The severity of the initial status of the recipient, duration and invasiveness of the surgery of liver transplantation, immunosuppressive therapy become mandatory objective prerequisites for the development of various complications.
The most common complications developing in the postoperative period are the primary nonfunctioning graft rejection of transplanted organ, the formation of biliary fistula, bleeding, sepsis, renal failure, the development of pulmonary and cardiac failure.
The absence of liver function after transplantation occurs in approximately 5% of patients and developed in the next 24 - 48 hours. The most common complication is due to violation of conservation of the donor liver (30 hours), the beginning of rejection or other causes. When this condition is violated bile. This condition requires immediate retransplantatsii.
First of all, the cause of graft dysfunction is a rejection, it may not only lead to the loss of the transplanted organ, but also to the death of the patient. Rejection can be acute (cellular) and chronic (duktopenicheskim), mild, moderate and severe.
The response of acute (cellular) rejection develops within 7 to 10 days and is often a reversible process. The patient begins to feel unwell, palpation of the liver is enlarged, heavy, painful, there is an increase in body temperature, worsening jaundice, palpitations. In the analysis, changes: There is a slight or moderate rise of bilirubin and secreted enzymes. In such a situation, usually increases the dose of immunosuppressive drugs. Chronic (duktopenicheskoe) rejection develops within 3 months, but possibly earlier development. This process is irreversible. Although in the beginning with increasing doses of hormones may temporarily improve.
Bleeding usually occurs in the early postoperative period. Here are the risk factors for reduced graft function, renal failure, massive blood loss, impaired venous drainage, improper suturing.
The development of sepsis may be associated with primary infection due to activation of a previous infection or previous addition of a secondary infection, the formation of bile or intestinal fistula, arterial thrombosis.
In general, post-transplant complications in the period can be divided into four groups: due to the patient prior to transplantation, graft quality, surgical complications and the complications of immunosuppressive therapy.
At the present time in the world are ongoing to develop new immunosuppressive regimes that effectively, with minimal side effects will prevent the first episode of acute rejection. Development of new medicines that during the subsequent chronic administration does not allow the development of rejection and do not endanger the patient's life due to adverse reactions.
