A major surgery such as a living donor liver transplant carries a number of post-operative complications for the donor and the recipient. Potential risks of complications for the donor have been reviewed in the “Living Donor Assessment” chapter. In this chapter, we visit the likely complications experienced by the recipient. Infection and rejection are the two (2) primary concerns that the transplant team addresses to stem the likelihood of other complications that may follow thereafter. There are also the technical complication of the surgery and complications caused by the immunosuppressant drugs.

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

Infection

Because the immunosuppressant interferes with your natural immunity, you are more susceptible to infections after the transplant. The most common types of infection are bacterial, fungal and viral. Up to two-thirds of all liver transplant patients had at least one episode of infection in the first 3 to 6 months.

Bacterial infection

A common concern where there is an incision to insert the T-tube to drain the bile. If you experience:

• Redness of the skin;
• Pus drainage
• Warmth around the T-tube site
• Fever
• The suture attached to the T-tube is broken
• Change in the length of the T-tube that is visible

Please contact your transplant surgeon/ physician immediately.

Viral infections

• The risk of contracting Cytomegalovirus (CMV) is the highest in the first month after transplant. Signs include:
  • High fever
  • Fatigue
  • Aching joints
  • Headaches
  • Visual disturbances
  • Pneumonia
• Herpes infection is mostly skin infection but sometimes it can occur in the lungs and around the eye area. It is characterised by cold sores and blisters around the mouth, and sores around the genital area. Women recipient should be aware of any unusual vaginal discharge. Though there is no cure, the sores are treated with topical or oral medication.
• Herpes zoster, also known as shingles, appears as a rash or small water blisters, usually on the chest, back or hip.

Rejection

The most serious complication following a liver transplant is rejection of the new liver by your body. Rejection is an attempt by the immune system to attack the foreign substance, in this case it’s the transplanted liver, and destroy it. To prevent rejection from occurring, patients must take immunosuppressant drugs lifelong. Unfortunately, there are few cases of rejection though immunosuppressant drugs are taken. The first episode often occurs within 2 months of surgery.

Symptoms of Rejection

• Fever higher than 39 degrees Celsius
• Fatigue or excess sleepiness
• "Crankiness"
• Headache
• Abdominal swelling, tenderness, or pain
• Decreased appetite
• Jaundice (yellow skin or eyes)
• Dark (brown/ orange) urine
• Itching
• Clay-coloured stools

None of these symptoms are specific for rejection but they are still important enough for you to take note when they occur. Please contact our transplant coordinator immediately if you encounter any of these symptoms.

Treating Rejection

When rejection is suspected, a liver biopsy is done to confirm. If detected early, the transplant team will control the rejection by changing the immunosuppressant drugs dosages or temporarily adding a new one.

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