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- Potential complications after liver transplant
can generally be grouped into the following categories.
Problems with the blood vessel connections,
the bile duct connection,
related to medical conditions, or medications.
In addition to this, bleeding is a common occurrence
in liver transplant.
It may occur during the operation
or in the first few days following the transplant
and it may require a return to the operating room
to fix bleeding or remove blood clots.
Liver disease itself makes people
at increased risk for bleeding.
One of the jobs of the liver is to make protein
that helps the blood clot.
It can take the new liver a bit of time
to get back to normal levels of function.
Blood transfusions at the time of transplant
and in the few days after transplant are common.
You may be at more risk for some complications than others
based on your other medical problems
or how ill you are at the time of transplant.
We will review the other types of complications
in more detail.
Blood vessels are tubes
that carry blood throughout the body.
When we make connections between your blood vessels
and the blood vessels of the new liver.
I like to ask people to think of it
like hooking two garden hoses together.
Our goal is to allow blood to flow easily
through the new connection from your body
into the new liver, and then back into your body.
The blood vessels may become narrowed or kinked
due to handling, the new connection, or positioning.
If we have suspicion that the blood vessels
are narrowed or kinked based on tests,
we have several ways we approach this.
Sometimes we use blood thinners to keep the blood
from getting clogged in the narrowed area.
Sometimes, we place a straw or stent through the narrowing
in order to prop it open and allow flow.
On rare occasions, we have to return to the operating room
to redo this connection.
What we want to avoid, or prevent from happening,
is blood cells getting stuck in the narrowing
and leading to clogging or clotting of the blood vessel.
If the blood vessel becomes completely clogged or clotted,
it can cause the liver not to function.
This happens infrequently,
but may require that we perform a new transplant.
Early re-transplantation occurs infrequently,
less than 5% of the time.
Reasons for early re-transplant
include blood vessel complications,
and also a situation termed primary non-function.
Primary non-function is a situation
where in spite of the liver looking acceptable
on paper and in person, and the operation being fine,
the liver does not function appropriately
for reasons that we do not completely understand.
In these situations,
we do a new transplant as soon as possible.
You may get a special status on the waiting list,
placing you at the top of the waiting list.
The bile duct is a tube that carries digestive fluid
from the liver to the intestine.
Complications with the duct include leaking
or narrowing of the connection.
If we have suspicion that there is
a narrowing of this connection,
we do a procedure called an ERCP.
This procedure is similar to an EGD
where we use a video camera to look into your stomach.
However, in an ERCP,
we look further into the area of the intestine,
which is connected to the liver.
In an ERCP, the video camera views into the intestine
and we look for any narrowing
in the connection to the liver.
If there is narrowing, temporary straws,
or tubes, like these blue tubes shown here,
are placed into the duct to stretch the connection.
In six to eight weeks, the procedure is repeated.
If the narrowing persists, the stents are replaced.
If the narrowing has resolved, the stents are removed.
In rare situations, we have to return to the operating room
to fix an area of narrowing.
After liver transplantation, you will take medications
to prevent rejection for the rest of your life.
These medications help protect your body
from attacking the new liver and causing damage to it.
The same cells that are weakened
in order to protect the new liver
are the cells that help protect our bodies from infection
and guard against abnormal appearing cells.
Because of this, these medications increase your risk
of infection and cancer.
The most common cancer
following liver transplant is skin cancer,
so it is important that you use
sun protection after transplant,
and that you see a skin doctor once a year.
There are some lifestyle changes
that go along with transplant that are largely targeted
at decreasing your exposure to infections.
You will learn more about these
during the evaluation process.
Survival following transplant is very good
with the one-year post-transplant survival
being greater than 90%.
Issues during the first year are largely related
to the complications of surgery previously discussed,
as well as infection.
The five-year post-transplant survival is 75 to 85%,
and may be affected by medical problems
you have unrelated to transplant.
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