Liver transplant - Complications of liver transplant
- Introduction
- Why a liver transplant is needed
- Who can use a liver transplant
- Waiting for a liver transplant
- How it is performed
- Recovery
- Complications of liver transplant
- 'Every day was a bonus'
- 'The operation changed my whole life'
- Results
Complications of a liver transplant can include rejection, an increased risk of infection, graft failure, biliary conditions and a higher risk of developing certain conditions, such as diabetes.
Liver rejection
It is common for the immune system to attack the new liver. This occurs in up to 40% of cases, typically in the first 7-14 days after the transplant.
Symptoms of liver rejection include:
- a high temperature of 38ºC (100.4ºF) or above
- vomiting
- diarrhoea
- yellow skin and yellowing of the whites of the eyes (jaundice)
- pale stools
- dark urine
- itchy skin
Most cases can be successfully managed by altering your dose of immunosuppressants.
Infection
Immunosuppressants make you more vulnerable to infection. You will be particularly vulnerable to:
- fungal infections
- cytomegalovirus (CMV) infection – a common virus that is part of the herpes family of viruses
Fungal infections
Aspergillosis and thrush (candidiasis) are fungal infections that commonly affect people after a liver transplant.
As a precaution, you will usually be given a course of antifungal medication, such as fluconazole, to take for several months after your transplant.
Symptoms of these types of fungal infection will depend on what part of your body is affected, but may include:
- scaling and redness of the skin
- itchiness
- in cases of vaginal infection, a discharge of a thick, white fluid from the vagina
More serious fungal infections can also develop inside your body, such as in the lungs (fungal pneumonia) or bloodstream.
Symptoms include:
- a high temperature of 38ºC (100.4ºF) or above
- shortness of breath
- dizziness
- chest pain
- a change in mental behaviour, such as confusion or disorientation
The symptoms of even a minor infection can rapidly get worse and can lead to fatal complications if you are taking immunosuppressants. You should see your GP or transplant team as soon as possible if you notice the symptoms of a fungal infection.
Cytomegalovirus (CMV) infection
As a precaution against cytomegalovirus (CMV), you may be given a course of antiviral medication to take for several months after your transplant.
Symptoms of a CMV infection include:
- a high temperature
- shortness of breath
- loss of appetite
- the appearance of large, painful ulcers in your mouth
- joint pain
- visual problems, such as blind spots, blurring and floaters (dark shapes that appear to be floating in your field of vision)
Contact your GP or transplant centre as soon as possible if you think you have a CMV infection.
Biliary conditions
After a liver transplant, there is a risk of conditions that affect the biliary tract, including:
- a bile leak
- scar tissue causing an obstruction
These can usually be treated with an endoscopy. A short, wire-mesh tube called a stent can be inserted to allow bile to flow more freely. In some cases, further surgery is needed.
Diabetes
Type 2 diabetes is a common and potentially serious complication of a liver transplant. It affects an estimated one in five people.
Symptoms of diabetes include:
- feeling very thirsty
- going to the toilet a lot, especially at night
- extreme tiredness
- weight loss and loss of muscle bulk
Exactly why liver transplant patients have an increased risk of developing diabetes is unclear. But more than half of all cases of diabetes that develop after a liver transplant are in people with a history of hepatitis C.
Kidney failure
Kidney failure is another common and serious complication that affects one in five people with a liver transplant, usually within five years.
Kidney failure happens when the kidneys lose their function and are no longer able to filter out waste products from the blood.
It is thought the main cause of kidney failure is a side effect of the calcineurin inhibitor type of immunosuppressant. These medicines are known to damage the kidneys in certain people.
Symptoms of kidney failure include:
- tiredness
- swollen ankles, feet or hands (due to water retention)
- shortness of breath
- nausea
- blood in the urine
Kidney failure can be treated with dialysis (artificially replacing some functions of the kidney) or a kidney transplant.
Graft failure
Graft failure is a medical term meaning that the transplanted organ is not working properly. It is one of the most serious complications of a liver transplant and occurs in 1 in 14 cases.
The most common cause of graft failure is a disruption to the blood supply to the transplanted liver caused by blood clots (thrombosis). This includes:
- hepatic artery thrombosis, which affects the blood vessel between the heart and liver (hepatic artery)
- portal vein thrombosis, which affects the vein between organs in the abdomen and the liver
Other causes of graft failure include:
- primary non-function, where the new liver does not work within the first few hours and a new transplant is required
In many cases, however, no obvious cause can be found.
A person with graft failure will deteriorate rapidly and can have a range of symptoms, ranging from muscle spasms to double vision, eventually leading to a coma.
While medication can stabilise the body in the short term, the only cure is to transplant a new liver into the body.
Post-transplant lymphoproliferative disorder (PTLD)
Post-transplant lymphoproliferative disorder (PTLD) is an uncommon and serious complication occuring in around 1 in 50 people who have had a liver transplant.
PTLD is a general term used to describe a range of symptoms caused by the Epstein-Barr virus infecting white blood cells, which in turn can lead to abnormal growths spreading throughout the body.
PTLD typically occurs in the first year after a transplant, although it can develop at any time.
Symptoms of PTLD include:
- high temperature
- swollen lymph nodes
- abdominal pain
- swollen tonsils, which can cause breathing difficulties
- weight loss
- abdominal pain
PTLD is a serious complication as it can cause multiple organ failure and death. An estimated 40% of people who develop PTLD after an organ transplant will die from the condition.
PTLD is treated by temporarily withdrawing the immunosuppressants and using antiviral medication to fight off the underlying viral infection.
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
- Kaposi's sarcoma (cancer that usually develops beneath the skin)
- lymphoma (a cancer that develops inside white blood cells)
- cervical cancer
It is thought this increased risk is a side effect of taking immunosuppressants.
The risk of skin cancer is particularly high – a person with a transplanted liver is thought to be 20 times more likely to develop skin cancer than the population at large.
Because of this increased risk, if you have had a liver transplant you should avoid prolonged exposure to sunlight or artificial forms of ultraviolet light, such as sunbeds or sun lamps. Regular check-ups with a dermatologist (skin specialist) will probably be recommended.
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