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CION Cancer Clinics
Infection risk after a liver transplant, and how to reduce it | CION Cancer Clinics
After a liver transplant, the medicines that stop your body rejecting the new liver also lower your defence against germs. Infections come more easily, so preventive medicines, clean food and water, handwashing and reporting any fever the same day all matter. This page explains which infections the transplant team watches for, what you and your family can do at home, and which signs mean going to hospital today. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed October 2026, next review due October 2027
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On this page
- Why are infections such a risk after a liver transplant?
- Which infections are most common after a transplant?
- What can I do to lower the risk of infection after a transplant?
- What do the words on my transplant papers mean?
- Is it true that a transplant patient must stay locked indoors?
- What this page cannot tell you
- Common questions about infection after a liver transplant
The short answer
Why are infections such a risk after a liver transplant?
After a liver transplant you take medicines that quieten your immune system so it does not attack the new liver. The same medicines make it harder for your body to fight germs, so infections come more easily and can become serious faster. Most of the risk can be reduced with preventive medicines, careful hygiene, safe food and water, and reporting a fever early.
The risk changes over time
The highest risk is in the first weeks and months, when the doses of anti-rejection medicines are at their highest and the body is still healing from a large operation. Later the doses usually come down and the risk falls, but it never returns fully to normal. You will be living with a lowered defence for as long as you take these medicines, which for most people is for life. Our page on immunosuppression for life explains what that means day to day.
Who this page is for
This page is for people who have had, or are about to have, a liver transplant for liver cancer, and the family members who will look after them at home. It is general information. Your transplant team's instructions come first, every time, because they know your medicines, your blood results and your donor's history.
A fever after a transplant is never something to wait out at home.What the team watches for
Which infections are most common after a transplant?
Different germs tend to cause trouble at different times. Your team plans its preventive medicines and blood tests around this pattern.
Early infections after the operation
In the first weeks the usual causes are bacteria around the wound, the bile ducts, the lungs, the urine or a drip line. These are the same infections anyone can get after major surgery, and they are treated in hospital.
Viruses that wake up again
Some viruses live quietly in most adults and can become active when immunity is lowered. Cytomegalovirus (CMV) is the best known. Your team checks for it with blood tests and may give a preventive antiviral tablet.
Also watched closely
- Hepatitis B, if you had it before the transplant
- Shingles and cold sores
- Epstein-Barr virus
Unusual lung and fungal infections
A lowered defence lets in germs that rarely trouble healthy people, including a type of pneumonia and some fungal infections. Preventive medicines are often given for a period after the transplant to guard against them.
Tuberculosis
TB is common in India, and an old, silent TB infection can become active once immunity is lowered. Many transplant teams screen for it before the operation and keep watching for it afterwards.
A cough that does not settle deserves a call to the team.Not sure whether this applies to you?
Ask an oncologist
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Go to hospital today if this happens
If someone who has had a liver transplant develops a fever, shivering, new yellowing of the eyes or skin, pain in the abdomen, breathlessness, new confusion or drowsiness, or diarrhoea they cannot keep up with, go to hospital the same day. Call the transplant team on the way and tell the emergency doctors about the transplant and the anti-rejection medicines. Do not wait for the morning, and do not start leftover antibiotics at home.
At home
What can I do to lower the risk of infection after a transplant?
Take every preventive medicine as written
The antiviral, antibiotic and antifungal tablets you are sent home with are there to stop an infection before it starts. Do not stop them early because you feel well, and never change the anti-rejection medicines without the team.
Wash hands, often and properly
Soap and water before eating, after the toilet and after touching animals is the single most useful habit for you and everyone at home. Visitors with a cold or fever should stay away until they are well.
Eat and drink safely
Drink boiled or filtered water. Eat food that is freshly cooked and hot. Avoid street food, cut fruit sold on the roadside, raw eggs, unpasteurised milk and undercooked meat or fish. Wash and peel fruit at home.
Keep up your vaccines, with the team's say
Some vaccines are given before the transplant, and the inactivated ones such as the flu vaccine are usually recommended afterwards. Live vaccines are generally not safe once you are on anti-rejection medicines. Family members should be vaccinated too. See our page on hepatitis B vaccination.
Keep every blood test and clinic visit
Many infections show up in blood results before you feel ill. Regular tests also check the medicine levels, which keeps the balance between infection and rejection right.
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On your discharge papers
What do the words on my transplant papers mean?
- Immunosuppressant
- A medicine that lowers the immune system's activity so the body accepts the new liver. These are the anti-rejection medicines.
- Preventive treatment
- A medicine given to stop an infection that has not started yet, usually for a set period after the transplant.
- CMV
- Cytomegalovirus, a common virus that most adults already carry quietly. It can cause fever, a low blood count or liver trouble in a transplant patient.
- Opportunistic infection
- An infection from a germ that rarely harms healthy people but takes its opportunity when immunity is low.
- Drug level
- A blood test that shows how much anti-rejection medicine is in your blood. Too much raises infection risk, too little raises rejection risk.
Commonly believed
Is it true that a transplant patient must stay locked indoors?
"After a transplant you can never leave the house or meet anyone."
Crowds and sick visitors are best avoided early on, but most people go back to walking outside, meeting family and, in time, working. The team will tell you when each step is reasonable for you.
"A home remedy or tonic will build up immunity again."
Herbal products and tonics can change the levels of anti-rejection medicines or harm the new liver. Show the team anything you are thinking of taking, without worrying about being judged.
"A mild fever is just the weather, so paracetamol is enough."
The immune system's warning signs are muted after a transplant, so a mild fever can hide a serious infection. Call the team the same day and let them decide.
"The family should keep a strict diet with very little protein."
Healing and fighting infection need enough protein. Ask the transplant dietitian what to eat rather than cutting foods out on your own.
Being straight with you
What this page cannot tell you
It cannot tell you which preventive medicines you need or for how long. That depends on your blood tests before the transplant, your donor's results, the anti-rejection plan and how your recovery goes. Only the transplant centre that operated on you can set that plan, and it changes as you recover.
Who this does not apply to
This page is not about infection risk during chemotherapy, immunotherapy or after a liver resection. Those carry different risks, and the advice is not the same. It also does not cover people who are still waiting for a transplant.
Where CION fits in
Liver transplants are carried out at licensed transplant centres, and the transplant team leads your infection care. CION's oncologists can help with the cancer side of follow-up, and with what to watch for over the longer term, including new cancers after a transplant.
If you are unsure whether a symptom counts, call your transplant team first. If you cannot reach them and the person has a fever, go to hospital.Questions we are asked
Common questions about infection after a liver transplant
How long does the high infection risk last?
It is highest in the first few months after the transplant, when anti-rejection doses are at their highest. It usually falls as the doses are lowered, but it stays above normal for as long as you take these medicines. That is why good habits are meant to last, not just for the first weeks.
Should I wear a mask after a liver transplant?
Many transplant teams advise a mask in crowded places, hospitals and on public transport, especially in the early months and during flu season. At home a mask is usually not needed unless someone in the house is unwell. Follow your own team's advice on this.
Can I keep pets at home?
Often yes, with care. Someone else should clean cages, litter and droppings, especially in the early months, and you should wash your hands after touching animals. Birds and new pets carry particular risks. Ask the team before bringing a new animal into the house.
Can family members get vaccines while I recover?
Yes, and it helps protect you. Household members are often encouraged to have the flu vaccine and to make sure they are protected against hepatitis B. A few live vaccines given to children need extra care around a transplant patient, so mention the transplant to the doctor giving them.
What if hepatitis B was the cause of my liver disease?
Hepatitis B can come back in the new liver if it is not kept under control. Most people continue antiviral tablets for life after the transplant, sometimes with other protection. The virus is controlled, not removed, so never stop these tablets unless the hepatologist tells you to.
Can I travel back to my district after discharge?
Many people do, once the team agrees. Before you go, know which hospital near home you would go to with a fever, carry a written summary of the transplant and medicines, and keep a reliable way to reach the transplant team. Plan how you will get back for blood tests.
Does an infection mean the new liver is failing?
No. Most infections after a transplant are treated and the liver keeps working. But some infections affect the liver directly, and rejection can look like an infection at first. That is why the team needs to see you and run tests quickly rather than guessing.
Can CION help after my transplant?
Your transplant centre leads your infection care and anti-rejection medicines. CION's oncologists can help with cancer follow-up, scans to check for the cancer returning, and questions about the longer term. Call the helpline and someone will tell you who to speak to.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- NIDDK — Liver Transplant - NIDDK
- MedlinePlus — Liver Transplantation
- NHS Blood and Transplant — Liver - Organ transplantation - NHS Blood and Transplant
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Immunosuppression for lifeWhat the anti-rejection medicines mean day to dayRejection: signs and what is doneThe other side of the balance, and how to tell them apartLife after a liver transplantWork, food, travel and what normal looks likeCancer coming back after a transplantWhy cancer follow-up scans continue
Talk to us
Have questions about follow-up after your transplant?
We can help you understand the cancer side of follow-up after a transplant and what to watch for over the years ahead. Call when it suits you and someone will listen. One helpline serves every CION centre.