Problems after transplant surgery for liver cancer
There is a risk of problems or complications after any operation.
Some complications can happen straight after surgery when you're in hospital. Or you might have problems after you go home.
Possible problems after a liver transplant include rejection, bile leakage or kidney problems. Other risks include infection, blood clots and bleeding.
Many problems are minor but some can be life threatening. Treating them as soon as possible is important. Your transplant team monitor you very closely after the operation to check for problems. Even when you go home they will see you often to make sure you are recovering well.
This information is for people who are having a liver transplant. We have separate information if you are having part of your liver removed. Your doctor might call this a liver resection or a hepatectomy.
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. Rarely, you might need more surgery to stop the bleeding.
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. Dialysis is a way of removing waste products and excess water that the kidneys normally filter out of your blood.
Bile duct problems
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.
During transplant surgery your gallbladder is removed. The main bile duct in the donor liver is connected to your main bile duct.
There is a risk of bile duct problems after a liver transplant. This could be:
- bile leaking from the join between the bile ducts, or
- narrowing of the bile duct
You may have a test called an 
to help your doctor diagnose and fix the problem. 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.
Types of rejection
Rejection after a liver transplant can be:
- immediate (acute) – this happens in the first 6 months after a transplant
- long term (chronic) – this happens more than 6 months after a transplant
Acute rejection is usually treated is with high dose steroids.
Chronic rejection is very rare. It can cause a breakdown of liver tissue and the bile ducts. Chronic rejection can be treated with medicines. But sometimes a second liver transplant is necessary.
Symptoms of rejection
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.
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.
Anti rejection medicines
To prevent rejection happening you take anti rejection medicines (immunosuppressants). You usually take these for the rest of your life. These medicines weaken your immune system so that it won't attack the liver.
You begin on a high dose of these medicines, and the dose reduces over time.
The most common anti rejection drugs include:
- tacrolimus (Prograf)
- prednisolone or other steroids
- cyclosporin (Neoral)
- mycophenolate mofetil (Cellcept)
- azathioprine
Most people have a combination of these drugs, such as tacrolimus, azathioprine and prednisolone.
All anti rejection drugs have possible side effects. You might need other medicines to reduce these.
One major side effect is that they increase your risk of getting infections. The risk is highest during the first few months because this is when you have high doses of these drugs. You will take regular antibiotics and antiviral medicines. You also have regular blood tests to monitor you while you are taking anti rejection drugs.
Infection
The drugs that prevent liver rejection stop your immune system fighting infections. This gives you a high risk of developing infections. The risk is highest during the first few months because this is when you have high doses of these drugs. You will take regular antibiotics and antiviral medicines.
It is important to avoid anyone with an infection, including those with a cold.
Avoiding foods such as undercooked meat, unwashed fruit and vegetables and unpasturised milk 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 will give you more information about ways to reduce your risk of infection.
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, you should contact a doctor immediately. This might be your emergency GP service. Or call 999 or go to your nearest accident and emergency department (A&E).
To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.
Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.
It's important to continue wearing compression stockings if you have been told to by your doctor.
Changes to sleeping habits
Some people experience sleep disturbances and poor sleep quality after their transplant. This might be because of:
- medication side effects
- stress and anxiety
- pain or discomfort after surgery
- spending time within a busy hospital ward
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.
Healthy living
Your transplant team will talk to you about keeping well after your liver transplant. This will include information about:
- safe and healthy eating and drinking
- weight
- exercise
- driving
- sun safety
- working
- sex and relationships
NHS Blood and Transplant service
The NHS blood and transplant service have information about liver transplants. This includes details about waiting lists, the transplant procedure and life after a transplant.
