The success of long-term liver transplantation depends on the quality of the management of possible complications. These include surgical complications, opportunistic infections, rejection, and recurrence of the initial disease. The side effects of immunosuppressive drugs - high blood pressure, glucose intolerance and diabetes, dyslipidemia and obesity, kidney failure, osteoporosis, some forms of cancer and anemia - are the focus of attention and special care.

General surgical procedures are quite possible in transplant patients. A pregnancy, despite being considered at risk, can be successfully completed in a considerable number of cases.

Liver transplantation (TH) is a treatment that significantly prolongs the survival of patients with terminal liver disease. The main indications for TH in adults are viral cirrhosis B and C, alcoholic cirrhosis, primary biliary cirrhosis, cholangitis, Wilson's disease, autoimmune hepatitis and fulminant hepatitis (viral, drug or toxic). More rarely, TH is the treatment of choice for certain metabolic diseases, including liver defects, such as familial hypercholesterolemia or familial amyloidosis.

After TH, the hospital stay lasts 2-3 weeks. The patient is then followed on an outpatient basis by the consulted liver transplant hospital in India and the attending physician. A check is made every week during the first three months, then it becomes fortnightly and monthly from the sixth month. A routine check includes, in addition to the history and targeted clinical examination, a blood test for the complete blood count, electrolytes, urea and creatinine, complete liver tests and measurement of the blood levels of immunosuppressants.

A patient who does not suffer complications during the first three months after TH has a low risk of mortality later and his quality of life is gradually approaching that of the general population. As a result, an increasing number of TH patients have been referred to the attending physician for long-term follow-up. This consists not only in the monitoring of liver function (in case of rejection or recurrence of the initial disease), but especially in the detection and treatment of the side effects of immunosuppression.

SURGICAL INTERVENTIONS IN THE TRANSPLANTED PATIENT

In general, surgical procedures in the transplanted patient are possible, but studies on this subject involve a limited number of patients. For example, orthopedic hip or knee replacement operations are not accompanied by increased mortality or morbidity. It must, however, be considered as abdominal interventions will be more difficult due to the TH.

PREGNANCY AFTER LIVER TRANSPLANTATION

Hormonal contraception or barrier methods are desirable until immunosuppression is stabilized at low doses. Pregnancy after TH is quite possible because of a return of menstruation and fertility. However, a moderately increased risk of preeclampsia, prematurity, and low birth weight should be reported. Pregnancy in this context remains at risk and should not occur in the first post-TH year.

IMMUNIZATIONS

Live vaccines after TH are contraindicated. Transplant patients should be vaccinated against hepatitis A and B (if they are not already immune), pneumococci, and influenza (annual vaccination). It should be considered that immunocompromised patients respond less effectively to vaccines. Travel is entirely possible, provided that the patient is aware of the general hygienic precautions to follow, has a sufficient supply of medicines and can go to liver transplant hospitals in the country visited if necessary.