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Rejection is a signal that your immune system has identified your new liver as foreign tissue, and is trying to attack it. Preventing rejection with immunosuppression medications is the first priority. An episode of rejection of the transplanted liver is very common.
Symptoms may include:
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- a low grade temperature
- decreased appetite
- abdominal discomfort
- joint and/or back pain
- tenderness over the liver
- increased abdominal fluid
- decrease in the amount of bile produced
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Because most people may not have obvious signs of rejection, your child's liver function tests will be closely monitored. If they are abnormal, a biopsy may be performed to confirm that your child is experiencing a rejection episode.
If your child has an episode of rejection, the amount of anti-rejection medication is increased or a different combination of anti-rejection medications is prescribed. In more than 95% of these cases, adjusting medications will stop rejection.
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The anti-rejection medications that your child is taking to prevent and treat rejection tell your immune system to accept the new liver. In doing so, they also can be telling the immune system to accept other things that it would ordinarily fight. In other words, the anti-rejection medications put your child at risk for developing an infection.
The most common infections result from viruses that have been lying dormant in your child's system or in the donated liver. To prevent infection, your child will take anti-bacterial, anti-virus, and anti-fungal medications for many months to years after transplant.
If an infection is suspected, your team may take sputum, blood, and urine samples, as well as samples from your child's catheter, wound, and drain sites.
Signs that you may notice in your child include:
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- Fever
- Tiredness or fatigue
- Diarrhea or vomiting
- Redness or drainage around the incision, bile, or tube site
- Cough
- Sore throat
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If your child develops an infection, it will be treated with medications specific for that infection.
If infection develops after your child has been discharged, it is usually treated with antibiotics as an outpatient. However, some people need to be readmitted for treatment with intravenous (IV) medications.
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On very rare occasions, a new liver does not function properly or at all after the operation, and a second transplant operation is urgently necessary.
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The new bile duct that was connected during surgery may leak or become blocked after the operation. A painless x-ray (called a cholangiogram) might be taken that involves injecting x-ray or contrast dye into the tube to see if there are problems. Most bile duct problems can be treated without further surgery, but some do require another operation.
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On rare occasions, problems may arise with the new connections between the veins and arteries of the new liver and those in your child's body to which they are connected. Laboratory tests, ultrasounds and x-rays help your team determine if problems are present. Occasionally, surgery is necessary to correct these problems.
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Bleeding from your child's incision or in the gastrointestinal tract is a possible complication that can be handled if identified quickly. Report any bleeding to your doctor immediately. Bleeding you should report includes bleeding from the incision, vomiting blood, and blood in bowel movements.
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Children who receive immunosuppression for organ transplants may develop a disorder in which lymphocytes (a particular kind of white blood cells) start growing in an abnormal fashion. This is usually triggered by an infection with or reactivation of Epstein Barr virus, which infects B-cells, a certain kind of lymphocytes. These abnormally growing cells may be found in lymph glands anywhere in the body, or in organs such as the intestine, the spleen, and even the liver graft itself.
Lowering the amount of immunosuppression can reverse the early stages of PTLD, but sometimes other treatments are necessary. Uncommonly, PTLD can progress to full-blown lymphoma (cancer of the lymph cells) requiring chemotherapy. Depending upon your child's history of EBV infection and the type and of immunosuppression needed, your child may be at risk for PTLD.
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When your child leaves the MSICU, you will learn how to provide care. Your role as a partner with the transplant team becomes extremely important at this point because your child's new liver will need lots of care, attention and monitoring to do its job. Having a new liver is a lifelong commitment.
While you are on the transplant unit, encourage your child to cough and deep breathe to keep the lungs clear of fluid. Encourage your child to get out of bed and walk around the unit at least three times a day. Walking increases blood circulation helps relieve gas pain and helps maintain muscle tone.
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Your transplant team will determine the appropriate medications for your child. They will include anti-rejection medications and possibly medications to control blood pressure, prevent infection and prevent fluid retention.
You will be trained in the correct usage and possible side effects of each medication while at the hospital. By taking responsibility for your child's medications while at the hospital, under the supervision of a nurse, you can make the transition to home less stressful.
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