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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.
Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. Despite attempts for >40 years immunological graft intolerance presented an impenetrable barrier to successful engraftment until the development in the late 1970s of the powerful calcineurin-inhibitor immunosuppressive agents. Their use over the last 17 years has led to small intestinal transplantation being generally considered as a routine option for patients with irreversible intestinal failure and failing parenteral nutrition. The 1-year patient survival rates (%) are now excellent for renal (95), liver (78), heart (82) and lung (75) transplantation. In contrast, survival rates for small intestinal transplantation have been slow to improve, although they are now approaching those for lung and liver transplantation (intestine 78%, intestine and liver 60%, multivisceral 66%), and well-performing centres report recent 1-year graft survival rates as high as 92%. Patient 5-year survival (%) has also improved (intestine alone 50, intestine and liver 50 and multivisceral 62) and compares increasingly favourably with renal (85), liver (67), heart (67) and lung (46). Currently, small intestinal transplantation is reserved for patients with irreversible small intestinal failure who have a poor prognosis on parenteral nutrition. However, as 5-year patient survival following intestinal transplantation approaches that for parenteral nutrition there will be increasing pressure to offer this modality of treatment as an alternative to parenteral nutrition, especially for those patients who have a poor quality of life as a result of parenteral nutrition.
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