of infection (a cold, cough, diarrhea, etc.), they must abstain from visiting your child for the duration of the symptoms.

For your child’s comfort, the number of visitors is limited to two people at a time.

  • Always wash your hands with soap and water before your first daily contact with your child.
  • Throughout the day, disinfect your hands before entering and leaving the room with a water-based alcohol solution. 
  • In case you come in contact with biological fluids, such as urine, blood or stool, wash your hands with soap and water.

How should we wash our hands?

Comment bien se laver les mains ?

Yes, that is a good idea. Remember to bring the dishes that they like. However, do not give them tap water. Our teams will provide you with bottled water.

Once opened, the bottle must be consumed within 24 hours. The food and the meal tray should be consumed quickly (do not keep “opened” food in the room).

At home

No. However, if one of your child’s siblings is sick, physical contact with the child who has undergone the transplant should be avoided as much as possible.

No, this is not necessary unless your child's blood pressure was high in the hospital. In this case, your doctors will ask you to measure it at home.

Up to 3 months after a liver transplant

  • Raw meat and cold meats, raw fish and smoked salmon, and raw eggs are forbidden.
  • Marbled cheeses (like Roquefort) or that have a mold/washed rind (like Camembert / Vacherin Mont d’Or) are prohibited. 
  • All pasteurized cheeses are allowed (Gruyère, Vacherin Fribourgeois, Emmental, Babybel, etc.), even cheese that says "raw milk" on the package.
  • Milk must be pasteurized or UHT. No raw milk from the farm.
  • All other drinks and tap water are allowed.

After and throughout the rest of the person’s life

  • Grapefruit (fruit, juice, juice mixture) is not allowed because it is incompatible with taking Tacrolimus or Cyclosporine

The storage, preparation and cooking of food must be done in a "clean environment": 

  • Clean your refrigerator regularly (once or twice a month)
  • Wash your utensils and dishes carefully:

- either by hand with hot water and liquid dish detergent (and then dry them with a clean towel)

- or in the dishwasher with the temperature set to 60°

  • Keep your work spaces clean.
  • Wash your hands before cooking.
  • Prepare small amounts at meals to avoid leftovers and cook all foods thoroughly.
  • Store fresh or already cooked foods in the refrigerator.
  • Eat leftovers, use up the baby food in jars and opened packages within 48 hours of storing them in the refrigerator.
  • Cook frozen foods directly without defrosting them first.
  • Never refreeze food that has already been thawed.
  • Check product expiration dates.
  • When shopping, wrap up fresh foods and then put them in an insulated bag to avoid breaking the cold chain.

No, just wash them carefully by hand or in the dishwasher.

It is not recommended to have birds, snakes, turtles or lizards as pets because of the risk of contamination with fungi. If you already have these animals as pets, your child who has undergone a transplant must avoid any contact with them and absolutely must not help with their care, such as cleaning cages, a vivarium or other terrarium, nor feed them.

Cats, dogs, horses, cows and other animals pose no problems. However, avoid getting any new animals as pets during the first year after transplantation. 

During the first six months after the transplant, it is best to avoid closed public places with a high density of people, such as shopping malls, movie theaters or concert halls, especially in winter.

If you need to go shopping or travel by public transport, try to go out during the times when things are less crowded.

In the ocean: yes, but you must apply “total SPF coverage” sunscreen because the effect of tacrolimus (immunosuppressive medication) makes the skin more sensitive to the harmful effects of the sun (skin cancer).

In a pool: It is recommended that public pools be avoided during the first post-transplant year. On the other hand, private swimming pools (at your home, or at the homes of friends or family) are allowed.

Usually 2 to 3 months after the transplant.

Generally 3 to 6 months after the transplant.

  • No sports for the first six weeks but it is recommended  to move as soon as possible and to walk.
  • For the first three months, no intensive or contact sports, and no scooter riding or jumping on a trampoline.
  • After that, no restrictions. Competitive sports up to the Olympic level are possible.

Using basic hygiene measures is the best way to avoid contamination.

You should use them on a daily basis, regardless of your location and situation (hospital, home, school, travel, etc.):

  • Wash your hands regularly with soap and water, for example, after using the toilet, before cooking or eating, on returning home, after recreational activities or taking a break, on leaving the hospital or the doctor’s office, etc.
  • Use a water-based alcohol solution when there is no water available.
  • If you have a cold, sneezing or coughing, use a tissue and dispose of it in the trash after use, and then wash or disinfect your hands.

 

Yes, as long as the child's seat is thoroughly dried after you have used the wipe to avoid leaving it wet. Moisture actually promotes the proliferation of fungi (fungal infections).

Drugs & vaccines

Yes, your child’s vaccination schedule will be resumed as early as one year after the transplant based on the Center's recommendation and follow-up.

For more information on vaccines: INFOVAC

Your child should always take tacrolimus or another immunosuppressant:

  • by mouth 
  • at the same time
  • under the same conditions, whether on an empty stomach or with a meal

These essential precautions help to reduce fluctuations in the level of medicationin the blood. The analysis of the results is therefore more reliable, which makes it easier to adjust the treatment.

However, if blood levels vary too much despite these precautions, doctors suggest that you give your child tacrolimus on an empty stomach within a certain time period before it eats any food.

Use the half-hour rule:

  • if your child has a vomiting episode within the first half hour after administering the medication, you can give your child the same dose again.
  • if the vomiting episode occurs a half hour or more after administering the medication, do not give it again because it has probably already been absorbed.

Please feel free to call our Center if you have any questions or if vomiting persists.

Do not change the tacrolimus administration schedule. Continue to give it to your child at the same time as usual based on the new time zone.

For example:

8 a.m. during standard time in the winter => 8 a.m. during daylight savings time in the summer

8 a.m. in Geneva => 8 a.m. in New York

Apart from paracetamol, please refer to the table below.

Interactions

All grapefruit products are prohibited. In fact, grapefruit juice can significantly increase tacrolimus levels in the blood and significantly increase its adverse effects on the kidneys.

If your child eats grapefruit or drinks juice containing grapefruit by accident, you must immediately contact the transplant team [1]to determine whether tacrolimus levels in your child’s blood should be checked.

To the best of our current knowledge, yes. A transplant recipient must take immunosuppressive treatment throughout his life. Studies are currently underway.

At first, six drugs a day are prescribed, as a preventive measure, to reduce the side effects of the immunosuppressant. They protect against high blood pressure, renal failure and the risk of viral or bacterial infection. Then, this number gradually decreases over the years (1 to 3/day).

Types of medication
Prednisolone® or Prednisone®
Bactrim®
Aspirin®
Valcyte®
Ursofalk®
Antihypertensive treatments:  Norvasc® (Amlodipine), Reniten® (Enalapril) 
Aquadek®, Magnesium, Calcimagon D3®

 

Yes. Even if your child has a nasogastric tube. As with tacrolimus, other immunosuppressive medication, including Nifedipine®, Amphomoronal® and Mycostatin®, should preferably be taken by mouth.

The other treatments can be administered through the tube. However, because the tube is temporary, it is best for your child to get used to taking its medication by mouth.

The information in the table below is used as a general rule, but treatment may vary depending on the situation:

Types of medication General duration for taking post-transplant medication
Prednisolone® or Prednisone® 3 months following a declining pattern
Bactrim®  One year
Aspirin® 3 months or according to the surgical indication
Valcyte® 6 months
Ursofalk® 6 to 12 months or depending on the medical indication

Antihypertensive treatments:  Norvasc® (Amlodipine), Reniten® (Enalapril) 

depending on your child’s recovery
Aquadek®, Magnesium, Calcimagon D3® depending on your child’s recovery

 

There are no contraindications for using homeopathy. In the absence of validated studies, care should be taken with products such as spagyric tinctures.

Regarding herbal medicine, vigilance is required regarding plant origin, concentrations and the quality of the preparations.

We invite you to discuss this with a team member who can get advice from the clinical pharmacology Division.

In case of fever

Your child is considered to have a fever if its temperature is higher than

  • 38°C during the first year after the transplant
  • 38.5°C after this

First, remove your child's clothes and give it a bath with the water half a degree below its temperature. You can give them paracetamol (Dafalgan®, for example).

If the fever persists despite these measures, call your pediatrician or take your child [1]directly to the closest Children’s Hospital.

IMPORTANT : THE MORE RECENT THE TRANSPLANT, THE GREATER THE NEED FOR YOUR CHILD TO BE SEEN BY A DOCTOR QUICKLY.

Yes, every 6 hours in case of pain or fever.

In case of fever or pain, it is recommended to give/use only paracetamol, Dafalgan®, Panadol®, BenUron®, etc.

CAUTION: Do not give Ibuprofen®, Algifor®, Irfen®, Brufen®, Nurofen®, etc., from the NSAID family (= non-steroidal anti-inflammatory drugs) because of the risk of renal failure.

If these medications are prescribed to you, refuse them. Please feel free to contact the Center in case of doubt.