Overview
Complications following liver transplantation include severe opportunistic infections like mucormycosis and unusual vascular issues such as isolated venous thrombosis, both of which can lead to acute graft failure and multiorgan dysfunction. 12Diagnosis
Clinical Presentation: Fever, imaging abnormalities (lesions, thrombosis), and signs of systemic involvement (hypotension, disseminated intravascular coagulation). 12
Laboratory Tests: Culture and sensitivity for suspected fungal infections; coagulation profile for thrombotic events. 12
Imaging: CT, MRI, or angiography to identify lesions and vascular occlusions. 12
Histopathology: Essential for confirming mucormycosis and assessing extent of vascular thrombosis. 12Management
Mucormycosis: Initiate liposomal amphotericin B; surgical debridement for progressive lesions. 1
Venous Thrombosis: Consider transvenous intrahepatic porto-systemic shunt; manage sepsis aggressively. 2
Supportive Care: Intensive care monitoring, anticoagulation (as appropriate), and organ support systems. 2Special Populations
Comorbidities: Patients with pre-existing biliary issues or those requiring re-transplantation may have higher risks of complications like those described. 12Key Recommendations
Early suspicion and prompt imaging for suspected fungal infections or vascular complications in transplant recipients is crucial (Evidence: Weak) 12
Initiate broad-spectrum antifungal therapy and surgical intervention for confirmed mucormycosis (Evidence: Weak) 1
Aggressive management of thrombotic events with interventional radiology and systemic anticoagulation, tailored to individual patient risk (Evidence: Weak) 2References
1 Parmentier C, Cruz-Martínez R, Quintero-Quintero MJ, Vilatobá M. Mucormycosis in Liver Allograft Following Transplant for Secondary Biliary Cirrhosis. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 2024. link
2 Robertson AG, Burroughs A, Davidson BR. Isolated venous thrombosis: a new cause of acute graft failure in a non-piggyback liver transplant (case report). Hepato-gastroenterology 2007. link
3 Foster JH. Automatic clip applier as an aid to liver resection. American journal of surgery 1986. link90089-9)