Post-Transplant Follow-up Care in Dhaka

The first year after liver transplantation is critical. During this period, the risk of acute rejection, infection, and surgical complications is highest. Regular follow-up allows early detection and prompt treatment of problems before they threaten graft function.

Beyond the first year, long-term follow-up focuses on managing chronic rejection, immunosuppression side effects (diabetes, kidney disease, hypertension), and cancer surveillance — ensuring the transplant continues to provide a good quality of life.

Dr. Arefin's follow-up protocol includes frequent visits in the first month (weekly to fortnightly), monthly visits for months 2–6, and quarterly visits thereafter. Each visit includes liver function tests, immunosuppression drug levels, and clinical assessment.

Imaging surveillance with ultrasound and, when indicated, CT or MRI helps detect vascular complications, biliary strictures, and tumour recurrence early. Endoscopic retrograde cholangiopancreatography (ERCP) is available when biliary issues are suspected.

Lifelong immunosuppression is required to prevent rejection, but these medications have significant side effects. Dr. Arefin monitors drug levels, adjusts doses based on liver function and side effect profile, and works with transplant physicians to optimise the balance between rejection prevention and infection risk.

Common immunosuppressants include tacrolimus, mycophenolate mofetil, and prednisolone. Over time, Dr. Arefin aims to minimise steroid exposure and reduce calcineurin inhibitor doses to protect kidney function.

Surgical complications after liver transplant include hepatic artery thrombosis, portal vein stenosis, biliary strictures, and bile leaks. Early detection through Doppler ultrasound and clinical vigilance is essential.

Dr. Arefin manages these complications through a combination of interventional radiology, endoscopic techniques (ERCP/stenting), and when necessary, reoperation. His surgical expertise in hepatobiliary anatomy makes him well-equipped to handle the technical challenges of transplant complication surgery.