Medical complications of liver transplantation

Orthotopic liver transplantation has become the standard of care for adult patients with endstage liver diseases. Knowledge in post-transplant medical complications has grown considerably in the last few decades. Graft rejection occurs in both early and late settings, and its diagnosis is confirmed and severity graded by a core needle liver biopsy. Acute rejections should be treated appropriately to avoid graft loss whereas chronic ductopenic rejection carries a poor prognosis without re-transplantation. The causes of acute kidney injuries are different from that of the chronic renal disease in post-transplant setting. With increasing prevalence of non-alcoholic fatty liver disease (NAFLD) and older transplant recipients, de novo diabetes and metabolic bone disease are becoming more recognized in the post-transplant era. De novo malignancy, post-transplant lymphoproliferative disorder, although less common, signals significant mortality in this population. The outcomes of graft rejection, renal dysfunction, diabetes, bone disease and de novo malignancy are dependent on timely recognition, alterations of the immunosuppression regimen, and occasionally liver re-transplantation in the setting of irreversible graft rejection and kidney transplantation in end-stage renal disease (ESRD). There is still significant mortality and morbidity associated with these medical complications despite our medical advances.