We want to inform you about some important points to our valuable patients who started a new life after liver transplantation.

Can liver transplant patients get a COVID-19 vaccine? Are vaccines effective in patients with liver transplantation?

The British Association of Gastroenterology (BSG) and the British Association for the Study of the Liver (BASL) have recommended to patients with liver transplant, chronic liver disease, and autoimmune hepatitis any COVID vaccine available in their countries

However, we do not have enough data on whether the protective effects of vaccines are at the same level in transplant patients as in healthy people. Although transplant patients are vaccinated according to the plan in their country, so that they stay safe and sound during pandemic, they should also obey rules: wearing the mask, keeping the social distance, and frequent hand washing.

Which vaccine (s) are more effective in liver transplant patients?

In accordance with the decisions made by the health authority of each country, countries have begun to reach different vaccines available on the world market. Pfizer/BioNTech and Oxford/AstraZeneca vaccines are effective vaccines. To date, comparing the results of studies conducted on the efficacy of these vaccines is inappropriate due to the difference in the methods of study. Although vaccine efficacy is not already possible to compare, all vaccines are effective and safe against COVID-19 infection. 1

Do COVID-19 vaccines have side effects? What are the side effects?

As with all methods of treatment, vaccines may have some side effects. During the approval process, along with efficacy, vaccine safety is investigated and the side effect profile is also defined. The safety study of Pfizer/BioNTech COVID vaccine was conducted over 43000 people. 1 Some of the side effects that have been detected are:

  • Pain at the injection site,
  • Feeling tiredness,
  • Headache,
  • Feeling achy,
  • Feeling or being sick.

If you experience side effects other than these, please contact a healthcare unit.

What should I eat after the liver transplant?

During the long period of illness, you have had decreased appetite, and, perhaps, you have lost a lot of weight. A regular, healthy and balanced diet program in your new life will accelerate your recovery. Because of the corticosteroid you are using, your appetite will be more than normal. In addition, you need to pay attention to some points in your nutrition.

  • Have a low fat, low-carbohydrate content diet. It is important that your diet program includes fresh vegetables and fruits, cereals, skimmed milk and dairy products, lean protein sources (red meat, fish).
  • You should check your body weight every day. Because your appetite is increased, eating too much between meals and/or junk food leads to weight gain. When you feel hungry between meals, better prefer water (or liquid) rather than having snacks. If you still feel hungry, then consume fresh fruits or vegetables after peeling.
  • Avoid salt consumption. As long as you take corticosteroid treatment, your body will have a tendency for water retention. Daily control of body weight is important in this respect. You will get used to prepare your dishes and foods without salt over time.
  • Avoid raw vegetables, moldy dairy products.
  • Avoid packaged foods.

When can I start my normal sex life after liver transplantation?

A few months after the transplant, you can start your normal sexual life. 2 Most men have sexual desire after a few months, and women begin regular menstruation after a few months after the transplant. There is no problem with skin contact unless you and your partner have influenza, herpes or other upper respiratory tract or sexually transmitted diseases. 2 If these situations exist, please contact our transplant team.

  • Before and after sexual intercourse, both your partner and you should take a shower with soap and water. 2
  • Some of the immunosuppressive drugs taken can reduce the effectiveness of contraceptive drugs. Therefore, the safest method of contraception is the use of condoms. Couples can contact our transplant team or a specialist in Obstetrics & Gynecology to learn about the most effective and appropriate method of contraception for themselves. 2
  • We advise our female patients to wait for 1-2 years to have a baby.


* Patient Information Booklet after Liver Transplantationat or from the contact number to answers to your questions you can reach by contacting us.


  1. British Liver Trust. Update for people with liver disease on the Covid-19 vaccine – British Liver Trust. Last accessed 09.02.2021.
  2. Group Florence Nightingale Hospitals. Liver Transplantation Center. A Handbook for Patients.

In the last one-year experience in COVID-19, we have learned that the disease may present itself in different clinical pictures. In rough speaking, acute illness lasts about 3 weeks. Chronic type lasts for up to 12 weeks.

Lately, the National Institute for Health and Care Excellence (NICE) defines long COVID as disease effects lasting for more than 12 weeks. Nearly 10% of patients with positive PCR for COVID do not recover after 3 weeks, and a smaller proportion for months.

Why do some people develop long COVID?

It is not known why some people recover late from COVID.

Scientists believe that;

  • Persistent viremia due to weak or absent antibody response,
  • Relapse or reinfection,
  • Inflammatory and other immune reactions,
  • Diminished physical strength and function,
  • Mental factors such as post-traumatic stress, may all contribute.

Moreover, long term respiratory, musculoskeletal, and neuropsychiatric sequelae may be observed in long COVID.

Are symptoms different in long COVID?

Symptoms of long COVID vary widely. Researchers divide the symptoms into two main groups as ones related to respiratory system (including headache and fatigue), and symptoms related to different parts of the body (i.e. heart, brain).

The most commonly reported symptoms are:

  • Fatigue
  • Shortness of breath (dyspnea),
  • Cough,
  • Joint pains,
  • Chest pain,
  • Depression,
  • Muscle pain,
  • Low-grade fever,
  • Digestive system (gastrointestinal) problems,
  • Headache,
  • Metabolic disruptions (i.e. poor control of diabetes),
  • Thromboembolic conditions,
  • Brain fog (it presents with confusion, difficulty in concentration and inability to express thoughts),
  • Skin rashes in various forms (i.e. vesicular, maculopapular),
  • Loss of smell is a very well-known, and long lasting symptom.

Another feature of long COVID is that some patients report that their symptoms have come back after recovery. When compared with short COVID, the recurrence rate is twice.

Are there any risk factors for long COVID?

Recently, a research group from the United Kingdom, the United States of America, and Sweden have conducted a self-reported study to define risk factors for developing long COVID by using a mobile application. It is shown that there is a clear link between having asthma and long COVID development.

Other predictive characteristics of patients for developing long COVID are:

  • Old age (>70 years),
  • Female gender,
  • Presence of five or more symptoms at the onset of the disease,
  • High body mass index (obesity),
  • Having diabetes or hypertension,
  • Having depression,
  • Severe acute COVID infection,

These characteristics are drawn as predictors from studies with limited sample size, and may be considered as preliminary findings. For more concrete definitions, further clinical studies with larger sample sizes should be performed.

How long does it take to recover from long COVID?

There is no definite time frame for recovery from long COVID; it may vary from person to person. Leicester researchers have reported that seven out of ten hospitalized patients with COVID-19 not fully recovered 5 months after the discharge.

The findings have once again supported that long COVID is a multisystem disease, because some signs related to autoimmunity, systemic inflammation, mental and neurological health problems are determined in post-hospitalization survivors.

Can children develop long COVID?

The Office for National Statistics (ONS) has published data of 9063 respondents of all ages from the UK Coronavirus Infection Survey. The survey is conducted to investigate ratio of COVID patients with elongated symptoms more than five weeks. The “estimates” have suggested that 13% of children between 2 and 11 years, 14.5% of children between 12 and 16 years have complaints including fatigue, cough, headache, muscle pains, loss of taste or smell still after 5 weeks of the diagnosis. Despite the limited data, it is clear that some children may also have long COVID.

Some recommendations for managing your symptoms at home

For fatigue and breathlessness

  • Do not over exert yourself: Carefully plan what you will do during the day
  • Break tasks into small pieces, so that when you sum up, the task will be completed.
  • Do some easy and some harder activities alternatively. Have some rest between them.
  • Plan your day according to your energy level.
  • Frequent resting is better than a few longer ones. Do not let yourself become exhausted.
  • If you feel breathless while doing something, rest for a while. Then go on the activity again. If you stop using your muscles, they will get weaker, and this will cause more problem in breathing. You must use your muscles.
  • Level of daily activity/exercise should be increased slowly and gradually i.e. short walks, simple strength exercises.

For mood and mental health

  • Be aware that some days may be worse during healing. Be prepared mentally and try to be kind to yourself.
  • Even you are isolated you can get in touch with family and close friends by phone. This will boost your mood.
  • Have a daily plan. This will help you develop the sense of stability.
  • Stay active (as far as possible of course) at home. When your body moves, then endorphins will be released more. Endorphines are known as “hormones of happiness).”

For memory and effective thinking

  • Make notes to remember i.e. your daily plan, medical appointments
  • Try to reduce distractions. A quiet environment may help you to be more concentrated.
  • A clear plan divided into steps will always be easier for you to apply and follow.

For joint or muscle pains

  • Flexibility exercises i.e. stretches, yoga, tai chi,
  • Strength exercises i.e. climbing stairs, lifting weights, working with resistance bands, may help for joint and muscle pains.
  • If you plan to have an exercise program, you should consult it with your doctor in the first place.



  1. BMJ 2020;370:m3026 | doi: 10.1136/bmj.m3026. Last access 8.4.
  2. Last access 8.4.2021.
  3. Last access 8.4.2021.
  4. Last access date4.2021.
  5. Last access date 12.4.2021.

On November 18, 2020; the second virtual meeting of “Webinar Series by Experts” has been performed about “Autologous Stem Cell Transplantation in Covid-19 Era”. Founding Director of Hematopoietic Stem Cell Transplant (HSCT) Center at the Group Florence Nightingale Hospitals, Prof. Mutlu Arat, M.D. has mentioned about pitfalls in pre-transplant procedures, and GVHD management bone marrow transplantation in Covid-19 era. During panel section, he has explained principles how to overcome challenging conditions.

We are delighted to have a total of 61 attendees from Azerbaijan, Russia, Georgia, Kazakhstan, Ukraine, Algeria, and Mongolia. We look forward to sharing experiences with our colleagues in new topics again!

You can reach webinar recording at

and direct further questions at [email protected]


On December 9, 2020; the third virtual meeting of “Webinar Series by Experts” has been performed about “Allogeneic Stem Cell Transplantation in Covid-19 Era”. Founding Director of Hematopoietic Stem Cell Transplant (HSCT) Center at the Group Florence Nightingale Hospitals, Prof. Mutlu Arat, M.D. has mentioned about pitfalls in pre-transplant procedures, and GVHD management bone marrow transplantation in Covid-19 era. During panel section, he has explained principles about how to overcome challenging conditions.

We are delighted to have a total of 48 attendees from Azerbaijan, Russia, Georgia, Kazakhstan, Ukraine, Mongolia, and Uzbekistan. We look forward to sharing experiences with our colleagues in new topics again!

You can direct further questions at [email protected]


In our Breast Health Center, breast cancer, breast disease treatment and breast conserving surgery have been applied with a multidisciplinary approach since 1992, sentinel lymph node biopsy after 1996 and oncoplastic breast surgery method for the last 10 years

Our specialist physicians have been working in scientific cooperation with; AAMC Breast Center Breast Center, the Breast Health Global Initiative, the Senologic International Society, World Society of Breast Health, Turkey Breast Diseases Association Federation and Turkey’s first fixed Breast Health established the Screening Center for Breast Health Association (memeder)
Early diagnosis and effective treatment can be provided with advanced devices in our breast health center.

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Group Florence Nightingale Hospitals Ltd UK 2020, all rights reserved.

Group Florence Nightingale Hospitals Ltd UK 2020, all rights reserved.