Acute liver rejection
Acute liver rejection is when the immune system suddenly attacks the new liver. It is a very common complication, occurring in up to 40% of cases, typically in the first 7-14 days after the transplant.
Symptoms of acute liver rejection include:
- a high temperature (fever) 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 of acute liver rejection can be successfully managed by increasing your dose of corticosteroids and/or switching from one calcineurin inhibitor to another.
Infection
Both corticosteroids and calcineurin inhibitors will make you much more vulnerable to infection. You will be particularly vulnerable to:
- fungal infections
- cytomegalovirus (CMV) infection – CMV is a common virus that is part of the herpes family of viruses
Fungal infections
Fungal infections that can affect a person with a liver transplant include aspergillosis and candidiasis (thrush).
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 develop inside your body, such as in the lungs (fungal pneumonia) or in the bloodstream.
Symptoms of an invasive fungal infection include:
- a high temperature
- 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 report any symptoms that could indicate you have an infection to your GP or transplant team as soon as possible.
Non-invasive fungal infections can be treated using antifungal creams and tablets. Invasive fungal infections may require admission to hospital and treatment with injections of antifungal medication.
As a precaution against fungal infections, you will usually be given a course of antifungal medication, such as fluconazole, to take for several months after your transplant. Common side effects of fluconazole include:
- nausea
- indigestion
- diarrhoea
- flatulence (‘farting’)
- skin rash
- headache
Cytomegalovirus (CMV) infection
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)
If you think you have a CMV infection, contact your GP or staff at your transplant centre as soon as possible.
CMV infections can usually be treated using antiviral medicines such as ganciclovir.
Side effects of ganciclovir include:
- high temperature
- nausea
- vomiting
- diarrhoea
- abdominal pain
As a precaution against CMV, you may be given a course of antiviral medication to take for several months after your transplant.
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 occur after a liver transplant are in people with a history of hepatitis C.
For more information, see the Health A-Z topic on type 2 diabetes.
Kidney failure
Kidney failure is another common and serious complication that affects one in five people with a liver transplant, usually within five years after the transplant.
Kidney failure is when the kidneys lose most or all of their functions and are no longer able to filter out waste products from the blood.
It is thought that the main cause of kidney failure is a side effect of calcineurin inhibitors. 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.
For more information, see the following Health A-Z topics:
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. Graft failure is thought to occur in 1 in 14 cases.
The most common cause of graft failure is an underlying problem that is disrupting the blood supply to the transplanted liver. 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, such as:
- reduced output of urine
- reduced levels of consciousness
- seizures
- muscle spasms
- double vision, and eventually
- coma
While medication can be used to stabilise the body in the short term, the only prospect for a 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 that occurs 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 (tumours) spreading throughout the body.
PTLD typically occurs in the first year after a transplant, though 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
- night sweats
- diarrhoea
PTLD is a serious complication as it can often 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:
- skin cancer
- lymphoma (a cancer that develops inside white blood cells)
- Kaposi’s sarcoma (cancer that usually develops underneath the skin)
- cervical cancer
It is thought that 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.
For more information, see the following Health A-Z topics:
