Good morning! You’re asking a lot of really great questions this morning. I hope I can shed some light on a few of the topics.

First, you’re absolutely right that antibiotics are not discriminatory and will also kill off any good bacteria in our guts. That’s why it’s crucial to take a probiotic a few hours between the doses of antibiotics to restore the normal flora in our guts. It is possible to take antibiotics long term without serious side effects if we keep a good balance of good/bad bacteria.
After 2.5 years on 2 antibiotics I’ve finally been able to stop them. Not once did I have any side gut issues from taking them. I kept up a daily regime of yogurt with live bacteria mixed with ground flax. Kept things healthy and active. So it is doable.

I’d like to help you in the understanding of Immuno-suppressant drugs in relation to a transplant. I did not have a solid organ transplant but needed a bone marrow transplant. (A new immune system) They are similar in some regards because of the medications involved but totally different when it comes to graft vs host issues.
But basically, immuno-suppressants for a transplant patient need to be thought of as Anti-Rejection drugs. They do not and will not cause bacteria in your intestines to die off. They do NOT lower gut bacteria. They are not antibiotics.

They are drugs meant to slow down the reaction/response time in the body’s natural defense system anytime sometime foreign is introduced to the body or in cases when there is an inflammatory disease that needs to have the immune system suppressed to halt the body’s attack on itself.
These are not bacterial cells in the gut. These would be the innate and acquired immune cells of the body found in the immune system.

So, in your case, with an upcoming Liver transplant, at the time of delivery, you will start on an anti-rejection drug. This is to keep your body’s defense system suppressed so that when it recognizes the new liver as a foreign invader, it can’t launch an all out attack on your new liver, thereby rejecting it. You will be on some form of anti-rejection drug for the rest of your life. Your liver is a vital organ and so, that takes precedence over NOT wanting to take the drug. In this case, the immunosuppressant, quite bluntly, is absolutely necessary. No drug, no liver, no life…
Life holds no guarantee and sometimes drugs buy us time!

However, with your being on the immuno-suppressant AKA, anti-rejection med, your entire immune system will not be as robust. That means you’ll be more prone to illness if you let your guard down. If you eat well with the precautions for food prep you’ll learn about prior to transplant, participate in daily exercise like walking, take your meds and use every measure available to avoid Covid by wearing a masks, staying out of crowds, etc. you’re going to be great! I am immuno-compromised and nothing stops me from enjoying the things I love. I’m just super cautious with masking and that means even with friends and family. Every day is a gift with my second chance at life and I refuse to waste a minute worrying.

Quite a few of our members and friends here on Connect have had Livers, hearts, kidneys, and offer a lot of really helpful information. I know you’ve already had conversions with @rosemarya, @athenalee and others. So I hope that with all of us behind you that you’ll start feeling comfortable with taking the immunosuppressants when it’s time.

To answer the questions in the last paragraph, yes, there is always a risk with a transplant. But without it, what life will you have? With a transplant you have the opportunity to have another chance at life. Yes, preexisting conditions can play a factor in how the patient recovers and also the match of the donated organ with the proteins having to be closely related. But that is helped along by the anti-rejection drugs. At transplant when it’s most critical, the drug levels will be higher but will gradually be tapered to a maintenance level. No one likes to take them but it can be a matter of the difference between a happy, healthy, sustainable life and passing away.

Have I helped answer some of your questions? Have any more? 😊

Like you @saundrella, I had many questions (and still have!) about the effect our immunosuppressant meds have on our bodies. But, as I was very close to dying and then was blessed to receive my new awesome liver, I’ll do anything my transplant team says to do in order to keep him happy and healthy.

Shortly after my release from the hospital, I was having sinus pain. I took a homeopathic I’d taken pre-transplant for sinus issues. I had my labs the following week, and my enzymes had shot way up. Lesson learned.

I now understand the metabolism of our drugs and the reason why so many other medications, along with many natural/herbal based remedies, interfere with our medications. Including taking probiotic supplements, as we can develop an overgrowth of good bacteria in our gut biome, which isn’t good.

Since we need our meds to live, the best way to keep a healthy gut biome and body is to eat well; limit unrefined sugars, white flour, and other simple carbohydrates; limit processed food; watch one’s salt; exercise; monitor one’s blood labs; and, always do what your transplant team says!

And, to echo Lori, keep asking questions and discussing here on Connect and with your team. As patients we’ve been through what you’re going through and your team certainly knows what you need to to get you through your surgery and post transplant!