Liver transplant complications - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:18:18Z

Prepared the page for translation

← Older revision		Revision as of 23:18, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

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

			</translate>
	{{Immunosuppressant medication complications}}		{{Immunosuppressant medication complications}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Signs/symptoms of infection		*Signs/symptoms of infection
	**[[Fever]] and localizing symptoms may be blunted due to immunosupression		**[[Special:MyLanguage/Fever\|Fever]] and localizing symptoms may be blunted due to immunosupression
	*[[GI bleed]]		*[[Special:MyLanguage/GI bleed\|GI bleed]]
	*[[RUQ pain]], especially with biliary complications		*[[Special:MyLanguage/RUQ pain\|RUQ pain]], especially with biliary complications
	*Neurologic findings		*Neurologic findings
	**[[focal neuro deficits]] or [[altered mental status]] due to bleed, infarct, thrombosis, osmotic demyelination, abscess, etc.		**[[Special:MyLanguage/focal neuro deficits\|focal neuro deficits]] or [[Special:MyLanguage/altered mental status\|altered mental status]] due to bleed, infarct, thrombosis, osmotic demyelination, abscess, etc.
	*[[Jaundice]]		*[[Special:MyLanguage/Jaundice\|Jaundice]]
	**may indicate rejection or biliary leak/stricture		**may indicate rejection or biliary leak/stricture
	*[[Nausea/vomiting]]		*[[Special:MyLanguage/Nausea/vomiting\|Nausea/vomiting]]


	==Differential Diagnosis==		==Differential Diagnosis==

	Most common problems in liver transplant patients involve:		Most common problems in liver transplant patients involve:
	*Acute graft rejection		*Acute graft rejection
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	*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)		*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)
	*Adverse effects of immunosuppressant drugs<ref> 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.</ref>		*Adverse effects of immunosuppressant drugs<ref> 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.</ref>

	===Infections<ref>Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.</ref>===		===Infections<ref>Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.</ref>===

	Time from transplantation affects the risk and type of infection.		Time from transplantation affects the risk and type of infection.
	*Early (within the first month)		*Early (within the first month)
	**Donor-derived - bacterial, fungal, parasitic		**Donor-derived - bacterial, fungal, parasitic
	**Nosocomial & surgical-site - [[C. diff]], [[aspiration Pneumonia]], [[UTI]], surgical-site, superinfection of graft tissue		**Nosocomial & surgical-site - [[Special:MyLanguage/C. diff\|C. diff]], [[Special:MyLanguage/aspiration Pneumonia\|aspiration Pneumonia]], [[Special:MyLanguage/UTI\|UTI]], surgical-site, superinfection of graft tissue
	*Intermediate (1-6 months after)		*Intermediate (1-6 months after)
	**'''Highest risk for opportunistic infections''' - [[PCP]], [[TB]], fungal ([[cryptococcus]], [[histoplasma]]), viral (BK virus, [[hepatitis B]]/[[hepatitis C\|C]], [[CMV]])		**'''Highest risk for opportunistic infections''' - [[Special:MyLanguage/PCP\|PCP]], [[Special:MyLanguage/TB\|TB]], fungal ([[Special:MyLanguage/cryptococcus\|cryptococcus]], [[Special:MyLanguage/histoplasma\|histoplasma]]), viral (BK virus, [[Special:MyLanguage/hepatitis B\|hepatitis B]]/[[Special:MyLanguage/hepatitis C\|C]], [[Special:MyLanguage/CMV\|CMV]])
	**Dormant host infection reactivation - [[HSV]], [[VZV]], [[EBV]]		**Dormant host infection reactivation - [[Special:MyLanguage/HSV\|HSV]], [[Special:MyLanguage/VZV\|VZV]], [[Special:MyLanguage/EBV\|EBV]]
	*Late (more than 6 months after)		*Late (more than 6 months after)
	**Community-acquired infection		**Community-acquired infection


	==Evaluation==		==Evaluation==

	*CBC		*CBC
	**Infection may cause leukocytosis or leukopenia		**Infection may cause leukocytosis or leukopenia
	*[[LFTs]]		*[[Special:MyLanguage/LFTs\|LFTs]]
	**Elevated in biliary, vascular, and rejection complications		**Elevated in biliary, vascular, and rejection complications
	*BMP		*BMP
	**[[Hyperglycemia]], sodium, and potassium derangements not uncommon		**[[Special:MyLanguage/Hyperglycemia\|Hyperglycemia]], sodium, and potassium derangements not uncommon
	*Coags		*Coags
	*Tacrolimus/cyclosporine levels		*Tacrolimus/cyclosporine levels
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	**Blood and urine cultures		**Blood and urine cultures
	**+/- PCR and other studies for viral/fungal pathogens as indicated		**+/- PCR and other studies for viral/fungal pathogens as indicated
	**Diagnostic paracentesis if evidence of [[SBP]]		**Diagnostic paracentesis if evidence of [[Special:MyLanguage/SBP\|SBP]]
	*Abdominal CT or [[Ultrasound: Abdomen\|ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis		*Abdominal CT or [[Ultrasound: Abdomen\|ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis
	*Biliary complications may need ERCP		*Biliary complications may need ERCP


	==Management==		==Management==

	*Consult transplant team		*Consult transplant team
	*High-dose [[steroids]] for rejection		*High-dose [[Special:MyLanguage/steroids\|steroids]] for rejection
	*See [[immunocompromised antibiotics]]		*See [[Special:MyLanguage/immunocompromised antibiotics\|immunocompromised antibiotics]]
	*See [[upper GI bleed]]		*See [[Special:MyLanguage/upper GI bleed\|upper GI bleed]]
	*See [[Spontaneous Bacterial Peritonitis]]		*See [[Special:MyLanguage/Spontaneous Bacterial Peritonitis\|Spontaneous Bacterial Peritonitis]]
	*See [[Graft-vs-host disease]]		*See [[Special:MyLanguage/Graft-vs-host disease\|Graft-vs-host disease]]


	==Disposition==		==Disposition==

	*Admit in consultation with transplant team		*Admit in consultation with transplant team


	==See Also==		==See Also==
	*[[Transplant complications]]
	*[[Neutropenic fever]]		*[[Special:MyLanguage/Transplant complications\|Transplant complications]]
	*[[Immunocompromised antibiotics]]		*[[Special:MyLanguage/Neutropenic fever\|Neutropenic fever]]
			*[[Special:MyLanguage/Immunocompromised antibiotics\|Immunocompromised antibiotics]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
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Elcatracho: /* See Also */

2021-03-08T19:57:34Z

ClaireLewis at 22:57, 29 September 2019

2019-09-29T22:57:25Z

← Older revision		Revision as of 22:57, 29 September 2019
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	*Vascular thrombosis		*Vascular thrombosis
	*Biliary leak or stricture		*Biliary leak or stricture
	*Infection
	*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)		*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)
	*Adverse effects of immunosuppressant drugs<ref> 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.</ref>		*Adverse effects of immunosuppressant drugs<ref> 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.</ref>
			===Infections<ref>Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med. 2016;34(11):2200-2208.</ref>===
			Time from transplantation affects the risk and type of infection.
			*Early (within the first month)
			**Donor-derived - bacterial, fungal, parasitic
			**Nosocomial & surgical-site - [[C. diff]], [[aspiration Pneumonia]], [[UTI]], surgical-site, superinfection of graft tissue
			*Intermediate (1-6 months after)
			**'''Highest risk for opportunistic infections''' - [[PCP]], [[TB]], fungal ([[cryptococcus]], [[histoplasma]]), viral (BK virus, [[hepatitis B]]/[[hepatitis C\|C]], [[CMV]])
			**Dormant host infection reactivation - [[HSV]], [[VZV]], [[EBV]]
			*Late (more than 6 months after)
			**Community-acquired infection

	==Evaluation==		==Evaluation==
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	**Elevated in biliary, vascular, and rejection complications		**Elevated in biliary, vascular, and rejection complications
	*BMP		*BMP
	**Hyperglycemia, sodium, and potassium ~~derrangements~~ not uncommon		**[[Hyperglycemia]], sodium, and potassium derangements not uncommon
	*Coags		*Coags
	*Tacrolimus/cyclosporine levels		*Tacrolimus/cyclosporine levels
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	**+/- PCR and other studies for viral/fungal pathogens as indicated		**+/- PCR and other studies for viral/fungal pathogens as indicated
	**Diagnostic paracentesis if evidence of [[SBP]]		**Diagnostic paracentesis if evidence of [[SBP]]
	*Abdominal CT or [[ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis		*Abdominal CT or [[Ultrasound: Abdomen\|ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis
	*Biliary complications may need ERCP		*Biliary complications may need ERCP

	==Management==		==Management==
	*Consult transplant team		*Consult transplant team
	*High-dose steroids for rejection		*High-dose [[steroids]] for rejection
	*See [[immunocompromised antibiotics]]		*See [[immunocompromised antibiotics]]
	*See [[upper GI bleed]]		*See [[upper GI bleed]]

Kxl328: /* Disposition */

2019-04-27T00:24:33Z

Disposition

← Older revision		Revision as of 00:24, 27 April 2019
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	==Disposition==		==Disposition==
			*Admit in consultation with transplant team

	==See Also==		==See Also==

Kxl328: /* Evaluation */

2019-04-27T00:24:06Z

Evaluation

← Older revision		Revision as of 00:24, 27 April 2019
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	**Blood and urine cultures		**Blood and urine cultures
	**+/- PCR and other studies for viral/fungal pathogens as indicated		**+/- PCR and other studies for viral/fungal pathogens as indicated
	**~~diagnostic~~ paracentesis if evidence of [[SBP]]		**Diagnostic paracentesis if evidence of [[SBP]]
	*Abdominal CT or [[ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis		*Abdominal CT or [[ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis
	*Biliary complications may need ERCP		*Biliary complications may need ERCP

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T20:47:44Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 20:47, 13 November 2016
Line 42:		Line 42:
	**+/- PCR and other studies for viral/fungal pathogens as indicated		**+/- PCR and other studies for viral/fungal pathogens as indicated
	**diagnostic paracentesis if evidence of [[SBP]]		**diagnostic paracentesis if evidence of [[SBP]]
	*Abdominal CT or US with doppler, if concern for rejection, biliary obstruction, or thrombosis		*Abdominal CT or [[ultrasound]] with doppler, if concern for rejection, biliary obstruction, or thrombosis
	*Biliary complications may need ERCP		*Biliary complications may need ERCP

ClaireLewis: /* Differential Diagnosis */

2016-09-23T14:47:34Z

Differential Diagnosis

← Older revision		Revision as of 14:47, 23 September 2016
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	Most common problems in liver transplant patients involve:		Most common problems in liver transplant patients involve:
	*Acute graft rejection		*Acute graft rejection
			**1 in 5 have rejection during first year, usually within <1 mo
	*Vascular thrombosis		*Vascular thrombosis
	*Biliary leak or stricture		*Biliary leak or stricture
	*Infection		*Infection
	*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)		*Malignancy (squamous cell carcinoma, lymphomas, post transplant lymphoproliferative disorder)
	*Adverse effects of immunosuppressant drugs<ref> 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.</ref>		*Adverse effects of immunosuppressant drugs<ref> 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.</ref>

	==Evaluation==		==Evaluation==

ClaireLewis: /* Management */

2016-09-23T14:28:45Z

Management

← Older revision		Revision as of 14:28, 23 September 2016
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	*Consult transplant team		*Consult transplant team
	*High-dose steroids for rejection		*High-dose steroids for rejection
	*See [[~~immunosupressed~~ antibiotics]]		*See [[immunocompromised antibiotics]]
	*See [[upper GI bleed]]		*See [[upper GI bleed]]
	*See [[Spontaneous Bacterial Peritonitis]]		*See [[Spontaneous Bacterial Peritonitis]]
	*See [[Graft-vs-host disease]]		*See [[Graft-vs-host disease]]

	==Disposition==		==Disposition==

ClaireLewis at 14:27, 23 September 2016

2016-09-23T14:27:47Z

← Older revision		Revision as of 14:27, 23 September 2016
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	*2nd most frequently transplanted solid organ		*2nd most frequently transplanted solid organ
	*May be from living or deceased donor		*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.)		*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 medication complications}}		{{Immunosuppressant medication complications}}
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	==Clinical Features==		==Clinical Features==
	*Signs/symptoms of infection		*Signs/symptoms of infection
	**Fever and localizing symptoms may be blunted due to immunosupression		**[[Fever]] and localizing symptoms may be blunted due to immunosupression
	*[[GI bleed]]		*[[GI bleed]]
	*[[RUQ pain]], especially with biliary complications		*[[RUQ pain]], especially with biliary complications
	*Neurologic findings		*Neurologic findings
	**focal deficits or altered mental status due to bleed, infarct, thrombosis, osmotic demyelination, abscess, etc.		**[[focal neuro deficits]] or [[altered mental status]] due to bleed, infarct, thrombosis, osmotic demyelination, abscess, etc.
	*Jaundice		*[[Jaundice]]
	**may indicate rejection or biliary leak/stricture		**may indicate rejection or biliary leak/stricture
	*Nausea/vomiting		*[[Nausea/vomiting]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*CBC		*CBC
	**Infection may cause leukocytosis or leukopenia		**Infection may cause leukocytosis or leukopenia
	*LFTs		*[[LFTs]]
	**Elevated in biliary, vascular, and rejection complications		**Elevated in biliary, vascular, and rejection complications
	*BMP		*BMP

ClaireLewis at 14:25, 23 September 2016

2016-09-23T14:25:53Z

@@ Line 1: / Line 1: @@
 ==Background==
-{{Transplant emergency types}}
+*2nd most frequently transplanted solid organ
 {{Immunosuppressant medication complications}}
 ==Clinical Features==
 ==Differential Diagnosis==
 ==Evaluation==
 ==Management==
+*Consult transplant team
 ==Disposition==

← Older revision		Revision as of 19:57, 8 March 2021
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	==See Also==		==See Also==
	*[[Transplant complications]]		*[[Transplant complications]]
			*[[Neutropenic fever]]
			*[[Immunocompromised antibiotics]]

	==External Links==		==External Links==