Infections and liver transplants

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.

Learn about risks from donated liver

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.