How should I monitor liver transplant recipients for signs of rejection or complications in the post-transplant period?

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 ¹. 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 ¹.

Immunosuppressant drug levels must be regularly checked to ensure therapeutic levels are maintained, reducing the risk of rejection while minimizing toxicity ¹. Imaging studies, such as Doppler ultrasound, are used routinely to assess vascular patency and biliary complications, which are common post-transplant issues ¹.

When rejection is suspected, liver biopsy remains the gold standard for diagnosis, allowing histological confirmation and grading of rejection severity ¹. 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 ¹. 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 ¹; (Fernandez and Gardiner, 2015); (Pan et al., 2025).