SECTION 17: OTHER POST-TRANSPLANT PROBLEMS

You may not have any problems after your transplant but most people experience at least a few minor or possibly more serious problems.

You will be given fairly high doses of immunosuppressant medications during your early postoperative period to overcome the risk of your body rejecting your new liver. This will make you more susceptible to infection. You will be screened for the presence of any infection on an ongoing basis while you are recovering in hospital following your transplant. Any infection that is of concern will be treated promptly with appropriate antibiotics.

During the first few weeks following transplant the most common sites of possible infection are your chest, (particularly if you are not coughing and doing your breathing exercises) and your wound.

If you had a lot of ascites pre-transplant, this tends to persist for a short period after the transplant operation. It will eventually disappear, but is prone to cause infection and leakage.

If wound infections develop, treatment consists of opening the wound, changing the dressings, and allowing healing to occur spontaneously. You will also require antibiotic therapy.

Occasionally infection may develop in the abdominal cavity, if this should happen it would be diagnosed and treated promptly. A surgical procedure may be required.

There is an increase in the frequency of diabetes in the first year following transplant. This is due to the side effects of two of the transplant medications, in particular, prednisone and Tacrolimus. This often settles down over time as the doses of your immunosuppressive medication are reduced.

Drugs that lower blood sugar levels may be required. This may take the form of tablets (oral hypoglycaemic agents) or Insulin by injection. If it is likely that you will be discharged home requiring regular Insulin injections, education will be provided by specialist Diabetic Sisters. Arrangements will be made for you to be followed by the RPAH Diabetes Centre or your own doctor.

This is a viral infection which usually comes on about four weeks after transplant. It may cause fevers, aches and pains. If you get this infection, you will receive anti-viral treatment (Ganciclovir) intravenously for two weeks. This will require admission to hospital.

Include problems related to the flow of bile from your liver, either a possible bile leak or the development of a stricture (narrowing) in one of the bile ducts. There may be problems with flow with the blood vessels going into the liver. These complications may require invasive procedures or even surgery to correct.

Not only does transplantation involves many physical changes to the body, but it also means many emotional changes. It is a tense, anxious time for both patient and family while they live through the waiting period, the transplant itself and often a prolonged recovery period. Along the way they may encounter and have to cope with many problems as they occur. The drugs given produce physical side effects that can be distressing to patients as they face changes in their body image and can also contribute to increased mood changes. Such mood changes may be irritability, depression and feelings of elation.

High blood pressure may be caused by the tacrolimus/cyclosporin or prednisone. It this is a problem you may require treatment with antihypertensive medication or alteration in your drug dosage.

This is a lung infection that doesn’t hurt healthy people even though we are exposed to it all the time. When the immune system is modified by drugs this infection can cause a serious form of pneumonia, especially in the first six months after transplant. This is prevented by taking Bactrim/Resprim three times a week for the first year following transplantation.

Bone mineral density can decrease during the first 3 months after transplant, due to the high doses of immunosuppressant medication required to prevent rejection. This ‘thinning of the bones’ may result in fracture, particularly in the vertebrae (back-bones) or the ribs. Calcium and Vitamin D is given help prevent this. Other treatments are also available for patients at higher risk.

MRSA is a bacterial infection that can be acquired in hospital. It is a bacteria that is resistant to a number of antibiotics. If you should happen to acquire this infection while in hospital, you may be treated by an intravenous antibiotic (vancomycin). To stop the spread of this infection, you will be nursed in a single room or in a ward with other patients who have this infection. Visitors will be asked to wear protective clothing.

Although not a routine procedure, some patients will have a T-tube placed at the time of transplant surgery. The T-tube is a flexible rubber tube that runs through the skin in your upper abdomen to the bile duct (the duct that carries bile from your liver to your intestine).

Prior to your discharge the T-tube will be clamped. It will remain in place for approximately six to eight weeks from the date of your surgery. The T-tube will be removed in the X-ray Department. It requires admission to hospital for at least two nights.

It is important that you observe the T-tube insertion site every day for any signs of infection such as redness or drainage. The site must be cleansed every day with Betadine and the T-tube strapped securely. If you feel the stitches holding the t-tube to the skin are breaking, you should notify the clinic, and arrangements will be made to have a couple of new stitches inserted.

Regular blood tests will monitor your kidney function. Medication you are required to take following your transplant, particularly tacrolimus/cyclosporin can cause deterioration of your kidney function. Your renal function is monitored in all your regular blood tests. The transplant team will adjust your medications to minimise the risk of kidney dysfunction. It is a good idea for you to maintain a good fluid intake at all times, particularly in hot summer weather to minimise any adverse effects your medication regime may have on your kidney function.

These are common problems after transplant. Other risk factors, which may influence the development of hyperlipidaemia, include age, diabetes and obesity.

Dietary reduction in calories and fat intake is recommended, combined with exercise. Your lipid (blood fat) levels will be monitored at regular intervals following your transplant. Your blood pressure is also checked at each clinic visit. Many patients require ongoing treatment with antihypertensive medication and your doctor may suggest the use of cholesterol-lowering therapy.

Early recognition and treatment of high blood pressure, control of hyperlipidemia, control of obesity and good blood sugar control for diabetic patients are important in preventing long-term cardiovascular problems, such as heart problems or strokes.