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Problems after surgery

There’s a risk of problems or complications after any operation. Many problems are minor but some, although usually rare, can be life threatening. Treating them as soon as possible is important. 

Your surgeon will talk to you about the possible complications of the operation and general anaesthetic before you sign the consent form to have the operation. Your doctors and nurses monitor you very closely after the operation to check for problems, and even when you go home they still see you quite often to make sure you are recovering well.

There are some general complications that may happen after any surgery including;

  • infection such as a chest, wound or urine infection
  • blood clots

After a liver transplant some of the possible problems include;

Bleeding

After a liver transplant, it's 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 whilst it's moved from the donor hospital to the transplant centre. So it takes time for the liver to warm up and begin to work as it should.

You can have a blood transfusion if you lose a lot of blood. You might need more surgery, but this isn’t the case for most people.

Kidney problems

There is a risk that your kidneys may stop working properly after the operation. They usually recover over time but you might need dialysis for several weeks afterwards.

Bile leakage

Bile is a fluid that helps to digest food by breaking down fat. The liver makes bile which is stored in the gallbladder. Small tubes called bile ducts carry the bile, and connect the liver and gallbladder to the small bowel. Your gallbladder is removed during the transplant. 

There is a risk of bile leaking from the join between the bile ducts. You may have an ERCP to help your doctor diagnose and fix the problem, or in some cases you may need surgery.

Blockage of blood supply to new liver

There's a small risk that a blood clot may block part of the blood supply to the new liver and stop it from working properly. If this happens you might need more surgery or drugs to thin the blood. And if there has been damage to the new liver you might need another transplant. 

Rejection of the new liver

There is a risk that your body might reject your new liver. Rejection after a liver transplant can be immediate (acute) or long term (chronic).

Acute rejection

Acute rejection usually happens in the first 7 to 14 days after a transplant, but can happen 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 sees your new liver as foreign and will try to fight it.

To prevent this happening you take anti rejection medicines, probably for the rest of your life. This medication weakens your immune system so that it won't attack the liver. Your transplant team will give you very detailed instructions on 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
  • cyclosporin (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. The risk is greatest during the first few months as this is when you have high doses of these drugs. You have regular blood tests while you are taking anti rejection drugs, to make sure you're taking the right amount.

Tell your doctor straight away if you have any symptoms of rejection. These include;

  • a high temperature
  • flu-like symptoms such as chills, aches, tiredness
  • tummy pain or swelling
  • yellowing of the skin and eyes (jaundice)

Treatment is with high dose steroids.

Chronic rejection

Chronic rejection is very rare. But it can happen around a year after a transplant. It is caused by a breakdown of liver tissue and the bile ducts.

Doctors think that people who have acute liver rejection that doesn't respond well to treatment are more at risk of developing chronic rejection. It can be treated with medicines, but sometimes a second liver transplant is necessary. 

The symptoms of chronic and acute rejection are similar. 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 check.

    Infection

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

    It’s important that you avoid anyone with an infection, including those with a cold. Your nurse will tell you about foods you should avoid during this time to reduce the risk of infection such as listeria or salmonella. Foods include;

    • raw fish 
    • uncooked eggs
    • blue veined and soft mould-ripened cheeses such as Brie, Camembert and Stilton
    • unpasteurised yoghurts and milk

    Your dose of anti rejection drugs is decreased after about 3 months. But you will still be more prone to picking up infections than normal.

    Changes to sleeping habits

    Many people who have a liver transplant have trouble sleeping at first. This might be partly because of the stress of your situation. And also because you spend quite a while on a busy hospital ward. If you have any pain, this can also affect how well you sleep.

    Tell your doctor if you are in pain or continue to have trouble sleeping.

    Depression and anxiety

    You might feel anxious or depressed for a time. It's 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.

    Last reviewed: 
    14 Nov 2018
    • Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
      A Vogel and others
      Annals of Oncology, 2018. Volume 29, Supplement 4, Pages 238-255

    • EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
      European Association for the Study of the Liver
      Journal of Hepatology, 2018. Volume 69, Pages 182-236

    • EASL Clinical Practice Guidelines: Liver transplantation
      European Association for the Study of the Liver
      Journal of Hepatology, 2016. Volume 64, Pages 433-485

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