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Problems after surgery

There is a risk of problems or complications after any operation. Find out about the possible problems after your liver transplant.

Many problems are minor but some can be life threatening.Treating them as soon as possible is important.

Excessive bleeding

After a liver transplant it is common to have some bleeding for up to 48 hours after the operation. This is because the liver normally controls blood clotting.

The donor liver is kept extremely cold for a few hours before being transplanted. So it will take time for the liver to warm up and begin to work as it should.

If you lose a lot of blood then you'll need to have a blood transfusion to replace any lost blood. Or you may even need more surgery. But this isn’t the case for most people.


Rejection after a liver transplant can be acute or chronic.

Acute rejection

Acute rejection usually happens in the first 7 to 14 days after a transplant, but can happen even several months later. Your immune system protects your body against infections by recognising foreign bodies, such as bacteria and viruses, and then trying to destroy them. Unfortunately your immune system will see your new liver as foreign and try to destroy it.

To prevent this happening you will need to take anti rejection medicines for the rest of your life. This medication will damp down your immune system so that it won't attack the liver. You will have very detailed instructions of how to look after yourself and which medicines to take when you go home.

The most common anti rejection drugs include:
  • tacrolimus (Prograf)
  • prednisolone or other steroids
  • ciclosporin (Neoral)
  • mycophenolate mofetil (Cellcept)
  • azathioprine

Most people have a combination of these drugs, for example, tacrolimus, azathioprine and prednisolone. One major side effect from all these drugs is that they increase your risk of picking up infections.

Chronic rejection

This is very rare. But it can happen around a year after a transplant. The symptoms of chronic and acute rejection can be the same, but the causes are different. Chronic rejection is caused by a breakdown of liver tissue and bile ducts. It is thought that people who have acute liver rejection that do not respond well to treatment are more at risk of developing chronic rejection. Chronic rejection can be treated with medicines, but sometimes a second liver transplant is necessary. 

Some people don’t have any symptoms at all but their liver function tests are abnormal. If your doctor suspects rejection, you will probably have a liver biopsy to test for it.


    The drugs that prevent liver rejection stop your immune system fighting infections. This gives you a very high risk of developing a serious infection, especially in the first 3 months after your transplant.

    Your dose of anti rejection drugs is decreased after about 3 months. Although you will still be more prone to picking up infections, the risk will then not be as high.

    It is important that you avoid contact with anyone with an infection. This includes people with the common cold.

    Changes to sleeping habits

    Many people who have a liver transplant have sleep disturbances. This is partly because of the stress of your situation. And also because you will spend quite a while in a noisy hospital ward, sleeping in a strange bed. 

    Tell your doctor if you continue to have trouble sleeping.

    Depression and anxiety

    Be prepared for some depression and anxiety. It is very common in people who have had transplants, especially immediately following the operation and for several months after.

    Talk to your doctor or nurses and ask them for help. You may be able to get some counselling to help you and your family through this difficult time. Don't suffer in silence. 

    Last reviewed: 
    02 Aug 2015
    • Hepatocellular carcinoma: ESMO–ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up
      C. Verslype, O. Rosmorduc, P. Rougier,
      Ann Oncol (2012) 23 (suppl 7)

    • EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma
      European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer
      ​April 2012Volume 56, Issue 4, Pages 908–943

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