Complications of liver transplant

Complications of a liver transplant can include rejection, an increased risk of infection, graft failure, biliary conditionsand a higher riskof developing certain conditions including some types of cancer.

Liver rejection

In up to one in every three people, the immune system attacks the new liver and stops it from working properly. This is known as rejection and it usually occurs in the weeks or months after a transplant.

Rejection can occur without causing any specific symptoms, although possible signs can include:

• a high temperature (fever)
• vomiting
• Traveller's diarrhoea
• a lack of energy
• abdominal (tummy) pain
• yellow skin and yellowing of the whites of the eyes ( jaundice )
• pale stools, dark urine and itchy skin

In most cases, rejectioncan be successfully managed by altering your dose of immunosuppressant medication.

Infections

As immunosuppressant medication weakens your immune system, they can make youmore vulnerable to infection.

Do what you can to reduce your risk of picking up infections. As a precaution, you may be given a course ofantiviral medication, antibiotics and/or antifungal medication for a few months after your transplant, to reduce your risk of picking up infections.

If you think you may have an infection, contact your GP or transplant centre for advice. Prompt treatment may be required to prevent serious complications.

Common symptoms of infection include a fever, headaches , aching muscles and diarrhoea.

Biliary conditions

After a liver transplant, more than one in every 10 people experience a problem affecting theirbiliary tract,such asa bile leakor an obstruction caused by scar tissue in the bile ducts.

If you have a bile leak, the bile may need to be removed from the abdomen by inserting a drainage tube.

Obstructions in thebile ducts can oftenbetreatedwith an endoscopy where ashort tube called a stent is inserted toallow bile to flow more freely although further surgery may be needed.

Kidney failure

Kidney failureaffects up to one in every three people with a liver transplant, usually as a side effect of taking immunosuppressant medication.

Kidney failurehappens when thekidneys lose their function and are no longerable to filter out waste products from the blood.

Symptoms of kidney failure can include:

• tiredness
• swollen ankles, feet or hands
• shortness of breath
• feeling sick
• blood in yoururine

Your doctors will closely monitor your kidney function and the level of immunosuppressant medication in your blood during your follow-up appointments to detect potential kidney problems.

If your kidneys do fail, you will need to have dialysis (where a machine is used to replicate kidney function) or a kidney transplant .

Graft failure

Graft failure is a medical term meaning that the transplanted organ is not working properly. It's one of the most serious complications of a liver transplant andoccursin around one in every 10 people.

The most common cause isa disruption to the blood supply to the transplanted liver, caused by blood clots (thrombosis ).

Graft failure can develop suddenly, or slowly over a longer period of time. Symptoms can include jaundice, fluid retention (oedema), mental changes and a swollen tummy.

Medication can stabilise the body in the short term, but the only cure is to transplant a new liver into the body as soon as possible.

Cancer

People with a transplanted liver have an increased risk of developing some types of cancers, such as:

• non-melanoma skin cancer
• melanoma skin cancer
• cervical cancer

There is also around a one in 50 chance of developing a type of cancer that affects the white blood cells in people who have had an organ transplant known as post-transplant lymphoproliferative disorder (PTLD).

Due to the risk of these conditions, it's important to attend all of your follow-up appointments and any cancer screening tests you're invited to. You should alsoavoid prolonged exposure to sunlight or artificial forms of ultraviolet light, such as sunbeds or sun lamps.