Avoid complications after liver transplant and take care of your new liver baby carefully

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Article ◆ Ding Yanling “Liver Foundation” Consultation ◆ Wu Yaoming (Attending Physician, Department of Surgery, National Taiwan University Hospital, Assistant Professor of Surgery, National Taiwan University School of Medicine)

Liver transplantation is the removal of a diseased liver and the transplantation of a new liver. It can be said to be the last hope for liver disease patients.

The standard of liver transplant surgery in Taiwan is very high, with a success rate of up to 90%. However, liver transplantation is not a matter of peace of mind. There are still many possible complications and lifelong issues that need to be paid attention to.

Mr. Wang only found out that he was a hepatitis B carrier when he was undergoing a medical examination in the army. However, he did not know what problems hepatitis B carriers would cause at that time, so he did not care about it. He has worked hard for his career for more than 30 years and has no major physical problems. He thought he was healthy, but during a general health checkup, he unexpectedly discovered that he had cirrhosis of the liver.

After that, Mr. Wang had regular follow-up examinations at the insistence of his family. However, liver cancer was discovered during a liver ultrasound examination. Unexpectedly, it recurred a year after resection. Mr. Wang’s son volunteered to donate his liver in order to help his father regain his health. For his father, Mr. Wang regained his health after receiving a healthy liver donation from his son. He is determined to take better care of his “darling” in the future so as not to let down his son’s brave liver donation.

(Taipei News) “Did my liver transplant succeed?” People who undergo liver transplants are usually critical patients, so after liver transplant surgery, family members will definitely feel uneasy and worried about whether the operation was successful.

Does it work after liver transplantation? As long as bile secretion is seen in the recipient patient on the operating table, it means that the transplanted liver has begun to function. After that, the patient will stay in the intensive care unit for about a week to observe the liver and cardiopulmonary function. Generally speaking, the respirator can be removed within 1 week after the operation. After everything is normal, you can be discharged from the hospital about 1 month later.

One week after surgery is the most critical

To truly define whether the operation is successful, it is usually determined by evaluating the patient’s health status “within one month after operation”, and the most critical risk period is within one week after operation, because liver rebleeding, blood vessel obstruction, Problems such as acute rejection usually occur within 1 week. As long as this period of time has passed, the operation is successful.

From often having to go to the emergency room and being hospitalized, to being able to live like a normal person, does liver transplantation mean that life changes from black and white to color? The answer is yes, but liver transplant is a major operation and may face some complications in the future, so patients must be careful.

Complications of liver transplantation can be divided into “short-term” and “long-term” depending on the time point.

Short term such as rejection and infection. In order to reduce rejection, “anti-rejection drugs” must be used, but the use of anti-rejection drugs may cause a decrease in immunity, making the patient susceptible to infection. These are two ends of the scale, a balance must be struck. Generally speaking, acute rejection is most likely to occur “7 to 10 days after surgery.”

In terms of infection, since the patient has a central venous catheter, a urinary catheter, a respirator and other devices after the operation, the newly transplanted liver has not yet functioned well after the operation, and the resistance is poor, coupled with the use of anti-rejection drugs May increase the risk of infection, which is most likely to occur 1 to 2 weeks after surgery.

Poor liver quality leads to complications

The third short-term complication of liver transplantation is that the transplanted liver fails to function, with an incidence rate of about 1% to 5%. The main reason is the poor quality of the transplanted liver. Sometimes because the recipient has life-threatening conditions such as blast hepatitis, if someone happens to donate a liver, in order to save lives, a liver that is not of the best quality has to be used. This may affect the function after transplantation, but living donor liver transplantation is There is sufficient time to evaluate suitable liver donor candidates, so this situation is relatively rare.

The fourth complication is the risk of bleeding. Especially for liver transplant recipients, liver failure cannot produce coagulation factors before liver transplantation, resulting in a tendency to bleed before surgery, increasing the risk of bleeding during and after surgery. Some patients may only need hemostatic injections, but some patients with severe bleeding may need a second incision to enter the abdominal cavity for hemostatic surgery.

The fifth common complication is insufficient permeability of the suture. There are four anastomoses required during liver transplantation, including the hepatic vein, portal vein, hepatic artery and bile duct. These four anastomoses must be very smooth to maintain the function of the liver after transplantation. Therefore, these four anastomoses must be closely observed after the operation. The transparency of the place. If the hepatic vein is stenotic and blocked, ascites may occur. If the portal vein is blocked, the liver cannot get enough blood flow to maintain its function. Pay more attention to the permeability of the hepatic artery and bile duct anastomoses, because the diameter of the two is only about 0.2 to 0.3. About centimeters, so the operation must be performed under a microscope. If the hepatic artery anastomosis is not permeable and the liver cannot function, a second operation may be needed to repair it.

Other complications include decreased renal function and renal failure. These conditions are usually most likely to occur in the intensive care unit and during hospitalization in the first week after surgery and must be closely observed.

Watch out for rejection and infection throughout your life

In terms of long-term complications, “rejection” and “infection” are still issues that patients need to pay attention to throughout their lives. Since anti-rejection drugs must be used throughout their lives, they will suppress the body’s immunity and make them prone to colds and other infections.

“The currently commonly used anti-rejection drugs can easily affect kidney function, so they must be tracked regularly.

A small number of patients (taking medication for more than 10 years) need “kidney dialysis”.

About 10% to 20% of patients may have blood sugar,

If you have metabolic problems such as elevated blood lipids or uric acid, you should also pay attention to bone loss.

The above situations require long-term follow-up and observation.

The success rate of liver transplantation is about 90%.

Any surgery has risks, especially a major surgery like liver transplant.

There is about a 10% chance of failure,

This includes death within 1 month of surgery. “

The so-called liver transplant failure means that the transplanted liver does not perform the expected function. The reason may be that the transplanted liver itself is of poor quality. The second factor may be caused by poor permeability of the four anastomotic blood vessels and tissues. The liver cannot maintain normal functions. A small number of patients may have livers that function initially, but may suffer from severe bleeding or death after transplantation.

What should you do if you find that your transplanted liver is not functioning properly? If a suitable donor liver is found, the patient can choose to undergo a liver transplant. The current record for liver transplantation in Taiwan is three liver transplants. The patient is a hepatitis C patient. In the early years, when there was no long-acting interferon treatment, even if liver transplantation was performed for patients with hepatitis C, the recurrence rate of liver C was almost 100%, so this patient had a total of three liver transplants. The current situation is stable and has been tracked for nearly 10 years.

With the development of antiviral drugs, the recurrence rate of patients with hepatitis B has dropped from 80% to 10% after liver transplantation. Although patients with hepatitis C will still relapse, about 30% of patients with hepatitis C will relapse after treatment with antiviral drugs and interferon. The treatment efficiency is very high. Currently, more new drugs are being developed, which can increase the treatment efficiency for hepatitis C patients to 80% or 90%. In 2013, foreign oral dosage forms of new drugs have been launched, which is worth looking forward to.

Take anti-rejection drugs for life

Immunize and reduce susceptibility to infection

Although you can live a normal life after liver transplantation, you must follow your doctor’s instructions and take your medications on time, especially “anti-rejection drugs” that need to be taken for life.

Commonly used anti-rejection drugs are “three-in-one drugs”, including cyclosporine or FK506 and Sanchido, commonly known as “Little C”, plus steroids.

Anti-rejection drugs are immunosuppressants. The most common side effect is decreased immunity and susceptibility to infection, followed by 10% to 20% possibility of metabolic problems and nephrotoxicity. Pay attention to tracking kidney function. If the patient is a hepatitis B carrier, hepatitis B carriers will still be present after liver transplantation, so he must take “antiviral drugs” for life to prevent the new liver from developing cirrhosis or liver cancer due to hepatitis B virus infection.

If you are a patient with hepatitis C, you will still have hepatitis C after liver transplantation. Usually, you still need to take anti-hepatitis C virus drug treatment six months after liver transplantation to reduce the recurrence rate.

It is best to have less contact with pets

In addition, after liver transplantation, it is best for patients to have less contact with pets to avoid pet parasite infections, and avoid contact with pigeons and other birds to avoid cryptococcal infection. It’s best to wear a mask to protect yourself during flu season. In terms of diet, you should eat cooked foods, avoid raw foods such as sashimi, and avoid strenuous exercise that causes a lot of sweating for six months after the operation. After you recover, you can exercise as much as ordinary people.

Venoarterial obstructionAffect liver function

Question 1. I have a relative who came back from a liver transplant abroad. After returning, his jaundice has been high and he is also very tired. What should I do? Was the liver transplant a failure?

Answer 1There are many reasons for high jaundice. First of all, you should check the hepatic vein, portal vein, hepatic artery and bile duct. How is the permeability of these four anastomoses? If it is blocked, it may affect liver function. You can arrange imaging or ultrasound examination. If it is true, If there is any obstruction, additional surgery may be necessary to avoid transplant failure.

The second situation may be rejection, which can be clarified by sectioning. The third situation may be that the patient originally had hepatitis B or C carriers and the hepatitis virus relapses; the fourth situation is infection, which can be confirmed through blood, urine and imaging tests.

Take anti-rejection drugsHigh risk of cancer

Question 2. Will taking anti-rejection drugs for a long time after liver transplantation reduce immunity and make it easier to catch a cold?

Answer 2.Can. The function of anti-rejection drugs is to reduce the patient’s own immunity to reject the transplanted organ. Therefore, the use of anti-rejection drugs will inherently cause the problem of lowered immunity. In addition to the common minor problems of being prone to colds, long-term observation may reveal that lowered immunity may There is an increased risk of malignant tumors. According to long-term foreign tracking, patients taking anti-rejection drugs have a six-fold increased risk of skin cancer and lymphoma.

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