Possible Liver Transplant Complications

People who receive a liver transplant may develop complications after surgery. Your transplant team will help you understand the warning signs of possible complications, discuss your care, and recommend further treatment when necessary.

Rejection

Rejection is the most common complication following transplant surgery. It happens when the immune system, which defends the body against foreign agents such as viruses or bacteria, treats a transplanted organ as foreign and will try to attack it. To prevent your body from rejecting your new liver, you will take medications called immunosuppressants to suppress the immune response that rejects the foreign tissue.

Infection

As a liver transplant recipient, you will be more susceptible to infection because of immunosuppressant medications. The risk of infection from bacteria and viruses is greatest in the early period after transplant when dosages of medicines are at their highest. That’s why it is important to protect yourself from exposure to infections while in the hospital. Here’s how:
• Anyone entering your room must wash their hands.
• Avoid large crowds of people in the first month after transplant.
• Avoid people with colds or the flu.
• Carefully clean any cuts or scrapes that you receive with anti-bacterial soap (such as Safeguard or Dial) and water.
• Always call the transplant coordinator if you suspect an infection or develop a fever.
• Normal sore throats and ear infections can turn into bigger problems in transplant patients because your immune system is suppressed. Please notify the transplant coordinator of any signs of infection such as fever, shortness of breath, cough, sore throat, fatigue, headache or flu-like symptoms.
• The transplant center does not have a requirement for antibiotic prophylaxis before dental and oral procedures; these medications may be given at the discretion of your treating provider.

Hypertension (High Blood Pressure)

Many transplant recipients take medications to control hyperten- sion or high blood pressure since prednisone and Prograf, two of the medications used to limit rejection, can raise blood pressure. Blood pressure is recorded as a top (systolic) and bottom (diastolic) number. Normal blood pressures range from 100/70 to 130/80. We will provide blood pressure guidelines and will expect you to call us if your blood pressure goes above or below the guidelines. Untreated high blood pressure can eventually damage your heart and other organs.

Renal (Kidney) Dysfunction

Some of the medications that patients are required to take after transplant to prevent rejection can have an adverse effect of the kidney's filtering function. The transplant team will use caution when considering the use of other drugs that can also be toxic to the kidneys in light of the potential adverse effects of the transplant medications.

Hyperlipidemia (High Cholesterol)

Hyperlipidemia can occur early post-transplant due to the effects of cyclosporine and Prograf. Patients may be placed on a cholesterol-lowering medication immediately following transplant for lipid control.

Post-Transplant Diabetes

Some of the immunosuppressant medications that you take may increase the likelihood of you developing diabetes. Diabetes is an increased level of sugar in your blood. Signs of diabetes may include excessive thirst, frequent urination, blurred vision, drowsiness, or confusion. Notify the transplant team if you notice any of these signs.

In some cases, high blood sugar can be reduced and managed by weight loss, careful diet and exercise. However, you may need an oral diabetes drug or insulin injections. If you get diabetes, you will be given special teaching about how to deal with this problem.

Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is a very common virus. About 70% of adults have been exposed to CMV at some time. It usually causes a flu-like illness with fever, general body aches, and a decreased appetite which lasts two or three days. After exposure to the CMV virus, your body forms antibodies in your blood to protect you from future exposures to CMV. This is similar to what happens after you have chicken pox. We are able to do blood tests to check both the transplant recipient and donor for the presence of CMV antibodies.

Because of the immunosuppressant medications, you will be at risk for infection with CMV after transplant. During the first few months, while the immunosuppressant doses are highest and your immune system is especially weak, the CMV virus can “reactivate” or “wake up”. A CMV infection can range from flu-like symptoms to more serious infections involving your stomach and lungs (pneumonia).

If either your or your donor were positive for CMV antibodies you will be given antiviral medications for the first few months after transplant. As your doses of immunosuppressants are lowered over time, your risk of CMV will decrease as well and the medication will be stopped. If you develop an active CMV infection again, you will be treated with medications in the vein.

Diseases from the Donor Organ

Donor organs are screened for various diseases in accordance with standards required by the United States Department of Health and Human Services – Centers for Disease Control (CDC) and the United Network for Organ Sharing (UNOS). However, transplant recipients may be at risk of contracting certain diseases from the organ donor, such as various types of infectious diseases and cancers, which are not detected during the organ screening process.