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Liver Transplant: Complications/Medications

for Veterans and the Public

Complications/Medications

Complications

Because several of these possible complications occur more often in the immediate post-transplant period (defined as first 3 months after transplant), transplant centers require you to remain nearby to allow for frequent monitoring by them so they can look for these events and take care of them quickly.

Related to Surgery:

A liver transplant is a complex process that requires hundreds of steps. While there are a number of possible complications, fortunately most are quite rare. One of the reasons you undergo so many tests before the surgery is to decrease the potential risks of heart attack, stroke or death. Despite all these tests, it is important to be aware that these things can happen. Occasionally, the new liver fails to work; if that happens, the transplant center does everything they can to find a new liver right away. In addition, one of the new anastamoses (connections) of the new liver, with blood vessels or other structures in the abdomen, can develop a complication requiring return to the operating room for repair or other procedures to open up the new connections.

Rejection:

Your immune system helps fight infections. It does this by recognizing self (your own cells and proteins) from non-self (those things that are foreign to your body). Anything it sees as nonself is attacked by your immune system and destroyed. Your new liver naturally is recognized as non-self and is attacked by your immune system. This process is called rejection. To control this natural immune response, your providers give you a combination of immunosuppressive medications (prednisone, tacrolimus, azathioprine, mycophenylate mofetil, cyclosporine, and sirolimus). You must take these medications for life. These medications all have side effects (discussed later) that often lead to the need to take additional medications to control them.

Occasionally, your immune system still rejects the liver, and additional medications may be added. While it is rare to lose your liver to rejection, untreated rejection can lead to permanent liver damage or even death. Rejection is monitored by routine lab work and letting your medical provider know if you are experiencing any symptoms.

Infection:

Because of the immunosuppression needed to prevent rejection, you will be at increased risk for infections. Occasionally, these infections can be fatal. There are things you can do to help prevent infection such as washing hands regularly, avoiding exposure to possible airborne fungal spores (e.g. avoiding smoking marijuana, certain occupational exposures), and avoiding contact with sick persons. You do not need to wear masks after you return home.

Since the immune system also plays a role in fighting cancer, you will be at increased risk for developing certain types of cancers such as skin cancer or post-transplant lymphoma (PTLD). The lifetime risk for lymphoma is only 1-2%, however, it emphasizes the need for good follow-up.

Related to Immunosuppressive Medications:

These potent drugs have a lot of side effects and potential long-term complications. These side effects will be monitored at your clinic visits, and your providers will make every attempt to control or decrease medication side effects. Most patients, however, will develop one or more complications, which then need to be managed.

Diabetes, kidney problems, high blood pressure, and high cholesterol are some of the more serious side effects. Some of the more annoying side effects include hair loss, insomnia, diarrhea, nausea, headaches, swelling, and neuropathy (nerve symptoms).

Do not take any new medications without talking with the transplant center or a physician trained in transplant. Many medications can interact with each other and cause elevated levels of immunosuppression, which may lead to serious toxicity. Even antibiotics, herbal remedies, ibuprofen, and grapefruit can do this!

Medications

When you have a transplant, you will need to learn how to plan for your medication needs after transplant. You will be taking medications every day for the rest of your life. You will want to know about them as much as possible -- how to take them, how they work, and their side effects.

Your medications are essential to the success of the operation and to your recovery.

Below, you will find a list of the medications you may be taking. There will be about 10-15 medications taken anywhere from once to four times a day. Over time, the number of drugs is tapered off so that usually by one year, you are taking 2-6 medications every day.

  • immunosuppressive medications -- help prevent rejection of the new liver; first doses are high and then are tapered down; you will take these for life
  • antibiotics/antivirals -- taken for the first 3-6 months after surgery when the immunosuppression is highest to prevent viral/bacterial infections
  • antacids -- taken to prevent stomach upset
  • antihypertensives -- may be prescribed to lower blood pressure
  • diuretics (water pills) -- may be needed to remove fluid
  • multivitamins, calcium, and vitamin D
  • insulin -- occasionally needed to treat diabetes caused by the prednisone or other immunosuppressive medications
  • cholesterol-lowering drugs -- may be started later if you develop high cholesterol
  • iron -- may be prescribed in some cases if you have low blood counts
  • aspirin -- may be prescribed if you had narrowing or blood clots in any of the blood vessels supplying the liver

Other Considerations

  • You will need to plan travel carefully and consider how you will have quick access to medical care if needed. You may want to avoid traveling to places with high incidence of diseases that could be spread through water, food, or insect bites.
  • You will have many medical appointments.
  • You will still have hepatitis C (if you had it before the transplant).
  • You will have a compromised immune system because of the medications you will take to stop your body from rejecting your liver. This means that your body will be less resistant to fighting off other illnesses.
  • You will be discouraged from participating in activities that pose a high risk to your health.
  • You will need to take medications for the rest of your life and may experience unpleasant side effects from them.
  • If you are considering having a child, definitely discuss this with the transplant team prior to conceiving.
  • You will feel better
  • Food will taste better -- watch your weight!
  • Do not drink, smoke, use drugs -- this is a lifetime commitment
  • Always keep the transplant center informed of your address and phone number as they follow you for life