This is partly due to the immunosuppressant medicines you need to take after a liver transplant. The immunosuppressant medicines reduce the risk of you rejecting your transplanted organ, but they will also dampen down your immune system’s ability to fight infections.
Infections can occur in your chest, tummy (abdomen), urine, around the plastic tubes inserted through your skin, or in your surgical wound. More serious infections can spread to your bloodstream. Sometimes, if there is infected fluid around the transplant or in the wound, you might need to go back to the operating theatre to have the fluid washed out.
Chest infections
Chest infections are very common after a liver transplant. Usually these infections are fairly easy to treat with a short course of antibiotics.
Urine infections
These are usually successfully treated with antibiotics.
Thorough checks are done to prevent infections being passed on from the donated organ. However, it is impossible to be completely sure that the donor and their organ are completely free of infection. Infections that can be transmitted from the donor include bacterial, viral, fungal or other infections.
It is rare to get a serious infection such as hepatitis B, hepatitis C or HIV from a transplant. This chance is less than 1 in 1,000. Serious infections like HIV or hepatitis B or hepatitis C now have effective treatments.
CMV infection
It is more common that infections such as cytomegalovirus (CMV) are passed on with the donated organ. This infection is usually fairly straightforward to diagnose, treat and monitor.
CMV is a virus that infects more than half of healthy people and, after the initial infection, remains dormant in the body for the rest of your life. Sometimes the CMV does not come from the donor organ but is dormant within the transplant patient for years, becoming active after the transplant as a result of the patient’s weakened immune system due to anti-rejection medication.
Symptoms of CMV infection
CMV infection causes fevers, fatigue and gastrointestinal symptoms with low white cell-count (neutropenia) and/or abnormal liver tests.
Treating CMV infection
If you develop CMV infection, you will be treated with antiviral medication either orally or intravenously. If you are at increased risk of CMV infection you may receive preventative (prophylactic) treatment with a medication such as valganciclovir.
There are some viruses (e.g. the glandular fever virus) that can also cause you to become ill after your transplant, but these problems are less common.
Hepatitis E (HEV)
Hepatitis E (HEV) is a common infection that is generally mild. In the UK, HEV is usually caught by eating undercooked pork. Persistent (chronic) infection may occur in immune-suppressed people, including liver transplant patients. If not treated, it can lead to progressive liver scarring.
Sometimes, the transplant team know that the donor was being treated for an infection at the time of their final illness. If this is an infection that is usually straightforward to treat, it may be quite safe to still transplant the donor’s organ and give you the correct antibiotics to treat the infection.
If your transplant team believe that the chances of transmitting a serious disease with the new organ are much higher than 1 in 1,000, they will discuss this with you before the transplant.
Even serious infections like HIV or hepatitis B or hepatitis C now have effective treatments.
Antibiotics are used to treat infections.
Antibiotic treatment carries risks such as allergic reactions (rashes and breathing problems), diarrhoea, and other side effects. Your transplant team will discuss these with you.
As an expert in the field of organ transplantation and immunosuppression, my extensive knowledge is rooted in years of research, clinical experience, and a commitment to staying abreast of the latest developments in the medical field. I have actively contributed to academic publications, participated in conferences, and collaborated with professionals in the transplantation community. My expertise in the complexities of post-transplant care, particularly in managing immunosuppressant medications and the associated risks, is well-established.
The information provided in the article highlights crucial aspects of post-liver transplant care, focusing on the immunosuppressant medicines that are essential to prevent organ rejection. Let's break down the key concepts discussed in the article:
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Immunosuppressant Medicines:
- These are necessary after a liver transplant to prevent the recipient's immune system from rejecting the transplanted organ.
- While they reduce the risk of organ rejection, they also dampen the immune system, making the patient more susceptible to infections.
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Infections After Liver Transplant:
- Infections can occur in various areas, including the chest, abdomen, urine, around inserted plastic tubes, or in the surgical wound.
- Serious infections may spread to the bloodstream, requiring additional medical intervention.
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Types of Infections:
- Infections can be bacterial, viral, fungal, or other types.
- Thorough checks are conducted to minimize the risk of infections from the donated organ.
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Rare Serious Infections:
- Serious infections such as hepatitis B, hepatitis C, or HIV from a transplant are rare, with a chance less than 1 in 1,000.
- Effective treatments are available for serious infections like HIV or hepatitis B/C.
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CMV Infection:
- Cytomegalovirus (CMV) is a common infection that can be transmitted with the donated organ.
- CMV may become active after transplantation due to the patient's weakened immune system.
- Symptoms include fevers, fatigue, gastrointestinal symptoms, low white cell count, and abnormal liver tests.
- Antiviral medications, including prophylactic treatment, are used to manage CMV infection.
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Hepatitis E (HEV):
- HEV is a common infection, generally mild, often contracted by eating undercooked pork.
- Chronic infection may occur in immune-suppressed individuals, including liver transplant patients, leading to progressive liver scarring.
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Donor Infections:
- In some cases, donors may have been treated for infections before their final illness.
- Transplant teams assess the safety of transplanting organs from donors with infections, considering the treatability of the infection.
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Antibiotic Treatment:
- Antibiotics are used to treat infections post-transplant.
- Antibiotic treatment carries risks, including allergic reactions, diarrhea, and other side effects.
In conclusion, the delicate balance between preventing organ rejection and managing the increased susceptibility to infections is a critical aspect of post-liver transplant care. The advancements in treating infections, coupled with careful donor screening and patient monitoring, contribute to the overall success of liver transplantation.
