Liver, Kidney, Sickle Cell and Biologic Therapy: Planning Your Operation

Cirrhosis increases surgical risk through impaired clotting, fluid shifts, infection, and poor wound healing. Before any planned operation, your team scores the severity of your liver disease (using the Child-Pugh or MELD score) and involves liver specialists (hepatology) in the decision.

• Elective surgery is also not advised during acute hepatitis, with uncontrolled ascites or encephalopathy, or with severe clotting problems that cannot be corrected.
• Where surgery goes ahead, the team optimizes nutrition, corrects clotting factors and platelets as needed, and controls ascites; minimally invasive techniques are preferred where feasible.
• Abdominal wall and gallbladder operations carry higher risk in liver disease and need particular care.

• If you have hemodialysis, planned surgery is usually scheduled for the day after a dialysis session, when your fluids and salts are best controlled.
• Protect your dialysis access (fistula, graft, or catheter): no blood pressure cuffs, needles, or pressure on that arm. Remind every staff member.
• Your potassium and blood count are checked before surgery; kidney disease commonly causes anemia, which is corrected before major surgery where possible.
• Many medicines — including some antibiotics and pain medicines — need dose changes in kidney disease, and anti-inflammatory painkillers are generally avoided unless your team advises them.
• Fluids during surgery are balanced carefully to avoid both dehydration and overload.
• If you have peritoneal dialysis, the surgical and kidney teams coordinate about pausing exchanges and protecting the catheter.
• If you still pass urine and are not on dialysis, tell the team before any scan with contrast dye, so the risk to your remaining kidney function can be weighed.

• Surgery can trigger a sickle cell crisis or a serious chest complication (acute chest syndrome), so your plan is made with the hematology team.
• For many operations, a straightforward top-up blood transfusion beforehand lowers the risk; research shows it protects as well as the more complex exchange transfusion for most patients. Minor procedures under local anesthesia may not need transfusion at all. The hematology team decides for your operation.
• You will be kept warm, well hydrated, and well oxygenated, with pain well controlled, and you will receive fluids while fasting — all of these reduce the chance of a crisis.
• Because sickle cell disease can reduce spleen function, infection prevention is taken especially seriously.

• Tell the team the exact name of your biologic or arthritis medicine and when your next dose is due.
• Low-dose methotrexate for rheumatic disease is usually continued around surgery.
• Many biologic medicines are paused for one dosing interval before major planned surgery and restarted once the wound is healing well and there is no infection.
• Transplant medicines are never stopped without the transplant team.
• Never stop these medicines yourself: stopping incorrectly can either increase infection risk or make your condition flare. The plan is made with your prescribing specialist.

Is my liver disease too severe for this operation?

Your team will score your liver disease and discuss it with the liver specialists. For more severe disease, they may recommend treating the liver first, or an alternative to surgery.

Can I have my operation on a dialysis day?

Surgery is usually planned for the day after dialysis, when your fluids and salts are best controlled.

Will I need a blood transfusion because of my sickle cell disease?

For some operations, yes, to reduce the risk of a sickle crisis. For smaller procedures, it may not be needed. The hematology team will advise.

Should I stop my biologic injection before surgery?

Possibly, but it depends on the exact medicine and your operation. It is planned with your specialist — please do not stop it yourself.