What are the Most Common Liver Transplant Complications?

Liver transplant is a risky surgery usually performed as a last resort to save patients’ lives. Risk of liver transplant complications begins immediately after the surgery and can continue for years after the operation. Rejection is the most serious and ongoing complication and can lead to the patient’s death. Major bleeding, clotting and infections also are serious liver transplant complications immediately following surgery—each risk declines as time passes. After a liver transplant, patients also face the possibility developing cancer.

Transplant surgery involves using a donor organ—sometimes from a brain dead donor and sometimes a partial liver from a live person. The body treats the new liver as an invader and the immune system tries to attack it in an attempt to reject the organ. Patients take heavy doses of immunosuppressants to lower the risk, but sometimes the immune system’s response is too strong to overcome liver transplant rejection. About two-thirds of liver transplant patients experience some level of rejection. If severe enough, re-transplantation is required.

The immunosuppressants used to lower rejection chances put patients at higher risk of developing infections. Infections are considered among the most common liver transplant complications. People with other health conditions, such as AIDS, or those who have recently undergone chemotherapy or another organ transplant are most susceptible to post-surgical infections. Infection risk declines gradually as time passes after surgery and the body adjusts to the new liver.

Major bleeding post-surgery is another common complication. Bleeding is common with any major surgery, but can be especially pronounced in liver transplants. The new liver must quickly produce proteins to clot blood; if not, bleeding remains a likely complication. Sometimes bleeding can be controlled through transfusions to replace the lost blood. Internal bleeding post-transplant often is corrected with follow-up operations.

Conversely, some patients experience clotting problems. The vessels that supply blood to the liver may clot following surgery, which puts the organ—and the patient’s life—at risk. Patients are monitored daily with ultrasounds for several days after surgery to detect any clotting. A follow-up surgery usually is required to remove clots.

As time passes, the risk of liver transplant complications drops somewhat. Bleeding, clotting and infection issues decline over time, for instance, but rejection remains an ongoing issue. Patients remain on immunosuppressants to keep the rejection risk low, and the continued use can lead to cancer. Skin cancer and lymphoma are particularly worrisome long-term liver transplant complications because the immunosuppressants kill the white blood cells that would normally attack malignant cell growth.