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The most common causes of death after the first year following liver transplantation are recurrent and de novo malignancy, return of the original liver disease in the graft, sepsis, cardiovascular disease, and chronic rejection. Review frequency varies between centers and depends partly on patient morbidity. The aim of follow-up is to screen for graft dysfunction and the late complications of liver transplantation. Complications of immune suppression may be related to the original etiology or unrelated and similar to other organs. Azathioprine (AZA) or mycophenolate mofetil (MMF) are often used as long-term maintenance immunosuppression. Up to 45% of liver transplant recipients have metabolic syndrome that includes excessive weight gain, hypertension, diabetes, and hyperlipidemia. Biliary stricture and incisional hernia are the most common late surgical complications after liver transplantation. Psychosocial health should be considered as an important facet in the long-term management of liver transplant recipient.
This chapter focuses on how to select patients who will gain maximum benefit from lung transplantation (LT). It outlines the general considerations and exclusions pertaining to all potential recipients and focuses on disease specific guidance for the major recipient groups: chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), and idiopathic pulmonary arterial hypertension (IPAH). Pulmonary infections with highly resistant bacteria have been shown to have poorer outcomes in comparison with non-infected patients. The presence of fungus in the native lungs can cause problems after LT and needs careful assessment in each individual. The presence of comorbidities outside of the failing respiratory system is important considerations that can impact patient outcomes. COPD accounts for approximately 40% of LTs performed, with CF and IPF accounting for 20% each. In the current era there remains a critical shortage of donor organs, and thus unfortunately, recipient selection remains extremely important.
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