Liver Diseases pp 741-756 | Cite as

Surgical Complications Following Liver Transplant and Their Management

  • Rahul S. Koti
  • Helen Tzerbinis
  • Brian R. DavidsonEmail author


Surgical complications are common after orthotopic liver transplantation. They have a significant detrimental impact on graft and patient survival and they increase medical costs. Their treatment may require vascular and biliary interventions by the interventional radiologists, re-operations or when graft salvage is impossible, retransplantation. Postoperative bleeding is the commonest cause for reoperation after OLT. Vascular complications in the early postoperative period are life threatening, with hepatic artery thrombosis and portal vein thrombosis being the most common. Most patients with hepatic artery thrombosis ultimately require retransplantation. Early detection and treatment of bile leaks and anastomotic biliary strictures usually result in good graft and patient survival. However, nonanastomotic biliary strictures are difficult to treat and most patients require retransplantation. Intra-abdominal infections and wound complications often require readmissions and reoperations, and close follow up and clinical examination are important in their early detection and effective treatment. Complications are more common when transplant is performed in advanced cirrhosis and with marginal donor livers, such as those from DCD (donated after cardiac death) donors. Optimal management of intraoperative coagulopathy and optimization of anaesthesia (see chapter 70: Anaesthesia for Liver Transplantation) and surgical techniques are important in preventing postoperative surgical complications. Early diagnosis and treatment of complications improves graft and patient survival but when graft damage is severe, early retransplantation can save the patient’s life.


Liver transplantation Complications Surgical Postoperative Morbidity Mortality Retransplantation 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rahul S. Koti
    • 1
    • 2
  • Helen Tzerbinis
    • 1
    • 2
  • Brian R. Davidson
    • 1
    • 2
    Email author
  1. 1.HPB and Liver Transplant UnitRoyal Free London NHS Foundation TrustLondonUK
  2. 2.Centre for Surgical Innovation, Organ Repair and Transplantation, Division of Surgery, Hampstead CampusUniversity College London (UCL)LondonUK

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