Food Safety After Liver Transplant

Liver Transplant Patients are Vulnerable to Food-borne Illness

Many people with weakened immune systems have a chronic illness of some type, such as cancer, kidney failure, chronic liver disease, diabetes, or AIDS. Liver transplant patients are also at risk because their immune systems are purposely suppressed to prevent donor organ rejection.

Can risks be controlled?

Yes. By following basic rules of food safety, people at risk can help protect themselves whether they eat at home or dine out.

How can I protect myself when I dine out?

The single most important thing to remember when you eat out is never to eat raw foods of animal origin, such as fish, beef (steak tartar), or seafood. Eating raw oysters, for example, can cause serious problems. Raw oysters can harbor a number of harmful organisms, including a particularly deadly bacterium called Vibrio vulnificus. For people with liver disorders, the death rate from eating this bacterium can be as high as 50 percent.

Do not eat undercooked foods of animal origin. This means no rare roast beef or undercooked hamburger. Avoid foods that include raw or undercooked eggs, such as Caesar salad, Hollandaise sauce, some custards, and chocolate mousse. Do not eat soft cheeses, and discard moldy foods.

Foods should be well cooked, and they should be served to you hot – not lukewarm. Cooking foods thoroughly destroys potentially harmful organisms, and not allowing foods to stand longer than two hours at room temperature helps keep them safe.

How can I protect myself at home?

According to the Centers for Disease Control and Prevention, one of the most important causes of food borne illnesses at home is cross-contamination. Cross-contamination occurs when juices or blood from uncooked meat, poultry, or fish comes into contact with other foods by means of cutting boards, utensils, plates, countertops, or hands.

When you cut up raw chicken on your cutting board, place it on a plate, spread it in a bowl, and then put it in the oven, you have created several potential sources of food borne disease:

  • The cutting board
  • The knife
  • The plate
  • The bowl
  • The counter
  • Your hands

All need to be thoroughly washed with hot, soapy water.

What does it mean to cook foods thoroughly?

Meat and poultry should be cooked at an oven temperature of at least 325oF (163oC). Poultry should be cooked to an internal temperature of 180o F (82oC); beef or pork should be cooked to 165oF (74oC). Red meat should be brown or gray inside. Poultry juices should run clear. Fish should flake with a fork. When adding herbs or spices to food, cook them for at least five minutes.

Wild game, such as bear, boar, or deer (venison), should be cooked to the recommended temperature. USDA-grade meat purchased in a store should be cooked to more than medium rare.

Recent data suggest that raw or undercooked eggs may be a significant source of salmonella infection. This is important information for people with weakened immune systems, especially those receiving chemotherapy, since they sometimes turn to soft-cooked eggs as a protein source. Eggs must be thoroughly cooked – both the yolks and whites should be solid – to be safe. Do not eat raw cookie dough or cake batter.

One final note in regard to dairy products: The Institute's transplantation team recommends that immunosuppressed patients drink only pasteurized milk and eat only cheese made from pasteurized milk.

What about food safety when purchasing food?

We recommend that patients and their families:

  • Don't buy foods in damaged containers, such as containers with cracks, dents, or bulging lids.
  • Don't buy cooked seafood.
  • Avoid foods from roadside stands and farmers markets unless regulated by the local health department.
  • Check meat, raw fish, and poultry for freshness by reading "sell-by" dates.
  • Avoid buying luncheon meat and cheese from a deli; it is safer to buy prepackaged meats and cheeses instead.

How can I sanitize food preparation areas?

We recommend that transplant recipient and those who prepare food for them:

  • Wash all surfaces that come in contact with raw meat, fish, and poultry.
  • Use cutting boards that do not get grooves in them.
  • Use separate cutting boards for different meats (such as beef, poultry, and fish).
  • If a dishwashing machine is available, use it instead of hand washing dishes.
  • Wash kitchen towels, cloths, and sponges often.
  • Scrub fruits and vegetables, and peel them whenever possible.
  • If the water source is a well, use bottled water or boil the water for 10 minutes before drinking it.

What about storing and thawing foods?

We recommend that people refrigerate perishables as soon as they get them home from the store. Store meats on a plate on the bottom shelf of refrigerator so that juices do not drip on other foods. If meat, poultry, or fish will not be used within a few days, freeze it immediately. Use an appliance thermometer to make sure that the refrigerator temperature is 40oF (4oC) or lower and freezer temperature is 32oF (0oC) or lower.

Store canned goods in a cool, dry place for not more than one year.

Because bacteria grow quickly at room temperature, thaw food in the refrigerator the night before cooking it or in the microwave just before cooking it.

How should I prepare leftovers?

Cool hot foods as quickly as possible by placing small portions into small, shallow containers. Warm foods can be placed into the refrigerator.

Keep leftovers for no more than three days. Heat leftovers to an internal temperature of 165oF (74oC).

For More Information

If you have more questions about food safety, call the United States Department of Agriculture Meat and Poultry Hotline at 800-535-4555, Monday through Friday from 10 a.m. to 4 p.m., EST. Residents of the Washington, D.C., area may call 202-447-3333. For information about seafood safety, call the Seafood Hotline at 1-800-FDA-4010 or, in the Washington, D.C., area, 202-205-4314.

Learn more about Liver Transplant Safety and Best Practices.