The liver transplant patient

Question 1

The Scar

Answer 1

‘Mercedes–Benz’ or roof–top scar –> Liver transplant

Question 2

Clinical signs

Answer 2

1. Scar (Mercedes-Benz or roof top scar -> liver transplant
2. Evidence of CLD (general, hand, face, chest and abdomen)
3. Signs of the Reason for liver transplantation
4. Evidence of immunosuppressive medication

Question 3

Clinical evidence of the reason for liver transplantation

Answer 3

• Slate‐grey pigmentation –> Haemochromatosis
• Other autoimmune disease –> PBC
• Tattoos and needle marks –> Hepatitis B, C

Question 4

Evidence of immunosuppressive medication

Answer 4

• Ciclosporin: gum hypertrophy and hypertension
• Steroids: Cushingoid appearance, thin skin, ecchymoses

Question 5

Top three reasons for liver transplantation

Answer 5

• Cirrhosis
• Acute hepatic failure (hepatitis A and B, paracetamol overdose)
• Hepatic malignancy (hepatocellular carcinoma)

Question 6

Success of liver transplantation

Answer 6

• 80% 1‐year survival
• 70% 5‐year survival

Question 7

Causes of gum hypertrophy

Answer 7

• Drugs: ciclosporin, phenytoin and nifedipine
• Scurvy
• Acute myelomonocytic leukaemia
• Pregnancy
• Familial

Question 8

Skin signs in (any) transplant patients

Answer 8

* Malignancy
⚬⚬ Dysplastic change (actinic keratoses)
⚬⚬ Squamous cell carcinoma (100 × increased risk and multiple lesions)
⚬⚬ Basal cell carcinoma and malignant melanoma (10 × increased risk)
* Infection:
⚬⚬ Viral warts
⚬⚬ Cellulitis