Problems after a transplant for liver cancer

There is a risk of problems or complications after any operation. Many problems are minor. But rarely, some problems can be life threatening. Treating these as soon as possible is important. 

Your surgeon will talk to you about the possible complications of the operation and general anaesthetic before you sign the consent form to have the operation. Your doctors and nurses monitor you very closely after the operation to check for problems. Even when you go home they still see you often to make sure you are recovering well.

There are some general complications that may happen after any surgery including;

• infection such as a chest, wound or urine infection
• blood clots

Bleeding

After a liver transplant, it's common to have some bleeding for up to 48 hours after the operation. This is because the liver normally controls blood clotting.

The donor liver is kept extremely cold whilst it's moved from the donor hospital to the transplant centre. So it takes time for the liver to warm up and begin to work as it should.

You can have a blood transfusion if you lose a lot of blood. You might need more surgery, but this isn’t the case for most people.

Kidney problems

There is a risk that your kidneys may stop working properly after the operation. They usually recover over time. But you might need dialysis for several weeks afterwards.

Bile leakage

Bile is a fluid that helps to digest food by breaking down fat. The liver makes bile which is stored in the gallbladder. Small tubes called bile ducts carry the bile, and connect the liver and gallbladder to the small bowel. Your gallbladder is removed during the transplant. 

There is a risk of bile leaking from the join between the bile ducts. You may have a test called an ERCP to help your doctor diagnose and fix the problem. Or in some cases you may need surgery.

Blockage of blood supply to new liver

There is a small risk that a blood clot may block part of the blood supply to the new liver and stop it from working properly. If this happens you might need more surgery or drugs to thin the blood. And if there has been damage to the new liver you might need another transplant. 

Rejection of the new liver

There is a risk that your body might reject your new liver.

Your immune system protects your body against infections by recognising foreign bodies, such as bacteria and viruses. It tries to destroy them. Unfortunately, your immune system sees your new liver as foreign and will try to fight it.

To prevent this happening you take anti rejection medicines, usually for the rest of your life. This medication weakens your immune system so that it won't attack the liver. Your transplant team will explain how to take these medicines and how to look after yourself when you go home. You have regular blood tests while you are taking anti rejection drugs, to make sure you're taking the right amount.

Symptoms of rejection

The symptoms of rejection include;

• a high temperature
• flu-like symptoms such as chills, aches, tiredness
• tummy pain or swelling
• yellowing of the skin and eyes (jaundice)

Tell your doctor straight away if you have any symptoms of rejection. 

Rejection after a liver transplant can be immediate (acute) or long term (chronic).

Acute rejection

Acute rejection usually happens in the first 7 to 14 days after a transplant. But it can happen several months later.

Treatment is with high dose steroids.

Chronic rejection

Chronic rejection is very rare. But it can happen around a year after a transplant. It is caused by a breakdown of liver tissue and the bile ducts.

Doctors think that people who have acute liver rejection that doesn't respond well to treatment are more at risk of developing chronic rejection. Chronic rejection can be treated with medicines. But sometimes a second liver transplant is necessary. 

The symptoms of chronic and acute rejection are similar. Some people don’t have any symptoms at all. Blood tests (liver function tests) might show your liver is not working properly. If your doctor suspects rejection, you will probably have a liver biopsy to check.

Infection

The drugs that prevent liver rejection stop your immune system fighting infections. This gives you a high risk of developing a serious infection, especially in the first 3 months after your transplant.

It is important to avoid anyone with an infection, including those with a cold. Avoiding some foods can reduce the risk of infection such as listeria or salmonella. This is particularly the case in the first few months after your transplant.

Your transplant team can give you more information about this.

Your dose of anti rejection drugs is lowered after about 3 months. But you still have a higher risk of getting an infection than normal.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery. This is because you might not move about as much as usual. Clots can block the normal flow of blood through the body. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs. This causes a blockage in the lung called a pulmonary embolism. Symptoms include:

• shortness of breath
• chest pain
• coughing up blood
• feeling dizzy or light headed

If you have any symptoms of a blood clot when you are at home, see your GP or go to your nearest accident and emergency department (A&E).

To try to prevent blood clots you wear compression stockings after surgery. You also have daily injections for several weeks to thin your blood. And your nurses will encourage you to get up as soon as possible or do regular leg exercises. 

Changes to sleeping habits

Many people who have a liver transplant have trouble sleeping at first. This might be partly because of the stress of your situation. And because you spend quite a while on a busy hospital ward. If you have any pain, this can also affect how well you sleep.

Tell your doctor if you are in pain or continue to have trouble sleeping.

Depression and anxiety

You might feel anxious or depressed for a time. It's very common in people who have had transplants, especially straight after the operation and for several months afterwards.

Talk to your doctor or nurses and ask them for help. You may be able to get some counselling to help you and your family through this difficult time.