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Eating Healthy Diet and Nutrition

Healthy eating habits before and after your transplant can make a big difference in your long-term health. In fact, making good food choices is a good idea not only for you as a transplant recipient, but also for everyone in your family.

Weight Loss

The Transplant Institute offers a weight loss program for patients who have a high Body Mass Index (BMI). Optimal weight loss is beneficial and also mandatory to prevent complications before, during and after your transplant surgery.

Our nutritionist will provide you with the necessary tools and resources, such as meal plans, recipes and educational materials, to help you achieve a healthy weight. We encourage follow-up appointments every 4 to 6 weeks with the nutritionist to check progress. Some patients may also benefit from discussions with our transplant psychologist, who can help address behavioral issues linked to overeating, such as depression and stress, and set strategies and goals.

Pre-transplant Diet

Before your transplant, your doctor or nurse may refer you to the nutritionist for a variety of reasons. If you are malnourished due to liver disease, we will work with you to maintain and improve your nutritional status while you are being evaluated, waiting on the list, and also after your transplant. Diet plays a crucial role in helping to prevent certain common complications of liver disease.

Our nutritionist can provide you with individualized diet educational material, and answer any questions you may have.

Diet Therapy to Manage Complications


The most common complication of liver disease/cirrhosis is ascites, which is a buildup of fluid in the abdomen and elsewhere. Increased abdominal pressure makes you feel prematurely full (early satiety), so you may not be able to eat as much as you normally should. Early satiety can negatively affect your nutritional status.

It is important to follow a low sodium diet (typically 2 grams/day) to avoid fluid collection and minimize edema (swelling). Your nutritionist will explain which foods are high in sodium, what alternatives and substitutes you might consider, and how to interpret food labels.


When the liver is unable to metabolize, or use, protein efficiently, ammonia levels can increase in your bloodstream, which can lead to encephalopathy. Symptoms of encephalopathy include confusion, drowsiness and behavioral changes. In severe cases encephalopathy can progress to coma.

To help prevent encephalopathy you must take your medications exactly as directed. Protein is not restricted in the case of encephalopathy; however, the type of protein you eat is important. For example, your nutritionist may advise you to eat a mix of protein foods from meat and vegetable sources such as eggs, dairy products, nuts, lentils and beans, but to consume less red meat. Also, you may be able to better tolerate protein-rich foods if you eat them throughout the day rather than all at once.

Other Complications

Liver disease can cause other dietary complications as well. Fat malabsorption can occur due to lack of bile salts. This condition can lead to oily stools, weight loss, and malabsorption of fat-soluble vitamins (A, D, E and K) and minerals such as calcium, magnesium and zinc. Some patients may experience high or low blood sugars, or weight gain or loss. Modifications in diet can help prevent or minimize all of these complications. Because each patient is unique, your nutritionist will provide you with an individualized meal plan.

Nutritional Supplements

Your nutritionist and/or doctor may recommend that you drink nutritional supplements, and write you a prescription. If your individual insurance does not cover this type of treatment, your nutritionist will write an appeal letter to your insurance company for approval.

If at any time, either before or after your transplant, you are unable to eat enough food, or drink enough liquids, to meet your nutritional needs, we may need to supplement your calorie intake with tube feedings. Tube feedings can help prevent further weight loss and/or improve your nutritional status.

If you need a feeding tube, your doctor will admit you to the hospital. Doctors will place the feeding tube directly into your stomach by using an endoscopic procedure (through the mouth) or a percutaneous surgical procedure (through the skin). We start the tube feedings in the hospital so we can closely monitor you, to be sure you are tolerating the feeds without any problem. If you go home on tube feeds, you nutritionist and doctor will monitor your condition weekly.

Immediately After Your Transplant

For the first few weeks after your transplant, you will need good nutrition to help your body heal. It is crucial to eat enough calories and protein to help your incision heal, fight infection and gain back any weight you may have lost prior to your transplant. Food safety plays a significant role. You should avoid raw and/or undercooked meats to prevent food-borne illnesses. Also, eat only thoroughly cooked oysters, clams or mussels to minimize your risk of serious infection from Vibrio vulnificus. You can read more about the dangers of this bacterium at

Once your transplant is working well, your appetite and sense of taste will likely improve. The risk of weight gain is high, as is post-transplant new onset diabetes due to the side effects of the anti-rejection medication. So it is especially important to avoid high calorie foods with low nutritional value, such as doughnuts, candy, cookies, ice cream and other junk food.

When planning meals, these recommendations will help ensure a healthy diet:

  • Eat three meals each day, and include protein in every meal. Good protein sources include poultry (chicken and turkey), fish and seafood, red meats and yogurt. Although high in cholesterol, eggs, nuts and dairy products such as milk and cheese are also good sources of protein.
  • Consider taking a multivitamin supplement to meet your vitamin and mineral needs if your appetite is poor or if you are not eating a balanced diet. Check with your doctor or nutritionist before you take any vitamin/herbal supplements to make sure that they are safe for you and have no adverse interactions with the medication you are taking.
  • Maintain a low salt and low potassium diet until the transplant team says you can increase salt and potassium. Check with your nutritionist for specific lists of food that are low in salt and potassium.
  • Be physically active, but consult with the transplant team before you start a new exercise regimen to make sure it is safe.
  • Avoid concentrated sweets and food high in saturated/trans fats. It is crucial to follow healthy eating guidelines long term to maintain good nutritional status.

Long-term Diet

Six to 12 weeks after surgery, the healing process is just about complete, so your calorie and protein needs will not be as high. Continue to focus on eating healthy foods and avoid gaining too much weight. You can work with our transplant nutritionist to develop an eating plan that is right for you, and use the following general information that is relevant to all transplant recipients.

To get the many nutrients your body needs every day, you must eat a variety of foods. Use the following chart to help you choose the right amounts of foods from each of the five food groups: vegetables, fruits, grain products, dairy products, and meats (or meat alternatives).

Food Group Serving Size Suggested Daily Serving
Bread, cereal, rice and pasta 1 slice bread; 1 ounce ready-to-eat cereal; 1/2 cup cooked cereal, rice, or pasta; 1/2 medium potato; 2 to 5 whole-wheat crackers Five to 11 servings
Vegetables 1 cup raw, leafy vegetables; 1/2 cup cooked or chopped raw vegetables; 1/2 cup vegetable juice Three to five servings
Fruit 1 medium apple, banana, or orange; 1/2 cup chopped, cooked, or canned fruit; 1/2 cup unsweetened fruit juice Two to four servings
Milk, yogurt and cheese 1 cup low fat or fat free milk; 2/3 cup yogurt; 1 ounce natural cheese; 2 ounces processed cheese Two to three servings
Meats, poultry, fish, dry beans, eggs and nuts 2 to 3 ounces cooked, lean meat (beef, veal, pork, chicken, turkey, fish) or meat alternative (see below) Two to three servings

Foods that equal one ounce of meat:

  • 1/2 cup cooked dry beans or lentils
  • 1 egg
  • 1 tablespoon peanut butter
  • 1/3 cup nuts
  • 4 ounces firm tofu

Warning: Grapefruit and Herbal Supplements

You should avoid grapefruit and products made with grapefruit because the acidity in grapefruit inhibits the metabolism of certain transplant medications. Also, please speak with your nutritionist or physician before taking any herbal supplements, as they may not be safe and may have potential harmful side effects.

Specific Diet Plans

We offer individual diet plans to help people manage weight loss, control fats and cholesterol, and limit salt and sugar. Also available are diet guidelines for people who must increase or decrease their potassium levels. Getting enough calcium is another key concern for many transplant patients.

Some of diet plans we offer include:

  • Nutritional guidelines for the pre-transplant patient
  • Nutritional guidelines for the post-transplant patient
  • Diet low in saturated fat and cholesterol
  • Diet low in potassium
  • Diet high in potassium
  • Diet low in salt
  • Consistent carbohydrate diet
  • Diet increasing calcium

The transplant nutritionist is available to provide specific diet education based on your individual needs. We encourage you to make an appointment so we can create a healthy eating plan for you.

Contact Information

Transplant Institute
Beth Israel Deaconess Medical Center
Lowry Medical Office Building, 7th Floor
110 Francis Street
Boston, MA 02215