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Digestive Health

What complications can result from a liver transplant?

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  • Whether it is from a deceased or living donor, a liver transplant is a demanding and complex surgery with the potential for serious, life-threatening complications. Before you or your child have a transplant, you should be fully aware of the risks like:
    • Biliary Leaks – Patients with reduced size liver grafts are at a greater risk for developing a biliary leak or stricture. The complication is related to inadequate blood supply to the biliary anastomosis (surgical connection) or a technical difficulty because of the small structures. Prompt attention is required with surgical re-exploration. Obstructions are managed with transhepatic stenting, to improve flow.
    • Hepatic Artery Thrombosis – is a serious complication wherein the hepatic artery, which is attached to the new liver’s artery, narrows or a blood clot forms. Correction requires surgical intervention.
    • Rejection – is the most common post-transplant complication and can often be managed. The first episode of rejection usually occurs about seven to 10 days after transplant, but can happen months later. The classic signs include a fever (temperature greater than 38.5C or 101F), elevation of the AST and ALT liver enzymes, dark urine or clay colored stools, loss of appetite, jaundice and/or pain over the graft. If rejection is confirmed, most patients receive large doses of steroids, but occasionally stronger medicine is required.
    • Infection – The same medications that prevent rejection also decrease the body’s ability to fight infection. As a result, care must be taken to limit exposure to infections such as colds or the flu. Common viral infections include CMV (cytomegalovirus), herpes and fungal infections such as candida. After transplantation, you are at increased risk for a number of bacterial infections, as well. Antibiotics are routinely given post-operatively to prevent a bacterial infection.
    • Post-Transplant Lymphoproliferative Disorders (PTLD) – occur when immuno-fighting “T” cells are suppressed because of anti-rejection medicines, and the “B” cells grow uninhibited. The body cannot effectively fight a viral infection like the Epstein-Barr Virus (EBV), which attacks B cells and causes their overproduction. In this case, the amount of immunosuppression medication is usually reduced to allow the immune system to recover and fight the overproduction of B cells. The usual signs and symptoms include fever, malaise, lymph node enlargement and liver and spleen enlargement.
  • Complications from liver transplant including bleeding requiring a blood transfusion or re-operation, bile leaks or strictures, infections, rejection and hernias. The most serious complication is when the new transplanted liver does not work and the patient requires immediate re-transplantation. Overall, more than half of patients undergoing liver transplantation will have some complication but most people will recover well. Thus the overall 1 year survival after transplantation approaches 90%.
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