Liver Transplant Center

Complications after a Liver Transplant

A pediatric liver transplant is a major, complex surgical procedure. Although the liver care team at Cincinnati Children’s is very experienced at managing the risks of transplant surgery, there are complications that can occur after the procedure. Some are not severe, while others may require follow-up treatment.

Potential Complications

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Liver Rejection

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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. The transplant physicians will prescribe medications to help prevent a rejection. However, approximately 50 percent of patients experience some level of rejection in the first year following transplant.

Your child’s physician will watch for liver rejection by measuring liver enzyme levels in routine blood work; elevated levels are often the only symptom of rejection. If your child’s physician suspects rejection, the liver care team will conduct a liver biopsy. If the doctor determines that the body is rejecting the new liver, your child's medications will need to be adjusted.

In most cases, treatment of rejection requires that your child be hospitalized for five to seven days. The doctor may repeat the liver biopsy to ensure that the rejection has been controlled. Usually, medications control rejection. In rare cases of severe and untreatable rejection, doctors may need to perform a new transplant.

Infection after Liver Transplantation

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Infection is a threat to every transplant patient. Rejection medications help the body accept the new liver, but they make it harder to fight infections. 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 do the same. Hand washing is the most effective way to prevent the spread of infection.

Kidney Problems

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Some transplant patients experience kidney problems after surgery, but these conditions are usually reversible. In rare instances, dialysis (an artificial kidney machine) is needed until the kidneys start working again.

Biliary Problems

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Some children have problems related to the bile duct, which allows bile to move in and out of the liver. In some cases, patients need to have drains placed and tests performed to make sure the bile ducts are working properly.

Primary Nonfunction

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When the liver is removed from the donor, it is placed in ice. Despite the care and precautions we take before the transplant, there are times when the new liver does not "wake-up" after surgery. This is called primary nonfunction. If this occurs, your child will need to be re-transplanted immediately.

Thrombosis

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At times, the hepatic artery or the portal vein (the vessels that supply blood to the liver), clot (thrombose) immediately after surgery. An ultrasound is performed daily for five days after surgery. If the doctor detects a clot, the team will surgically remove it. If the clot is detected quickly, it usually can be removed from the artery or vein. If the clot cannot be removed, doctors may need to perform a re-transplant.

Bleeding

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Bleeding is a common complication in any operation, especially liver transplantation. Doctors may need to perform an additional operation to control heavy bleeding.