Medical problems occurring after orthotopic liver transplantation.
Liver transplantation is complicated by specific medical problems. Diabetes mellitus occurs in 4-20% of patients undergoing liver transplantation. Patients with primary sclerosing cholangitis and ulcerative colitis experience up to a 13% incidence of colon cancer after transplantation. Lymphomas occur in 1-3% of patients after transplantation and account for 57% of malignancies occurring in adult patients. Atraumatic bone fractures occur in 22-38% of patients and neurological complications, including seizures, headache, and neuropathy occur in 19-47% of patients following liver transplantation. Patients undergoing liver transplantation may experience recurrence of their primary liver disease: hepatitis B, hepatitis C, primary biliary cirrhosis, autoimmune hepatitis, or primary sclerosing cholangitis. In patients not receiving immunoprophylaxis after transplantation for chronic hepatitis B, recurrent hepatitis B is seen in up to 90% of patients. This can be markedly reduced with hyperimmune globulin immunoprophylaxis. Recurrent hepatitis C is seen in the majority of patients; current treatment modalities are inadequate. Recurrence of primary biliary cirrhosis or primary sclerosing cholangitis in the allograft is infrequent. Autoimmune hepatitis may recur in up to 26% of patients following liver transplantation. Primary disease recurrence in the allograft and preventive strategies are discussed.
Carson
K L
KL
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Hunt
C M
CM
D001847:Bone Diseases / Q000209:etiology; D003920:Diabetes Mellitus / Q000209:etiology; D007172:Erectile Dysfunction / Q000209:etiology; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009369:Neoplasms / Q000209:etiology; D011247:Pregnancy; D012008:Recurrence