Liver Transplant Complications
Examing a Liver Transplant Patient
Liver Rejection | Infection | Lung Problems l Kidney Problems l Biliary Problems l Primary Non-function l Thrombosis l Bleeding
Complications may occur during a child's critical recovery period from a liver transplant.
Liver Rejection
Because your child has a transplanted liver, the body recognizes the liver is not its own. The body naturally wants to get rid of, or reject, the new liver. Your child will be given medications to help prevent a rejection. However, approximately 60 percent of liver transplant patients experience some level of rejection. Usually, medications control this rejection. In rare cases of severe and untreatable rejection, re-transplantation is required.
Signs of Rejection
Even with the anti-rejection drugs, called immunosuppressants, many patients have at least one episode of rejection while they are recovering from their surgery. Such an episode can occur at any time, but is most common during the first six months following surgery.
Therefore, it is important to recognize signs of rejection, including fatigue or a temperature greater than 101 degrees F (38.3 degrees C). Other signs can only be measured by regular blood tests, and include tenderness over the liver and an increase in liver function levels. Having one of these signs does not necessarily mean that rejection is occurring, but it is important to notify your liver transplant coordinator and / or primary care physician if these symptoms occur.
Rejection Treatment
In the event that rejection is suspected, your child will undergo a liver biopsy to confirm rejection. Rejection may be mild to serious. If the doctor determines that the body is rejecting the new liver, your child's present medications will need to be changed.
In most cases, your child is hospitalized for three to five days to have an initial treatment of the rejection. Adjusting the dosages of the medicines your child is taking or adding intravenous medicines when in the hospital usually can control the rejection. Repeat biopsies often are needed to assure that the rejection is over following treatment.
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Infection After Liver Transplantation
Infection is a threat to every transplant patient. Rejection medications help the new liver, but they make it harder for the body to fight infection. Cytomegalovirus (CMV) is one virus that commonly causes infection. CMV infection may cause flu-like illness or even no symptoms.
The Liver Care Team at Cincinnati Children's will prescribe many medications to help your child avoid infection. You can do your part by faithfully washing your hands every time you enter and leave your child's room and ensuring that visitors and health care professionals do the same. Hand washing is the most effective way to prevent the spread of infection.
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Lung Problems
Two things can cause small areas of the lung to collapse (atelectasis): the medication used to help your child sleep during surgery, and the long period of bed rest after the operation. In addition, the area where the surgeons operate is near the right lung. If your child is old enough to follow instructions and is breathing on his or her own, encourage your child to take deep breaths and to cough. This helps move air deep into the lungs and prevent pneumonia.
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Kidney Problems
Some patients experience kidney problems after surgery. These conditions are usually reversible. In rare instances, dialysis (an artificial kidney machine) is needed until the kidneys start working again.
Biliary Problems
Some children have problems related to the bile duct and need to have drains placed and tests performed to make sure the bile ducts are working properly.
Primary Non-function
When the liver is removed from the donor, it is placed in ice. Despite the care and precautions we take pre-transplant, there are times when the new liver does not "wake-up" after surgery. This is called primary non-function. If this occurs, your child will need to be re-transplanted immediately.
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Hepatic Artery Thrombosis / Portal Vein Thrombosis
HAT is Hepatic Artery Thrombosis, and PVT is Portal Vein Thrombosis. At times, the hepatic artery or the portal vein (vessels that supply blood to the liver) clot (thrombose) immediately after surgery. A Doppler ultrasound is performed daily for five days after surgery to check blood flow in these vessels. If the ultrasound detects a clot, your child will return to the operating room to have the clot removed. If the clot is detected quickly, it usually can be removed from the artery or vein. If the clot cannot be removed, your child may need re-transplantation.
Bleeding
Bleeding is a common postoperative complication associated with any operation, especially liver transplantation. Sometimes additional operations are required to stop heavy bleeding.
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Written 5/03, rev. 6/07
