Intermediary Folllow-Up at Liver Transplantation

The second period of follow-up takes place in conventional hospital settings and lasts an average of 6 weeks, Monitoring of liver and kidney function tests and blood cyclosporine trough levels is carried out daily. Prednisone is given orally and its dosage diminished to 0,5mg/kg per day at 1 month, cyclosperine is progressively switched from i.v. to oral.Three main complications are observed in this period :

1. Rejections is always possible and is managed as described above.

2. CMV infection must be searched for by repeated blood and urine cultures; the combination of prevention with specific immunoglobulins, early detection, and DHPG (dehydrosyphenylguanine, Gancyclovir) treatment of the symptomatic forms has made the severe forms of CMV infections vey rare.

3.Biliary complications occur in 10%-15% of cases and may be of two types: either stenosis at the level of the anastomosis, unrrelated to hepatic artery thrombosis and cured by endoluminal dilation or surgical repair, or as a delayed consequence of hepatic artery thrombosis; treatment of the latter is difficult, using various types of interventional radiology techniques, reoperation on the bile ducts, and sometimes retransplantion.