Update on post-liver transplantation infections, malignancies, and surgical complications.
Complications of liver transplantation are not limited to acute and chronic rejection, and recurrence of original disease, but include surgical complications, most commonly hepatic artery occlusion, infections, and development of de novo malignancies. In the early posttransplantation period, procurement/preservation injury, non-immunologic injury to the graft during harvesting and implantation, is manifested by centrilobular hepatocyte pallor and cholestasis but rarely leads to significant graft dysfunction. Ischemic complications, such as hepatic artery thrombosis, are more serious complications and may lead to early graft loss or biliary stricture. Infectious complications generally occur in the mid-to-late period after transplantation; cytomegalovirus (CMV) remains a common pathogen. Human herpes 6 virus infection has been implicated in allograft dysfunction, but is usually seen in the setting of co-infection with CMV. De novo malignancies are emerging as a significant cause of mortality after liver transplantation; risk is cumulative, and increases with time posttransplantation. Development of such malignancies in the setting of solid organ transplantation is multifactorial, and is related to individual and regional predispositions to malignancy, pre-transplantation disease states, recipient viral status, and use and intensity of immunosuppression regimens.
Washington
Kay
K
Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. kay.washington@vanderbilt.edu
D000818:Animals; D002177:Candidiasis / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D006083:Graft Occlusion, Vascular / Q000473:pathology; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology; D006499:Hepatic Artery; D006566:Herpesviridae Infections / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D009369:Neoplasms / Q000209:etiology*; D009926:Organ Preservation; D011183:Postoperative Complications / Q000473:pathology; D015427:Reperfusion Injury / Q000473:pathology; D013927:Thrombosis / Q000209:etiology / Q000473:pathology; D013997:Time Factors