A majority of primary diseases for which orthotopic
liver transplantation is carried out may recur in the liver allograft, mostly in adults. As the indication criteria,
transplantation surgery and post-
transplantation care improve, the patients survival lengthens as well, leading to concurrently increasing incidence as well as an increase in the relevance of recurrent diseases, which are the most significant cause of late liver graft dysfunction. The frequency, clinical consequences and therapeutic options of different disease recurrence vary considerably. Even recently the worst prognosis has been associated with
hepatitis C for 100%
reinfection, this situation is beginning to change with new oral
antiviral drugs, as has already been successfully done with
hepatitis B. Among immune-mediated disorders,
primary biliary cirrhosis recurrence affects 30 - 50% of transplant patients, albeit with mild consequences. Graft loss and subsequent necessity of retransplantation are observed in almost 10% of patients with
primary sclerosing cholangitis recurrence. 30% prevalence rates for
autoimmune hepatitis recurrence are reported but the frequency of graft loss has declined considerably due to maintenance of
corticosteroid therapy. Excessive relapse of alcohol consumption in patients with
liver transplant for
alcoholic liver disease leads most commonly to extrahepatic complications. Recurrent non-
alcoholic steatohepatitis is rarely connected with graft loss in 5 - 10 years after
transplantation. The diagnosis of a recurrent disease following
liver transplantation is to a large extent based on histopathological features. In the differential diagnosis, other causes of graft dysfunction must be excluded.