Liver transplant complications

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Background

  • 2nd most frequently transplanted solid organ
  • May be from living or deceased donor
  • Most common causes of liver failure necessitating transplant include hepatitis C or B infection, alcoholic cirrhosis, idiopathic/autoimmune liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, and acute liver failure (e.g. drug/toxin induced, acute hepatitis, etc.)

Immunosuppressant Medications

Clinical Features

Differential Diagnosis

Most common problems in liver transplant patients involve:

  • Acute graft rejection
    • 1 in 5 have rejection during first year, usually within <1 mo
  • Vascular thrombosis
  • Biliary leak or stricture
  • Infection
  • Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)
  • Adverse effects of immunosuppressant drugs[1]

Evaluation

  • CBC
    • Infection may cause leukocytosis or leukopenia
  • LFTs
    • Elevated in biliary, vascular, and rejection complications
  • BMP
    • Hyperglycemia, sodium, and potassium derrangements not uncommon
  • Coags
  • Tacrolimus/cyclosporine levels

Additional work up will depend on presentation, but may include:

  • Infectious workup
    • Blood and urine cultures
    • +/- PCR and other studies for viral/fungal pathogens as indicated
    • diagnostic paracentesis if evidence of SBP
  • Abdominal CT or ultrasound with doppler, if concern for rejection, biliary obstruction, or thrombosis
  • Biliary complications may need ERCP

Management

Disposition

See Also

External Links

References

  1. Liver Transplants: Practice Essentials, Orthotopic Liver Transplantation, Immunosuppression Agents. Emedicinemedscapecom. 2016. Available at: http://emedicine.medscape.com/article/776313-overview#a1. Accessed September 23, 2016.