Overview of dermatologic problems following liver transplantation
- Jean-François Dufour, MD
Jean-François Dufour, MD
- Associate Professor
- University of Bern
- Patrick Antony Oberholzer, MD
Patrick Antony Oberholzer, MD
- University of Bern
- Section Editor
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
Liver transplantation recipients, like other solid organ transplantation recipients, have an increased risk of dermatologic problems due to their long-term immunosuppression and benefit from pre-and post-transplantation screenings, and management by a dermatologist and dermatologic care should be integrated into the comprehensive, multidisciplinary care of liver transplantation recipients [1,2]. Cutaneous findings include aesthetic alterations, infections, precancerous lesions, and malignancies. The severity of skin alterations ranges from benign, unpleasant changes to life-threatening conditions [3-5]. In addition to skin cancer diagnosis and management, visits with a dermatologist serve to educate and improve the patient's sun-protection behavior.
Among all solid organ transplantations, liver transplantation requires the least amount of immunosuppression, sometimes even permitting its complete cessation . As a result, patients who have undergone liver transplantation tend to have fewer dermatologic complications compared with other solid organ transplantation recipients . However, due to the large volume of the liver, patients undergoing liver transplantation receive more donor lymphocytes than kidney, heart, or lung transplantation recipients. Because of the immunosuppression, the transplanted lymphocytes proliferate and rarely trigger graft-versus-host-disease [8,9].
This topic will provide an overview of dermatologic disorders that may be seen following liver transplantation. A detailed discussion of skin cancer following solid organ transplantation and the general management of patients following liver transplantation are discussed separately. (See "Development of malignancy following solid organ transplantation" and "Prevention and management of skin cancer in solid organ transplant recipients" and "Liver transplantation in adults: Long-term management of transplant recipients".)
EFFECT OF TRANSPLANTATION ON PREEXISTING DERMATOLOGIC DISORDERS
Patients undergoing liver transplantation may have preexisting dermatologic disorders that are subsequently affected by transplantation. In many cases, the disorders improve either as a result of removal of the diseased liver or because of the immunosuppression patients receive.
Dermatologic manifestations of liver disease — In patients with dermatologic lesions related to cirrhosis or associated with specific forms of liver disease, transplantation often leads to improvement in the dermatologic findings (table 1).
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- EFFECT OF TRANSPLANTATION ON PREEXISTING DERMATOLOGIC DISORDERS
- Dermatologic manifestations of liver disease
- Coexisting dermatologic disorders
- Previously treated skin cancer
- DERMATOLOGIC COMPLICATIONS AFTER LIVER TRANSPLANTATION
- Cosmetic problems and side effects of immunosuppressive therapy
- Dermatologic infections
- Skin cancer
- PREVENTION AND MANAGEMENT
- SUMMARY AND RECOMMENDATIONS