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Liver Transplant Patient Guide
Postoperative Complications

A number of postoperative complications are possible:

Infection of the T-tube site and dislodgment of the T-tube

A concern for any patient who has a T-tube to drain bile is that the area where the T-tube enters the skin can become infected. A patient should call the transplant office if he has a fever or if any of these symptoms occur:

  • redness of the skin
  • warmth around the T-tube site
  • drainage from the site

Dislodgment of the T-tube - the T-tube can become dislodged (moved out of place). The patient should call the transplant office immediately if he notices these signs:

  • breakage of the suture that is attached to the T-tube
  • change in the length of the T-tube that is visible

Bile leak and biliary stenosis (narrowing of the bile duct)

Bile leak - A bile leak occurs when bile collects outside the bile ducts. A patient who has a leak may experience pain over the liver, nausea, and/or fever. If this occurs, call the transplant office immediately.

Biliary stenosis (narrowing of the bile duct) - Occasionally, the bile duct narrows and eventually may become blocked. If this occurs, surgery may be necessary to correct it.

Infections

Immunosuppressive medications interfere with a patient's natural immunity; therefore, the patient will be more susceptible to infections after transplant surgery. The following are some of the most common infections:

Viral Infections:

Cytomegalovirus (CMV) - CMV is one of the viral infections that occur most frequently in transplant patients. The risk of CMV is highest in the first months after transplantation. Signs include fatigue, high temperature, aching joints, headaches, visual disturbances, and pneumonia. Treatment may include hospitalization.

Herpes-simplex virus type I and II - These viruses most often infect the skin but can also occur in other areas such as the eyes and lungs. Type I typically causes cold sores and blisters around the mouth, and type II causes genital sores. Herpes is an infectious disease and can be transmitted sexually. Herpes infections in transplant patients, however, were not necessarily transmitted sexually.

Most herpes-simplex infections are mild, but occasionally they can be severe. Although there is no cure for herpes, it can be treated. Depending on the severity of the infection, the treatment is either topical, oral, or intravenous (IV). A patient should contact the transplant team immediately if he believes he has herpes.

Symptoms of herpes include feeling weak and having painful fluid-filled sores in the mouth or genital area. Women should also be aware of any unusual vaginal discharge.

Herpes zoster (shingles) - Shingles appear as a rash or small water blisters, usually on the chest, back, or hip. The rash may or may not be painful. A patient should notify the transplant office if such a rash ocurs.

Fungal Infections:

Candida (yeast) - Candida is a fungus that can cause a variety of infections in transplant patients. It usually appears in the mouth and throat but may also be in the surgical wound, eyes, or respiratory and urinary tracts. Candida is most severe in the bloodstream. If infection occurs in the mouth or throat, it is called thrush. Thrust produces white, patchy lesions (raw areas), pain or tenderness, a white film on the tongue, and difficulty swallowing. Candida can also infect the esophagus (the tube from your mouth to your stomach) or, in women, the vagina. Vaginal infections usually produce an abnormal discharge that may be yellow or white. A patient should notify the transplant office if a Candida infection ocurs.

Bacterial Infections:

Wound infections - Bacterial wound infections occur at the surgical site. If a patient has a fever or notices redness, swelling, tenderness, or drainage at the incision, he should notify the transplant team. After a wound culture (a test for bacteria) is taken, an antibiotic will be prescribed if infection is present.

Other Infections:

Pneumocystis carinii is a germ similar to a fungus, and it is normally found in the lung. In people whose immune systems are suppressed, it may cause a type of pneumonia (PCP). Early in the illness, a mild, dry cough and a fever may occur. If a patient suspects that he has a cold or flulike illness, he should contact his physician immediately.

High blood pressure

High blood pressure and heart disease are common disorders that become more frequent as people grow older. High blood pressure is also a side effect of some medications. A patient may need to take a medication to control his blood pressure.

There are many different types of drugs available to control high blood pressure. A patient may need to try several different medications. The transplant team or local physician will select the one that works best for each specific patient.

A diuretic (water pill) may also be prescribed to lower blood pressure, increase urine output, and remove extra fluid.

Rejection

The body's immune system protects a person from infection by recognizing certain foreign substances, such as bacteria and viruses, and destroying them. Unfortunately, the immune system recognizes a new liver as a foreign substance also.

Rejection is an attempt by the immune system to attack the transplanted liver and destroy it. To prevent rejection from occurring, a recovering patient must take immunosuppressive medications, as prescribed, for the rest of his life.

In spite of all precautions, rejection episodes can occur. Up to 75% of all liver-transplant recipients will have at least one rejection episode, even though these people are taking immunosuppressants. The first episode often occurs within 2 months of surgery. Rejections are usually controlled by changing the dosages of immunosuppressive medications or temporarily adding a new one.

If detected early, most rejection episodes can be treated successfully. A patient should be alert to the signs and symptoms of rejection and inform his transplant team promptly if he has the following.

  • fatigue
  • fever
  • abdominal pain or tenderness
  • dark yellow/orange urine
  • clay-colored stools
A patient may not have any symptoms, but his liver-function tests may be abnormal, suggesting that rejection is occurring. This is why maintaining a strict appointment schedule with the transplant team is critical.

When rejection is suspected, it is usually confirmed by a liver biopsy. Based on the results, the transplant team will decide the best treatment. As with all transplant patients, a patient may have biopsies at regular intervals to monitor his liver function.

Diabetes

Some of the immunosuppressive medications may cause diabetes. Diabetes is an increased level of sugar in the blood.

Symptoms of diabetes may include: increased thirst, increased frequency of urination, blurred vision, and confusion. A patient should notify his transplant team or local physician if he experiences any of these symptoms.

Blood sugar can be reduced through weight loss, careful diet, and exercise. An oral diabetes drug or insulin injections may be necessary.

If a patient develops diabetes, he will receive specialized teaching about how to deal with this problem.

When to Notify the Transplant Team

There is no way to predict accurately which patients will have problems. The transplant team will do their best to reduce the likelihood of complications and to treat them promptly if they occur. Following instructions carefully and keeping the transplant team informed of any difficulties will help a patient return quickly to a normal, active life.

A patient should notify the transplant team if he:

  • has prolonged illness (nausea, vomiting, diarrhea)
  • is unable to take medicines by mouth due to illness
  • thinks the directions on the label may be different from what he was told
  • has trouble removing child-resistant caps
  • has a reason to take aspirin, TYLENOL® (acetaminophen), other pain relievers, cold remedies, or diet pills
  • feels he is having a reaction to the medications
  • has had a change in health or eating habits
  • has a new prescription from his local doctor or a change in a current prescription
  • experiences any unusual symptoms or side effects, as they may be related to the medications he is taking
  • is undergoing dental work of any kind

 

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USC Hepatobiliary, Pancreas and
Abdominal Organ Transplant

1450 San Pablo Street
Healthcare Consultation Center 4
Suite 6200
Los Angeles, CA 90089

For Liver, Pancreas & Bile Duct Surgery,
please call (323) 442-7172
Fax: (323) 442-7173

For Organ Transplant Information,
please call (323) 442-5908

Fax: (323) 442-5721

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