Monitoring liver transplant recipients for signs of rejection or complications during the post-transplant period requires a multifaceted approach combining clinical assessment, laboratory testing, imaging, and sometimes histological evaluation. Regular clinical review is essential to detect symptoms such as fever, jaundice, abdominal pain, or changes in liver function, which may indicate rejection or other complications NICE NG50. Biochemical monitoring includes serial liver function tests (LFTs) to detect elevations in transaminases, bilirubin, and alkaline phosphatase, which are sensitive indicators of graft injury or rejection NICE NG50.
Immunosuppressant drug levels must be regularly checked to ensure therapeutic levels are maintained, reducing the risk of rejection while minimizing toxicity NICE NG50. Imaging studies, such as Doppler ultrasound, are used routinely to assess vascular patency and biliary complications, which are common post-transplant issues NICE NG50.
When rejection is suspected, liver biopsy remains the gold standard for diagnosis, allowing histological confirmation and grading of rejection severity NICE NG50. Recent advances highlight the potential role of novel biomarkers in blood, such as donor-derived cell-free DNA and specific immune signatures, which may provide earlier and less invasive detection of acute rejection Pan et al. 2025. However, these biomarkers are adjuncts and not yet standard practice.
Close monitoring for infectious complications and metabolic derangements is also critical, as these can mimic or exacerbate rejection NICE NG50. Overall, a structured post-transplant surveillance protocol integrating clinical, biochemical, imaging, and histological data, supplemented by emerging biomarker research, optimizes early detection and management of rejection and complications in liver transplant recipients NICE NG50; Fernandez & Gardiner 2015; Pan et al. 2025.
Key References
- NG50 - Cirrhosis in over 16s: assessment and management
- CG165 - Hepatitis B (chronic): diagnosis and management
- (Neuberger et al., 2017): Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.
- (Fernandez and Gardiner, 2015): Critical Care of the Liver Transplant Recipient.
- (Pan et al., 2025): Diagnostic and predictive biomarkers of acute rejection after liver transplantation.