Surgical complications are any problems with your new organ that are related to the surgery. Some of these problems show up a day or two after your transplant. Post-operative complications are problems that can appear a few weeks or a few months later.
Surgical and post-operative complications include:
- thrombosis (clots) of main blood vessels
- bile duct problems
- wound infection
- fluid collections
- blood problems that require a transfusion.
Thrombosis
Thrombosis is another name for a clot, or blockage, in a blood vessel. Blood clots can build up in the vessels in or around the new liver and stop blood from reaching the liver. Because blood carries oxygen around the body, a clot can, in rare cases, prevent enough oxygen from getting to the liver. This could cause serious damage.
Clotting is more common in younger children, but it can also affect teens. If you have any clots, your transplant team will give you medications to treat them and prevent more from developing. In some cases, the surgeon may want to try to remove the blood clot during an operation if it is found in one of the major liver blood vessels.
Bile duct problems
Bile is a fluid that breaks down fats in the small intestine during digestion. The bile ducts are tubes that carry bile from the liver to the small intestine. About 10 to 15 per cent of patients will have complications involving the bile ducts (sometimes called the biliary tract) after liver transplant. Ultrasounds and regular blood work will help the transplant team diagnose any problems as soon as possible.
Wound infection
Any time you have surgery, there is a chance that the incision (cut) may become infected. The infected area may look red and there may be some drainage of fluid or pus. If you have an infection, you will need to treat it by changing dressings or taking antibiotics.
Fluid collections
Often fluid can collect and build up in the abdomen (belly) after a liver transplant. If you had a lot of fluid in your abdomen before your transplant (called ascites), you will likely still have some there afterwards. The fluid will gradually disappear with the help of some diuretics, which are medications that help you urinate (pee) more often.
The fluid may be:
- ascites
- bile
- blood.
Ascites
Ascites is a build-up of fluid in the belly. It happens when the liver cannot make enough albumin to keep fluid in the blood vessels. It takes time for your new liver to start working well enough to help move the fluid out of the belly and into the blood vessels.
It can take a while to get rid of this fluid because it can come back even after it is drained. Getting rid of excess lymph fluid often means extra ultrasounds and trips to the hospital. Sometimes only surgery can fix the problem.
Bile
Biliary leaks can happen after a transplant for two main reasons.
- During your liver transplant, surgeons may connect your own bile duct to the bile duct belonging to your new liver. Sometimes, the connection between these two tubes does not heal properly. This can cause bile to leak from this area. You may need further surgery to repair this problem.
- If you did not receive a whole liver, the part of the liver that was reduced to fit you may leak a small amount of bile into your abdomen while it is healing. This problem usually resolves by itself over time. Biliary leaks can sometimes cause an infection, which needs to be treated with antibiotics.
Blood
A collection of blood is called a hematoma. When there is bleeding, the blood forms a collection around or beside the liver. Most of the time, no treatment is needed because your body slowly re-absorbs the blood. However, if there is a lot of bleeding, the surgeon might choose to operate again to stop it.
Blood problems that require a transfusion
Anemia is a common condition that occurs if you have lower than normal levels of healthy red blood cells (hemoglobin). Most liver transplant patients experience anemia before their transplant because of chronic (long-term) liver disease.
Blood loss during surgery may make anemia worse. Some of the medications you need to take after transplant can also lower your red blood cell count.
When you lose too much blood, you need a transfusion (donation of another person’s blood) to replace it. Depending on the amount of blood you lose during your surgery, you may need blood transfusions in the operating room.
Sometimes anemia can last for a few months after transplant. The transplant team may ask you to take an iron supplement.
