State of the Art: Liver Transplantation Management from an Internist’s Point of View

Liver transplantation has become a standard procedure for various acute and chronic liver diseases including hepatocellular carcinoma. The following review highlights the most important aspects in the short- and long-term management of patients undergoing liver transplantation because only with optimal follow-up 5‑year survival rates of more than 70% can be achieved. During the first postoperative year, hepatic artery thrombosis, stenosis of the bile ducts, and infectious complications are the leading causes of graft loss and mortality. Not only bacterial infections, but also reactivation of latent infections, especially cytomegalovirus (CMV) disease, are prognostic, and specific prophylaxis is mandatory depending on the patient’s risk factors. Rejection episodes are also more common during the early period following transplantation but are rarely the cause of graft loss due to potent, calcineurin-inhibitor-based immunosuppression. After the first postoperative year, de novo malignancy, cardiovascular disease and chronic rejection are the leading causes of morbidity and mortality. Prevention and early detection of these immunosuppression-associated complications are important aspects regarding long-term aftercare. Acute and chronic nephrotoxicity of calcineurin inhibitors remains a challenge in the early and long-term posttransplant period, often requiring conversion of the immunosuppression to a calcineurin-inhibitor-free regimen. © 2018, Springer-Verlag GmbH Austria, ein Teil von Springer Nature.