Liver transplantation has become quite an effective procedure for patients with acute or chronic end-stage liver disease. Earlier, liver transplant surgery was considered as the last therapeutic procedure for patients who were suffering from extreme liver diseases. As patients were generally in a very serious condition by the time of surgery, premature mortality rates were pretty high. However, over the years, the survival rate has increased a lot, but there are still other complications that need to be dealt with. Despite all the surgical, medical, and technological advancements, even today, a liver transplant is a complex procedure that still has a significant morbidity-mortality rate.
The Function of the Liver
The largest internal organ in the body, the liver is responsible for a lot of vital functions. Essential for the survival of a human body, the absence of the liver cannot be compensated. Some of the vital functions of the liver include –
- The production of bile juice, which is a mixture of chemicals and is important for digestion.
- Helping break down food to turn it into energy.
- Acting as a filter for removing harmful substances from the blood.
- Producing infection-fighting chemicals.
- Making chemicals which are required for blood clotting.
- Storing vitamins, iron, and other essential substances.
What is a Liver Transplant and Who Needs It?
A complicated medical procedure, a liver transplant includes the removal of an infected liver, which is replaced with a healthy one. This is a procedure that has been done for over 38 years now. Many people who have undergone the surgery lead perfectly normal lives later.
A liver transplant is performed when the patient’s liver fails to perform its vital functions and regular medical treatment fails to recover those functions. There are many conditions that can lead to liver failure. However, the most common indication that a patient requires a liver transplant is the scarring of the liver or liver cirrhosis. Some of the common causes of liver cirrhosis include –
- Alcoholic liver disease
- Fatty liver
- Chronic hepatitis B
- Chronic hepatitis C
- Genetic diseases
- Autoimmune liver diseases
In addition to liver cirrhosis, a transplant may also be recommended in case of liver cancer, acute liver failure, or bile duct diseases.
Complications of Liver Transplant
A liver transplant may have several complications, some which may occur immediately after the procedure and some that may occur after some time. They are divided into two groups – immediate complications and long-term complications.
Immediate Complications
The immediate or short-term complications of a liver transplant include –
Technical Complications: One of the most frequent complications of transplant are arterial complications, mainly thrombosis, i.e. blood clotting of the hepatic artery, which supplies blood to the liver.
Medical Complications: A patient might face complications once the gradual improvement of liver activity starts. In such cases, the patient’s ICU stay is prolonged and the chances of mortality increase. Some of the most common medical complications that can occur post-transplant are neurological respiratory complications, kidney problems, and hemodynamic alterations.
Infections: A major short-term complication which may occur after the transplant are infections. The anti-rejection drugs (immunosuppressants), used to suppress the immune system to prevent it from rejecting the new liver, increase the risk of infection. This issue reduces with time and most of the infections can be treated as they occur.
Rejection: If anti-rejection drugs are not given, the newly transplanted liver will experience invariable rejections from the immune system. This happens because the immune system is unable to differentiate between the transplanted liver and unwanted viruses and bacteria. This is why anti-rejection drugs are prescribed to reduce the risk of rejection.
Liver Graft Dysfunction: An early graft dysfunction may occur due to the following conditions –
- Problem with the graft itself, which includes liver rejection, non-specific cholestatic syndrome, and dysfunction or malfunction.
- Issues may be caused by the surgical technique, including vascular or arterial, poor drainage of the suprahepatic veins, and portal thrombosis (biliary).
- Other causes include drug-related liver toxicity or infections.
Long Term Complications
In the bygone years, liver transplantation surgery was considered to be an experimental procedure and was reserved as the last option for patients in extremely critical conditions. In those days, the long-term complications were not of great concern. However, today, as the rate of survival has gone up, increased attention is being paid to the long-term complications, which are highly related to the immunosuppressive treatment. These complications generally occur after a few years of the surgery and mainly include chronic renal failure, diabetes mellitus, dyslipidaemia, obesity, systemic arterial hypertension, bone or neurological complications, and the development of de novo tumours.
Chronic Rejection: Usually not evident till after at least 6 months after the transplant. It is not clear why, but there are still chances of the body rejecting the liver.
Renal Failure: Chronic renal failure, after the transplant, is closely related to the use of calcineurin inhibitors. Depending on the criteria used to define it and the method for assessing renal function, the prevalence of the complication is variable.
Arterial Hypertension: One of the most common complications faced by liver transplant patients post-surgery is arterial hypertension, with a prevalence varying from 50-70% in the first few months. However, it decreases gradually once the immunosuppressive drugs doses are reduced.
Diabetes Mellitus: After the transplantation, some patients may develop diabetes mellitus. The occurrence of this depends on the time that has passed since the transplantation and particularly on the immunosuppressive drugs used.
Bone Complications: Osteopenia, when the bones become weaker than normal, is commonly seen in patients with advanced chronic liver infections. Almost 20-40% liver transplant recipients may suffer from atraumatic bone fractures after the surgery. The most common locations of these fractures include the vertebrae and the ribs.
Obesity: Obesity has a prevalence rate of 15-40% for a period of one year after the surgery, which is when the highest weight gain is seen in patients. It is one of the most frequent long-term complications.
Despite various advancements in the medical and surgical fields, liver transplant still remains a complex medical procedure with both short- and long-term complications. However, the survival rates for the procedure have also increased and most of the complications can be treated.
