Extrahepatic causes of morbidity and mortality of liver recipients in the long-term posttransplantation period

Nowadays, the one-year survival rate of liver transplant recipients is 80-90 %. In the long term after surgery, there are increased risks of death compared with the general population. At the same time, in the structure of death of recipients, extrahepatic causes prevail over graft pathology. Cancers, cardiovascular diseases, infections, metabolic disorders, and kidney disease are key factors that negatively affect long-term outcomes of transplants. The article provides an overview and summary of current data on the prevalence, structure and prognostic value of various types’ of late post-transplant extrahepatic pathology in liver transplant recipients.

1. Adam R, Karam V, Cailliez V, O Grady JG, Mirza D, Cherqui D et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int. 2018;31(12):1293-1317. https://doi.org/10.1111/tri.13358 PMID: 30259574.

2. Gelson W, Hoare M, Dawwas MF, Vowler S, Gibbs P, Alexander G. The pattern of late mortality in liver transplant recipients in the United Kingdom. Transplantation. 2011;91(11):1240-1244. https://doi.org/10.1097/TP.0b013e31821841ba PMID: 21516069.

3. Vionnet J., Abraldes, Juan G. , Miquel R., et al. Immunological risk stratification of stable long-term liver transplant recipients employing non-invasive tools. OS-213. Program and abstracts of the THE INTERNATIONAL LIVER CONGRESS. 2021. J Hepatology. 75(Suppl.2): s.235-236

4. Schoening WN, Buescher N, Rademacher S, Andreou A, Kuehn S, Neuhaus R et al. Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. Am J Transplant. 2013;13(9):2384-2394. https://doi.org/10.1111/ajt.12384 PMID: 23915357.

5. Agopian VG, Petrowsky H, Kaldas FM, Zarrinpar A, Farmer DG, Yersiz H et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg. 2013;258(3):409-421. https://doi.org/10.1097/SLA.0b013e3182a15db4 PMID: 24022434.

6. Young K, Liu B, Bhuket T, Wong RJ. Lower Likelihood of Post-transplant Graft Failure, Death, and Retransplantation in the Era of Direct-Acting Antivirals. J Clin Exp Hepatol. 2020;10(6):581-589. https://doi.org/10.1016/j.jceh.2020.02.003 PMID: 33311895

7. Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K et al. Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg. 2000;232(4):490-500. https://doi.org/10.1097/00000658-200010000-00004 PMID: 10998647

8. Koshy AN, Gow PJ, Han HC, Teh AW, Jones R, Testro A et al. Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years. Eur Heart J Qual Care Clin Outcomes. 2020;6(4):243-253. https://doi.org/10.1093/ehjqcco/qcaa009 PMID: 32011663

9. Jain A, Singhal A, Fontes P, Mazariegos G, DeVera ME, Cacciarelli T et al. One thousand consecutive primary liver transplants under tacrolimus immunosuppression: a 17- to 20-year longitudinal follow-up. Transplantation. 2011;91(9):1025-1030. https://doi.org/10.1097/TP.0b013e3182129215 PMID: 21378604

10. Åberg F, Gissler M, Karlsen TH, Ericzon BG, Foss A, Rasmussen A et al. Differences in long-term survival among liver transplant recipients and the general population: a population-based Nordic study. Hepatology. 2015;61(2):668-677. https://doi.org/10.1002/hep.27538

11. Barber K, Blackwell J, Collett D, Neuberger J; UK Transplant Liver Advisory Group. Life expectancy of adult liver allograft recipients in the UK. Gut. 2007;56(2):279-282. https://doi.org/10.1136/gut.2006.093195 PMID: 17008365

12. Rabkin JM, de La Melena V, Orloff SL, Corless CL, Rosen HR, Olyaei AJ. Late mortality after orthotopic liver transplantation. Am J Surg. 2001;181(5):475-479. https://doi.org/10.1016/s0002-9610(01)00595-5 PMID: 11448447

13. Vogt DP, Henderson JM, Carey WD, Barnes D. The long-term survival and causes of death in patients who survive at least 1 year after liver transplantation. Surgery. 2002;132(4):775-780. https://doi.org/10.1067/msy.2002.128343 PMID: 12407365

14. Watt KD, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant. 2010;10(6):1420-1427. https://doi.org/10.1111/j.1600-6143.2010.03126.x PMID: 20486907

15. De Luca L, Kalafateli M, Bianchi S, Alasaker N, Buzzetti E, Rodríguez-Perálvarez M et al. Cardiovascular morbidity and mortality is increased post-liver transplantation even in recipients with no pre-existing risk factors. Liver Int. 2019;39(8):1557-1565. https://doi.org/10.1111/liv.14185 PMID: 31233663

16. Egeli T, Unek T, Ağalar C, Derici S, Ozbilgin M, Akarasu M et al. Analysis of Causes and Risk Factors for Late Mortality After Liver Transplant: How Can We Obtain Better Long-Term Survival? Exp Clin Transplant. 2020;18(2):182-187. https://doi.org/10.6002/ect.2017.0346 PMID: 29863452

17. Maltseva A.P., Syutkin V.E., Kolyshev I.Yu., Rudakov V.S., Svetlakova D.S., Sadykhov Z.A. et al. Transplantation in oncology: the future of a multidisciplinary approach. Transplantologiya. The Russian Journal of Transplantation. 2019;11(3):218-233. https://doi.org/10.23873/2074-0506-2019-11-3-218-233

18. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109(3):433-438. https://doi.org/10.1161/01.CIR.0000111245.75752.C6 PMID: 14744958

19. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469-480. https://doi.org/10.1111/j.1464-5491.2006.01858.x PMID: 16681555

20. Anastácio LR, Lima AS, Toulson Davisson Correia MI. Metabolic syndrome and its components after liver transplantation: incidence, prevalence, risk factors, and implications. Clin Nutr. 2010;29(2):175-179. https://doi.org/10.1016/j.clnu.2009.08.008 PMID: 19783330

21. García-Pajares F, Peñas-Herrero I, Sánchez-Ocaña R, Torrres-Yuste R, Cimavilla-Román M, Carbajo-López A et al. Metabolic Syndrome After Liver Transplantation: Five-Year Prevalence and Risk Factors. Transplant Proc. 2016;48(9):3010-3012. https://doi.org/10.1016/j.transproceed.2016.07.038 PMID: 27932133

22. Laryea M, Watt KD, Molinari M, Walsh MJ, McAlister VC, Marotta PJ et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl. 2007;13(8):1109-1114. https://doi.org/10.1002/lt.21126 PMID: 17663411

23. Gitto S, de Maria N, di Benedetto F, Tarantino G, Serra V, Maroni L et al. De-novo nonalcoholic steatohepatitis is associated with long-term increased mortality in liver transplant recipients. Eur J Gastroenterol Hepatol. 2018;30(7):766-773. https://doi.org/10.1097/MEG.0000000000001105 PMID: 29505475

24. Bianchi G, Marchesini G, Marzocchi R, Pinna AD, Zoli M. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl. 2008;14(11):1648-1654. https://doi.org/10.1002/lt.21588 PMID: 18975273

25. Rezende Anastácio L, García Ferreira L, Costa Liboredo J, de Sena Ribeiro H, Soares Lima A, García Vilela E et al. Overweight, obesity and weight gain up to three years after liver transplantation. Nutr Hosp. 2012;27(4):1351-1356. https://doi.org/10.3305/nh.2012.27.4.5768 PMID: 23165585

26. Leonard J, Heimbach JK, Malinchoc M, Watt K, Charlton M. The impact of obesity on long-term outcomes in liver transplant recipients-results of the NIDDK liver transplant database. Am J Transplant. 2008;8(3):667-672. https://doi.org/10.1111/j.1600-6143.2007.02100.x PMID: 18294163

27. Thoefner LB, Rostved AA, Pommergaard HC, Rasmussen A. Risk factors for metabolic syndrome after liver transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando). 2018;32(1):69-77. https://doi.org/10.1016/j.trre.2017.03.004 PMID: 28501338

28. Gitto S, Magistri P, Marzi L, Mannelli N, De Maria N, Mega A et al. Predictors of solid extra-hepatic non-skin cancer in liver transplant recipients and analysis of survival: A long-term follow-up study. Ann Hepatol. 2022;27(3):100683. https://doi.org/10.1016/j.aohep.2022.100683 PMID: 35151902

29. van Son J, Stam SP, Gomes-Neto AW, Osté MCJ, Blokzijl H, van den Berg AP et al. Post-transplant obesity impacts long-term survival after liver transplantation. Metabolism. 2020;106:154204. https://doi.org/10.1016/j.metabol.2020.154204 PMID: 32173406

30. Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E et al. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl. 2013;19(1):3-26. https://doi.org/10.1002/lt.23566 PMID: 23281277

31. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol. 2010;53(1):199-206. https://doi.org/10.1016/j.jhep.2010.01.040 PMID: 20451282

32. Laish I, Braun M, Mor E, Sulkes J, Harif Y, Ben Ari Z. Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events. Liver Transpl. 2011;17(1):15-22. https://doi.org/10.1002/lt.22198 PMID: 21254340

33. Hüsing A, Kabar I, Schmidt HH. Lipids in liver transplant recipients. World J Gastroenterol. 2016;22(12):3315-3324. https://doi.org/10.3748/wjg.v22.i12.3315 PMID: 27022213

34. Kockx M, Kritharides L. Hyperlipidaemia in immunosuppression. Curr Opin Lipidol. 2016;27(6):631-632. https://doi.org/10.1097/MOL.0000000000000363 PMID: 27805973

35. Deleuze S, Garrigue V, Delmas S, Chong G, Swarcz I, Cristol JP et al. New onset dyslipidemia after renal transplantation: is there a difference between tacrolimus and cyclosporine? Transplant Proc. 2006;38(7):2311-2313. https://doi.org/10.1016/j.transproceed.2006.06.125 PMID: 16980075

36. Agarwal A, Prasad GV. Post-transplant dyslipidemia: Mechanisms, diagnosis and management. World J Transplant. 2016;6(1):125-134. https://doi.org/10.5500/wjt.v6.i1.125 PMID: 27011910

37. Seymen P, Yildiz M, Türkmen MF, Titiz MI, Seymen HO. Effects of cyclosporine-tacrolimus switching in posttransplantation hyperlipidemia on high-density lipoprotein 2/3, lipoprotein a1/b, and other lipid parameters. Transplant Proc. 2009;41(10):4181-4183. https://doi.org/10.1016/j.transproceed.2009.09.069 PMID: 20005364

38. Manzarbeitia C, Reich DJ, Rothstein KD, Braitman LE, Levin S, Munoz SJ. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl. 2001;7(2):93-99. https://doi.org/10.1053/jlts.2001.21289 PMID: 11172391

39. Morrisett JD, Abdel-Fattah G, Hoogeveen R, Mitchell E, Ballantyne CM, Pownall HJ et al. Effects of sirolimus on plasma lipids, lipoprotein levels, and fatty acid metabolism in renal transplant patients. J Lipid Res. 2002;43(8):1170-1180. PMID: 12177161

40. Harper SJ, Gelson W, Harper IG, Alexander GJ, Gibbs P. Switching to sirolimus-based immune suppression after liver transplantation is safe and effective: a single-center experience. Transplantation. 2011;91(1):128-132. https://doi.org/10.1097/tp.0b013e3181fe131b PMID: 21452417

41. Nguyen LS, Vautier M, Allenbach Y, Zahr N, Benveniste O, Funck-Brentano C et al. Sirolimus and mTOR Inhibitors: A Review of Side Effects and Specific Management in Solid Organ Transplantation. Drug Saf. 2019;42(7):813-825. https://doi.org/10.1007/s40264-019-00810-9 PMID: 30868436

42. Chhatrala R, Siddiqui MB, Stravitz RT, Driscoll C, Sanyal A, Sargeant C et al. Evolution of serum atherogenic risk in liver transplant recipients: Role of lipoproteins and metabolic and inflammatory markers. Liver Transpl. 2015;21(5):623-630. https://doi.org/10.1002/lt.24100 PMID: 25762084

43. Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant. 2004;4(4):583-595. https://doi.org/10.1046/j.1600-6143.2003.00372.x PMID: 15023151

44. Kuo HT, Sampaio MS, Ye X, Reddy P, Martin P, Bunnapradist S. Risk factors for new-onset diabetes mellitus in adult liver transplant recipients, an analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Transplantation. 2010;89(9):1134-1140. https://doi.org/10.1097/TP.0b013e3181d2fec1 PMID: 20386364

45. Demirci MS, Toz H, Yilmaz F, Ertilav M, Asci G, Ozkahya M et al. Risk factors and consequences of post-transplant diabetes mellitus. Clin Transplant. 2010;24(5):E170-E177. https://doi.org/10.1111/j.1399-0012.2010.01247.x PMID: 20384711

46. Gitto S, De Maria N, Marzi L, Magistri P, Falcini M, Vitale G et al. Pre-transplant diabetes predicts atherosclerotic vascular events and cardiovascular mortality in liver transplant recipients: a long-term follow-up study. Eur J Intern Med. 2020;79:70-75. https://doi.org/10.1016/j.ejim.2020.05.041 PMID: 32616342

47. Roccaro GA, Goldberg DS, Hwang WT, Judy R, Thomasson A, Kimmel SE et al. Sustained Posttransplantation Diabetes Is Associated With Long-Term Major Cardiovascular Events Following Liver Transplantation. Am J Transplant. 2018;18(1):207-215. https://doi.org/10.1111/ajt.14401 PMID: 28640504

48. Albeldawi M, Aggarwal A, Madhwal S, Cywinski J, Lopez R, Eghtesad B et al. Cumulative risk of cardiovascular events after orthotopic liver transplantation. Liver Transpl. 2012;18(3):370-375. https://doi.org/10.1002/lt.22468 PMID: 22140067

49. John PR, Thuluvath PJ. Outcome of patients with new-onset diabetes mellitus after liver transplantation compared with those without diabetes mellitus. Liver Transpl. 2002;8(8):708-713. https://doi.org/10.1053/jlts.2002.34638 PMID: 12149764

50. Moon JI, Barbeito R, Faradji RN, Gaynor JJ, Tzakis AG. Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: Long-term follow up. Transplantation. 2006;82(12):1625-1628. https://doi.org/10.1097/01.tp.0000250361.60415.96 PMID: 17198248

51. Younossi ZM, Stepanova M, Saab S, Kalwaney S, Clement S, Henry L et al. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther. 2014;40(6):686-694. https://doi.org/10.1111/apt.12881 PMID: 25040315

52. Lv C, Zhang Y, Chen X, Huang X, Xue M, Sun Q et al. New-onset diabetes after liver transplantation and its impact on complications and patient survival. J Diabetes. 2015;7(6):881-890. https://doi.org/10.1111/1753-0407.12275 PMID: 25676209

53. Yasodhara A, Dong V, Azhie A, Goldenberg A, Bhat M. Identifying Modifiable Predictors of Long-Term Survival in Liver Transplant Recipients With Diabetes Mellitus Using Machine Learning. Liver Transpl. 2021;27(4):536-547. https://doi.org/10.1002/lt.25930 PMID: 33113221

54. Canzanello VJ, Textor SC, Taler SJ, Schwartz LL, Porayko MK, Wiesner RH et al. Late hypertension after liver transplantation: a comparison of cyclosporine and tacrolimus (FK 506). Liver Transpl Surg. 1998;4(4):328-334. https://doi.org/10.1002/lt.500040404 PMID: 9649648

55. Lim KB, Schiano TD. Long-term outcome after liver transplantation. Mt Sinai J Med. 2012;79(2):169-189. https://doi.org/10.1002/msj.21302 PMID: 22499489

56. Textor SC, Wiesner R, Wilson DJ, Porayko M, Romero JC, Burnett JC Jr et al. Systemic and renal hemodynamic differences between FK506 and cyclosporine in liver transplant recipients. Transplantation. 1993;55(6):1332-1339. https://doi.org/10.1097/00007890-199306000-00023 PMID: 7685934

57. Neal DA, Gimson AE, Gibbs P, Alexander GJ. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl. 2001;7(6):533-539. https://doi.org/10.1053/jlts.2001.24637 PMID: 11443583

58. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292. https://doi.org/10.1161/01.cir.0000441139.02102.80 PMID: 24352519

59. Konerman MA, Fritze D, Weinberg RL, Sonnenday CJ, Sharma P. Incidence of and Risk Assessment for Adverse Cardiovascular Outcomes After Liver Transplantation: A Systematic Review. Transplantation. 2017;101(7):1645-1657. https://doi.org/10.1097/TP.0000000000001710 PMID: 28296809

60. Nicolau-Raducu R, Gitman M, Ganier D, Loss GE, Cohen AJ, Patel H et al. Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transpl. 2015;21(1):13-21. https://doi.org/10.1002/lt.23997 PMID: 25213120

61. Borg MA, van der Wouden EJ, Sluiter WJ, Slooff MJ, Haagsma EB, van den Berg AP. Vascular events after liver transplantation: a long-term follow-up study. Transpl Int. 2008;21(1):74-80. https://doi.org/10.1111/j.1432-2277.2007.00557.x PMID: 17868273

62. Di Maira T, Rubin A, Puchades L, Aguilera V, Vinaixa C, Garcia M et al. Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients. Liver Transpl. 2015;21(6):812-822. https://doi.org/10.1002/lt.24128 PMID: 27396823

63. VanWagner LB, Montag S, Zhao L, Allen NB, Lloyd-Jones DM, Das A et al. Cardiovascular Disease Outcomes Related to Early Stage Renal Impairment After Liver Transplantation. Transplantation. 2018;102(7):1096-1107. https://doi.org/10.1097/TP.0000000000002175 PMID: 29557907

64. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931-940. https://doi.org/10.1056/NEJMoa021744 PMID: 12954741

65. Lamattina JC, Foley DP, Mezrich JD, Fernandez LA, Vidyasagar V, D'Alessandro AM et al. Chronic kidney disease stage progression in liver transplant recipients. Clin J Am Soc Nephrol. 2011;6(8):1851-1857. https://doi.org/10.2215/CJN.00650111 PMID: 21784823

66. Rasaei N, Malekmakan L, Mashayekh M, Gholamabbas G. Chronic Kidney Disease Following Liver Transplant: Associated Outcomes and Predictors. Exp Clin Transplant. 2022;21(2):93-103. https://doi.org/10.6002/ect.2022.0288 PMID: 36656117

67. Syutkin V.E., Salienko A.A., Olisov O.D., Zhuravel S.V., Novruzbekov M.S. The effect of early everolimus administration on the renal function while reducing the dosage of calcineurin inhibitors in liver transplant recipients in a long-term follow-up. Transplantologiya. The Russian Journal of Transplantation. 2021;13(2):121-129. https://doi.org/10.23873/2074-0506-2021-13-2-121-129

68. Syutkin V.E., Salienko A.A., Zhuravel S.V., Novruzbekov M.S. Changes in glomerular filtration rate in liver recipients after reduced exposure to calcineurin inhibitors with concomitant everolimus administration within the first year after immunosuppression conversion. Russian Journal of Transplantology and Artificial Organs. 2021;23(4):32-41. https://doi.org/10.15825/25/1995-1191-2021-4-32-41

69. Gijsen VM, Madadi P, Dube MP, Hesselink DA, Koren G, de Wildt SN. Tacrolimus-induced nephrotoxicity and genetic variability: a review. Ann Transplant. 2012;17(2):111-121. https://doi.org/10.12659/aot.883229 PMID: 22743729

70. Ader JL, Rostaing L. Cyclosporin nephrotoxicity: pathophysiology and comparison with FK-506. Curr Opin Nephrol Hypertens. 1998;7(5):539-545. https://doi.org/10.1097/00041552-199809000-00009 PMID: 9818201

71. Bahirwani R, Forde KA, Mu Y, Lin F, Reese P, Goldberg D et al. End-stage renal disease after liver transplantation in patients with pre-transplant chronic kidney disease. Clin Transplant. 2014;28(2):205-210. https://doi.org/10.1111/ctr.12298 PMID: 24382253

72. Sanchez EQ, Melton LB, Chinnakotla S, Randall HB, McKenna GJ, Ruiz R et al. Predicting renal failure after liver transplantation from measured glomerular filtration rate: review of up to 15 years of follow-up. Transplantation. 2010;89(2):232-235. https://doi.org/10.1097/TP.0b013e3181c42ff9 PMID: 20098288

73. Pawarode A, Fine DM, Thuluvath PJ. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. 2003;9(7):741-747. https://doi.org/10.1053/jlts.2003.50113 PMID: 12827563

74. Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931-940. https://doi.org/10.1056/NEJMoa021744 PMID: 12954741

75. Fujinaga K, Usui M, Yamamoto N, Ishikawa E, Nakatani A, Kishiwada M et al. Hypertension and hepatitis C virus infection are strong risk factors for developing late renal dysfunction after living donor liver transplantation: significance of renal biopsy. Transplant Proc. 2014;46(3):804-810. https://doi.org/10.1016/j.transproceed.2013.11.103 PMID: 24767353

76. Jin H, Wei Y, Qian Y, Zhang J, Xu Y, Zhou H et al. Renal histopathological lesions after liver transplantation: What can we find besides calcineurin inhibitor-induced nephrotoxicity?. BMC Nephrol. 2022;23(1):324. Published 2022 Sep 30. https://doi.org/10.1186/s12882-022-02952-y PMID: 36180855

77. Pillebout E, Nochy D, Hill G, Conti F, Antoine C, Calmus Y et al. Renal histopathological lesions after orthotopic liver transplantation (OLT). Am J Transplant. 2005;5(5):1120-1129. https://doi.org/10.1111/j.1600-6143.2005.00852.x PMID: 15816895

78. Chan GS, Lam MF, Kwan L, Fung SH, Chan SC, Chan KW. Clinicopathological study of renal biopsies after liver transplantation. Hong Kong Med J. 2013;19(1):27-32. PMID: 23378351

79. Allen AM, Kim WR, Therneau TM, Larson JJ, Heimbach JK, Rule AD. Chronic kidney disease and associated mortality after liver transplantation--a time-dependent analysis using measured glomerular filtration rate. J Hepatol. 2014;61(2):286-292. https://doi.org/10.1016/j.jhep.2014.03.034 PMID: 24713190

80. Ramachandran J, Juneja R, John L, Dutta AK, Chen JW, Woodman RJ et al. Chronic kidney disease following liver transplantation: a South Australian experience. Transplant Proc. 2010;42(9):3644-3646. https://doi.org/10.1016/j.transproceed.2010.06.022 PMID: 21094832

81. Al Riyami D, Alam A, Badovinac K, Ivis F, Trpeski L, Cantarovich M. Decreased survival in liver transplant patients requiring chronic dialysis: a Canadian experience. Transplantation. 2008;85(9):1277-1280. https://doi.org/10.1097/TP.0b013e31816c4e6b PMID: 18475183

82. Zhou J, Hu Z, Zhang Q, Li Z, Xiang J, Yan S et al. Spectrum of De Novo Cancers and Predictors in Liver Transplantation: Analysis of the Scientific Registry of Transplant Recipients Database. PLoS One. 2016;11(5):e0155179. https://doi.org/10.1371/journal.pone.0155179 PMID: 27171501

83. Piselli P, Verdirosi D, Cimaglia C, Busnach G, Fratino L, Ettorre GM et al. Epidemiology of de novo malignancies after solid-organ transplantation: immunosuppression, infection and other risk factors. Best Pract Res Clin Obstet Gynaecol. 2014;28(8):1251-1265. https://doi.org/10.1016/j.bpobgyn.2014.08.007 PMID: 25209964

84. Sherston SN, Carroll RP, Harden PN, Wood KJ. Predictors of cancer risk in the long-term solid-organ transplant recipient. Transplantation. 2014;97(6):605-611. https://doi.org/10.1097/01.TP.0000436907.56425.5c PMID: 24202142

85. Shalaby S, Burra P. De novo and recurrent malignancy. Best Pract Res Clin Gastroenterol. 2020;46-47:101680. https://doi.org/10.1016/j.bpg.2020.101680 PMID: 33158464

86. Habib SL, Rojna M. Diabetes and risk of cancer. ISRN Oncol. 2013;2013:583786. https://doi.org/10.1155/2013/583786 PMID: 23476808

87. Syutkin V.E., Gorodetskiy V.R., Salienko A.A., Probatova N.A., Kupryshina N.A., Novruzbekov M.S. Complete regression of generalized plasmacytoma of lymph nodes in a liver transplant recipient during the conversion of immunosuppressive therapy from tacrolimus to everolimus. Transplantologiya. The Russian Journal of Transplantation. 2021;13(3):272-279. https://doi.org/10.23873/2074-0506-2021-13-3-272-279

88. Voskanyan S.E., Syutkin V.E., Mal'tseva A.P., Rudakov V.S., Svetlakova D.S., Davtyan A.A. et al. Hemophagocytic syndrome and Kaposi sarcoma after liver transplantation. Transplantologiya. The Russian Journal of Transplantation. 2018;10(2):126-141. https://doi.org/10.23873/2074-0506-2018-10-2-126-141

89. Watt KD, Pedersen RA, Kremers WK, Heimbach JK, Sanchez W, Gores GJ. Long-term probability of and mortality from de novo malignancy after liver transplantation. Gastroenterology. 2009;137(6):2010-2017. https://doi.org/10.1053/j.gastro.2009.08.070 PMID: 19766646

90. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-485. https://doi.org/10.1016/j.jhep.2015.10.006 PMID: 26597456

91. Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3):1144-1165. https://doi.org/10.1002/hep.26972 PMID: 24716201