After your liver surgery

All types of surgery have potential side effects. The possible side effects after having a liver transplant include

• Excessive bleeding
• Rejection
• Infection
• Changes in your sleeping habits
• Depression and anxiety

Do bear in mind that if you haven’t had any major problems in the year following your transplant, then it is very unlikely that you will.

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. It has been 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 will 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. Fewer than 1 in 20 (5%) people need blood transfusions and fewer than 1 in 30 (3%) need to have more surgery.

Rejection

Rejection after a liver transplant can be acute or chronic.

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 medications 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 are

• Tacrolimus (Prograf)
• Azathioprine
• Prednisolone or other steroids
• Cyclosporin (Neoral)
• Mycophenolate mofetil (Cellcept)

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. Even though you are taking anti-rejection drugs, it is still possible to develop some acute rejection of your new liver in the first few weeks after your operation. If your new liver is being rejected you may have the following symptoms

• Fever
• Tiredness
• Breathlessness
• Yellow looking skin and eyes (jaundice)
• Feeling itchy

This will happen in about 6 out of 10 people (60%). Between 4 and 6 out of 10 people (40 to 60%) recover well from this after a course of high dose steroids. Usual treatment for acute rejection is to increase your anti-rejection and steroid medications.

Chronic rejection 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.

If you would like to read more about the immune system there is more information in the about cancer section of CancerHelp UK.

Infection

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 in your 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.  If you continue to have trouble sleeping let your doctor know.

Depression and anxiety

Be prepared for some depression and anxiety. This is very common in people who have had transplants, especially immediately following the operation and for several months after. If this happens, talk to your doctor or nurses. Ask for help. You may be able to get some counselling to help you and your family through this difficult time.

Look in the help and support section for organisations that can put you in touch with a support group. They can help you find counsellors in your area.

When it is time for you to go home you are likely to feel a bit anxious and may even feel that you’d rather stay where you are. This is very natural. It is very important that you take it easy for some weeks after you get home. Your body has still not recovered completely and you are still at a high risk of picking up an infection. 

Before you leave the hospital, the staff will spend time preparing you. They will talk with you about your medicines and side effects, how often you will have follow up appointments, and what to expect in the first year after your transplant. Initially you will see your doctors weekly to check that all is going well. You will see them less often as time goes on.

When you go home, there are some important things to keep in mind

• Stay away from people who are ill, including people who have colds
• Stay away from crowds, especially where there is poor ventilation
• Wash your hands often
• Make sure any meat you eat is cooked thoroughly
• Know the signs of infection including fever, a sore throat, or just generally not feeling well
• Tell your doctor if you have a white coating on your tongue or spots in your throat-this may be caused by an infection called thrush
• Women can also develop vaginal thrush so do let your doctor know if you have itching or discomfort
• Always take your medicines at the times scheduled, it is important not to miss any!
• Ask your doctor or pharmacist if any of the medicines you take should be stored in the refrigerator
• Talk to your doctor or transplant nurse about any new medicines or vitamins before you start taking them

Once they’ve started to recover from their operation, some people want to contact the family of the person whose liver they received. They want to say thank you for the chance they’ve been given and for the generosity of the family in allowing the liver to be a donated organ. This is perfectly acceptable as long as the contact is anonymous. It is usual for the transplant coordinator to help you write to the donor’s family. Usually this happens several weeks or months after the transplant. So if you are interested in doing this, ask your transplant coordinator about it.