Questions and answers

FAQ : After transplantation


Children's Hospital
Rue willy-Donzé 6
1205 Geneva

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The Swiss pediatric liver center - HUG
Rue willy-Donzé 6
1211 Geneva 14



Barbara Wildhaber
Barbara Wildhaber
Chief Medical Officer of the Pediatric Surgery Division
Valérie McLin
Valérie McLin
Attending Physician in the Gastroenterology, Hepatology and Pediatric Nutrition Unit

At the hospital

How long will my child be in Pediatric Intensive Care and Pediatric Surgery ?

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.

Can I stay with my child in Intensive Care ?

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

Can my child leave its room ?

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.

Are visits to the hospital by family members (brothers, sisters, aunts, etc.) allowed ?

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.

What special precautions must be taken during visits ?
  • 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 ?

Can I bring food for my child ?

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

Do we have to wear a mask ?

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.

Should we measure our child’s blood pressure at home ?

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.

Can we use a tube of ointment that has already been open and used for a few days or even a few months (e.g. Osa tube for teeth) ?

Yes, as long as you respect the expiration date shown on the package.

What precautions should we take in regard to diet ?

Up to 3 months after a liver transplant 

  • Raw meat, raw fish (including smoked salmon) and raw eggs are prohibited. Raw charcuterie products (dried meat, salami, etc.) are authorized if purchased in supermarkets, vacuum-packed and consumed within 24 hours.
  • 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, multifruit juice) and bitter orange (= Seville orange, used for jam, in syrup, candied with chocolate) are not allowed because they are incompatible with taking  tacrolimus or cyclosporine.

Be reassured: an accidental intake (for example in a multifruit juice) is not serious and does not lead to immediate or long-term consequences.

How should we prepare and store food ?

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.
Do we have to sterilize baby bottles after each use ?

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

Can we keep our pets ?

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. 

Can my child go out to public places ?

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.

Can my child go swimming ?

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.

When can my child return to school ?

Usually 2 to 3 months after the transplant.

When can my child return to the daycare center ?

Generally 3 to 6 months after the transplant.

What sports can my child do ?
  • 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.
What hygiene measures should we use ?

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.

How to wash your hands properly ?

Drugs & Vaccines

Are vaccines allowed ?

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.

How should I give tacrolimus to my child ?

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.

Can tacrolimus or another immunosuppressant be given through the nasogastric tube ?

No, they should preferably be taken by mouth.

What should I do if my child vomits ?

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.

What should I do when the time changes (standard time to daylight savings time and vice versa) or in case we change time zones ?

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
What are the interactions of tacrolimus with other medication ?

Apart from paracetamol, please refer to the interactions table (FR).

Will my child need to take an immunosuppressive treatment for life ?

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

Why are other types of medication prescribed ?

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®
  • Nopil®
  • Aspirin®
  • Valcyte®
  • Ursofalk®
  • Antihypertensive treatments:  Norvasc® (Amlodipine), Reniten® (Enalapril) 
  • Aquadek®, Magnesium, Calcimagon D3®
Should it also be taken orally ?

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.

How long will my child need to take medication (besides tacromilus) ?

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® At least 3 months following a declining pattern
Nopil®  At least one year
Aspirine® At least 3 months or according to the surgical indication
Valcyte® At least 6 months
l’Ursofalk® 6 to 12 months or depending on the medical indication
Nexium® At least 3 months
Antihypertensive treatments : Norvasc® (Amlodipine), Reniten® (Enalapril)  depending on your child’s recovery
Aquadek®, Magnésium, Calcimagon D3® depending on your child’s recovery


Why is my child not being treated to avoid chicken pox or EBV (Epstein-Barr virus), although it is taking valgancyclovir for Cytomegalovirus (CMV) ?

There are no effective prophylactic antivirals against those other viruses.

Can we use homeopathy or herbal medicine ?

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

Should I immediately go to the Children's Hospital or to my pediatrician ?

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.

Can I give my child paracetamol suppositories ?

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

What medicines should be given in case of fever or pain after the transplant ?

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.

Last update : 20/07/2023

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