Complications, risks, and consequences

Estimatedfrequency

Most significant/serious complications

Early complications (≤90 days after surgery)

Infection^a

 Wound

5–20 %

 Intra-abdominal (including liver subphrenic abscess)

1–5 %

 Intrathoracic (pneumonia; pleural, mediastinitis)

20–50 %

 Systemic

1–5 %

 Opportunistic (CMV, candidiasis, pneumocystis)^a

50–80 %

Vascular/coagulation related^a

Bleeding and hematoma overall

20–50 %

 Arterial, venous (caval, renal, portal, hepatic, or lobar vessels)

5–20 %

 Raw liver surface

5–20 %

 Extrahepatic

 

 Chance of returning to the operating theatre for post-op bleeding

5–20 %

 Vascular occlusion (all causes) (Non-thrombotic; partial or complete kinking; arterial stenosis)

5–20 %

Thrombosis

 Hepatic arterial

1–5 %

 Portal venous

1–5 %

 Hepatic venous

0.1–1 %

 IVC complications (stenosis; kinking)^a

1–5 %

 Coagulopathy (all causes)

20–50 %

 Disseminated intravascular coagulopathy

0.1–1 %

 Consumption posttransfusion (large bleed)^a

1–5 %

 Deep venous thrombosis

0.1–1 %

Liver related^a

 Subcapsular liver hematoma^a (major, at transplantation or liver biopsy)

5–20 %

 Hepatitis (drug, CMV, recurrent)^a

5–20 %

 Primary liver transplant nonfunction^a

2–5 %

 Common/extrahepatic/intrahepatic bile duct injury

1–5 %

 Bile collections

1–5 %

 Budd-Chiari (acute)^a

0.1–1 %

GI related^a

 Seroma/lymphocele formation^a

20–50 %

 Gastrointestinal injury, erosion, ulceration, perforation, hemorrhage

5–20 %

 Pancreatic or duodenal injury/fistula/pancreatitis

1–5 %

 Small bowel obstruction (early or late)^a [Ischemic stenosis/adhesion formation]

1–5 %

 Possibility of colostomy/ileostomy (very rare)^a

<0.1 %

Splenic injury

0.1–1 %

 Conservation (consequent limitation to activity; late rupture)

 

 Splenectomy

 

Lung/chest related^a

 Pneumothorax or pulmonary injury (direct)

50–80 %

 Pleural effusions^a

20–50 %

 Chest infection^a

5–20 %

 Surgical emphysema^a(major)

1–5 %

 Thoracic duct injury (chylous leak, fistula)^a

1–5 %

 Aspiration pneumonitis

0.1–1 %

 Air embolus (major)

0.1–1 %

 Diaphragmatic injury hernia or paresis

0.1–1 %

Cardiac related^a

 Cardiac arrhythmias (major)

20–50 %

 Pericardial effusion

1–5 %

 Myocardial injury/cardiac failure infarction (hypotension)

1–5 %

Renal related

 Acute renal failure (including hepatorenal syndrome)

5–20 %

 Renal/adrenal injury renal vein^a

1–5 %

Metabolic

 Hypoglycemia

5–20 %

 Hyperglycemia

1–5 %

Neurological

 Sleep disturbance, mental disturbance

50–80 %

 Seizures

1–5 %

 Cerebral edema

1–5 %

Wound dehiscence^a

0.1–1 %

Multisystem organ failure (renal, pulmonary, cardiac failure)^a

1–5 %

Early mortality^a

5–20 %

Intermediate complications (90–360 days after surgery)

Biliary related and fluid leaks^a

 Hyperbilirubinemia

50–80 %

 Biliary and serous/lymph ascites

20–50 %

 Bile duct obstruction (any cause) [Ischemia; stenosis]

5–20 %

 Bile leak

5–20 %

 Biliary collection

5–20 %

 Biliary fistula

1–5 %

 Persistent clinical jaundice

1–5 %

Rejection^a

 Early/late acute/hyperacute

20–50 %

 Chronic

0.1–1 %

Late complications (≥360 days after surgery)

Chronic liver rejection^a

5–20 %

Neurological^a(peripheral and central nervous systems)

5–20 %

Chronic renal failure (5–10 years)^a

20–50 %

Immunosuppression toxicity^a

5–20 %

Posttransplant malignancies (long term)^a

 Skin cancers (long term)^a

>80 %

 Lymphoproliferative disorders (lymphoma)^a

5–20 %

 Carcinomas^a

Individual

 Recurrence of malignancy (if transplanted for malignancy)^a

Individual

Recurrent cirrhosis (all causes)^a [Hep B, C, alcohol, biliary cirrhosis, sclerosing cholangitis, autoimmune hepatitis]

20–50 %

Biliary^a(all causes: stones, stenosis, recurrent cholangitis, sclerosis)

5–20 %

Metabolic

 Hyperlipidemia

20–50 %

 Hyperglycemia

5–20 %

 Osteoporosis

5–20 %

Graft-versus-host disease (GVHD)^a

0.1–1 %

Graft loss^a

 1 year (~10 %)^b

5–20 %

 5 year (~25 %)^b

20–50 %

Late mortality^a

5–20 %

Less serious complications

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