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Update on Post-Liver Transplantation Infections, Malignancies, and Surgical Complications

Washington, Kay MD, PhD

Advances in Anatomic Pathology: July 2005 - Volume 12 - Issue 4 - p 221-226
doi: 10.1097/01.pap.0000175113.55541.9c
Review Article

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.

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee.

This work was presented at Hans Popper Hepatopathology Society Companion Meeting, United States and Canadian Academy of Pathology, March 2004.

Reprints: Kay Washington, MD, PhD, C-3321, Medical Center North, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232 USA (e-mail

© 2005 Lippincott Williams & Wilkins, Inc.