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Sunday, January 27, 2008


Complications after Liver Transplant

Scar in the abdomen of a living donorLiver transplant(LT) as a procedure carries a high morbidity and mortality figure. The complication rate depends on several factors such as- clinical status of the patient at the time of transplant, cause of liver failure, associated organ failures, complexity of the operative procedure and the quality of the donor organ if one assumes good competence of the transplant team. Sicker the patient at the time of the assessment, higher the complication rate and higher will be the expense related to hospitalization. So good patient and good donor followed by competent surgery will distinctly reduce the incidence of complications. The complications encountered are death from bleeding during or immediately after transplant (5%), non functioning of the transplanted (5%), blockage of the artery supplying the liver (2%), blockage of portal vein supplying the liver (uncommon in patients with no pre-existing portal vein thrombosis) approximately 10% (with previous thrombosis), bile duct leak or stricture (8% in cadaver LT and 18% in live donor right lobe LT), bacterial infections (20%), viral infections(10%), fungal infections (5-10%), rejection (30% most curable), neuro-psychiatric problems (30% treatable), pressure sores or nerve palsies (2%), pleural effusion (25% treatable), recurrent ascites (8% most treatable), recurrent viral hepatitis, hernia, scar and other minor complications related to major surgery could be expected. Swelling of the leg may persist for a long period until the level of protein synthesis increases to normal levels. It takes approximately 3 months for the most issues related to liver transplant to settle down.

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