Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 49: I Have Been Asked To See A Patient Who Had A Liver Transplant 5 Years Ago In Another State. He Has Not Been Seen By His Liver Transplant Center In 2 Years. His Serum Creatinine Is 2.5 Mg/Dl But His Liver Enzymes And Liver Function Tests Are Normal. He Does Not Want To Go Back To His Transplant Center. What Should I Do? (continued)

R. Todd Stravitz, MD

Two categories of medical problems must be considered in liver transplant recipients several years after their transplant: allograft-related issues and general medical issues. Five years after orthotopic liver transplant (OLT), allograft-related issues include recurrence of the primary liver disease and less, commonly, chronic rejection or technical complications such as biliary strictures. The single most daunting problem facing liver transplant recipients in 2007 is hepatitis C, the leading cause of cirrhosis and the need for liver transplantation in the United States, which recurs…