Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of dermatologic problems following liver transplantation

Jean-François Dufour, MD
Patrick Antony Oberholzer, MD
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Kristen M Robson, MD, MBA, FACG


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 [6]. As a result, patients who have undergone liver transplantation tend to have fewer dermatologic complications compared with other solid organ transplantation recipients [7]. 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".)


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).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Christenson LJ, Geusau A, Ferrandiz C, et al. Specialty clinics for the dermatologic care of solid-organ transplant recipients. Dermatol Surg 2004; 30:598.
  2. Hofbauer GF, Anliker M, Arnold A, et al. Swiss clinical practice guidelines for skin cancer in organ transplant recipients. Swiss Med Wkly 2009; 139:407.
  3. Hassan G, Khalaf H, Mourad W. Dermatologic complications after liver transplantation: a single-center experience. Transplant Proc 2007; 39:1190.
  4. Schmied E, Dufour JF, Euvrard S. Nontumoral dermatologic problems after liver transplantation. Liver Transpl 2004; 10:331.
  5. Belloni-Fortina A, Piaserico S, Bordignon M, et al. Skin cancer and other cutaneous disorders in liver transplant recipients. Acta Derm Venereol 2012; 92:411.
  6. Ramos HC, Reyes J, Abu-Elmagd K, et al. Weaning of immunosuppression in long-term liver transplant recipients. Transplantation 1995; 59:212.
  7. Collett D, Mumford L, Banner NR, et al. Comparison of the incidence of malignancy in recipients of different types of organ: a UK Registry audit. Am J Transplant 2010; 10:1889.
  8. Smith DM, Agura E, Netto G, et al. Liver transplant-associated graft-versus-host disease. Transplantation 2003; 75:118.
  9. Burdick JF, Vogelsang GB, Smith WJ, et al. Severe graft-versus-host disease in a liver-transplant recipient. N Engl J Med 1988; 318:689.
  10. Satapathy SK, Bernstein D. Dermatologic disorders and the liver. Clin Liver Dis 2011; 15:165.
  11. Marinho RT, Perdigoto R. Images in hepatology. Reversible nail changes in primary biliary cirrhosis after liver transplantation. J Hepatol 1999; 30:330.
  12. Sale GE. Alopecia in liver transplant recipients. Br J Dermatol 1997; 136:635.
  13. Tsuboi H, Yonemoto K, Katsuoka K. Vitiligo with inflammatory raised borders with hepatitis C virus infection. J Dermatol 2006; 33:577.
  14. Schmidt HH, Manns MP. Images in hepatology. Regression of xanthelasmas in a patient with primary biliary cirrhosis after liver transplantation. J Hepatol 1998; 28:1077.
  15. Duvoux C, Tran Ngoc A, Intrator L, et al. Hepatitis C virus (HCV)-related cryoglobulinemia after liver transplantation for HCV cirrhosis. Transpl Int 2002; 15:3.
  16. Poikolainen K, Reunala T, Karvonen J, et al. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990; 300:780.
  17. Qureshi AA, Dominguez PL, Choi HK, et al. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch Dermatol 2010; 146:1364.
  18. Richard MA, Barnetche T, Horreau C, et al. Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence-based recommendations based on systematic review and expert opinion. J Eur Acad Dermatol Venereol 2013; 27 Suppl 3:2.
  19. Montaudié H, Sbidian E, Paul C, et al. Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Eur Acad Dermatol Venereol 2011; 25 Suppl 2:12.
  20. Otley CC, Hirose R, Salasche SJ. Skin cancer as a contraindication to organ transplantation. Am J Transplant 2005; 5:2079.
  21. Euvrard S. [Infectious cutaneous pathology after organ transplantation]. Ann Dermatol Venereol 1998; 125:939.
  22. Barr BB, Benton EC, McLaren K, et al. Papillomavirus infection and skin cancer in renal allograft recipients. Lancet 1989; 2:224.
  23. Itin PH, Battegay M. Skin problems in immunodeficient patients. Curr Probl Dermatol 2012; 43:9.
  24. Hofbauer GF, Freiberger SN, Iotzova-Weiss G, et al. Organ transplantation and skin--principles and concepts. Curr Probl Dermatol 2012; 43:1.
  25. Chak E, Saab S. Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review. Liver Int 2010; 30:1247.
  26. Otley CC, Pittelkow MR. Skin cancer in liver transplant recipients. Liver Transpl 2000; 6:253.
  27. Robbins HA, Clarke CA, Arron ST, et al. Melanoma Risk and Survival among Organ Transplant Recipients. J Invest Dermatol 2015; 135:2657.
  28. Clarke CA, Robbins HA, Tatalovich Z, et al. Risk of merkel cell carcinoma after solid organ transplantation. J Natl Cancer Inst 2015; 107.
  29. Derancourt C, Senser M, Atallah L, et al. [Granuloma annulare of the photoexposed areas in two liver transplant recipients]. Ann Dermatol Venereol 2000; 127:723.
  30. Roberts JP, Ascher NL, Lake J, et al. Graft vs. host disease after liver transplantation in humans: a report of four cases. Hepatology 1991; 14:274.
  31. Redondo P, España A, Herrero JI, et al. Graft-versus-host disease after liver transplantation. J Am Acad Dermatol 1993; 29:314.
  32. Jucglà A, Sais G, Curco N, et al. Calcinosis cutis following liver transplantation: a complication of intravenous calcium administration. Br J Dermatol 1995; 132:275.
  33. Pageaux GP, Perrigault PF, Fabre JM, et al. Lethal acute graft-versus-host disease in a liver transplant recipient: relations with cell migration and chimerism. Clin Transplant 1995; 9:65.
  34. Blemker AL, Dean RA, Weaver DC, et al. Transient porphyrinemia in a liver transplant recipient. Arch Dermatol 1991; 127:704.
  35. Sheth AP, Esterly NB, Rabinowitz LG, Poh-Fitzpatrick MB. Cutaneous porphyrialike photosensitivity after liver transplantation. Arch Dermatol 1994; 130:614.
  36. Takatsuki M, Uemoto S, Kurokawa T, et al. Idiopathic thrombocytopenic purpura after a living-related liver transplantation. Transplantation 1999; 67:479.
  37. Neumann UP, Kaisers U, Langrehr JM, et al. Fatal graft-versus-host-disease: a grave complication after orthotopic liver transplantation. Transplant Proc 1994; 26:3616.
  38. Komorowski RA, Clowry LJ. Porokeratosis of mibelli in transplant recipients. Am J Clin Pathol 1989; 91:71.
  39. Hernández-Cano N, De Lucas R, Lázaro TE, et al. Erythema elevatum diutinum after liver transplantation: disappearance of the lesions associated with a reduction in cyclosporin dosage. Pediatr Dermatol 1998; 15:411.
  40. Lübbe J, Sorg O, Malé PJ, et al. Sirolimus-induced inflammatory papules with acquired reactive perforating collagenosis. Dermatology 2008; 216:239.
  41. Euvrard S, Morelon E, Rostaing L, et al. Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 2012; 367:329.
  42. Feldmeyer L, Hofbauer GF, Böni T, et al. Mammalian target of rapamycin (mTOR) inhibitors slow skin carcinogenesis, but impair wound healing. Br J Dermatol 2012; 166:422.
  43. Brewer JD, Otley CC, Christenson LJ, et al. The effects of sirolimus on wound healing in dermatologic surgery. Dermatol Surg 2008; 34:216.