MEDICAL COMPLICATIONS OF LIVER-TRANSPLANTATION

Liver transplantation poses enormous and complex medical problems. Of the infective complications, bacterial infections are the commonest ov erall, but the single commonest is cytomegalovirus and the most deadly are the fungal infections. Therapeutic options and possibilities for prophylaxis are improving. Rejection, both acute and chronic, is the o ther major cause of mortality, and the balance between immunosuppressi on and infection is difficult. Cyclosporin treatment contributes to re nal impairment. hypertension, and multitudinous potential neurological problems. The risk of long-term neoplasia is unclear. Relatively more minor is the potential for osteoporosis and metabolic complications, such as diabetes and hyperlipidaemia. Hepatitis B disease has a sizabl e risk of recurrence, but the most recent prophylaxis regimes have imp roved relapse rates. Having survived the physical problems following t ransplantation, most of which occur in the first 6 months, there are c onsiderable psychosocial adjustments to be made particularly in the ca se of children where growth and development may have been delayed. Des pite all these difficulties, liver transplantation is an expanding and optimistic area with enormous potential.