Emerging causes of morbidity and mortality in organ transplant patients

PURPOSE OF REVIEW: As short-term allograft and patient survival has improved following solid organ transplantation, medium and long-term causes of morbidity and mortality have come to the forefront of patient care. RECENT FINDINGS: The metabolic syndrome has relatively recently been defined and is now being applied to studies of posttransplant morbidity and mortality. The metabolic syndrome, and its individual risk factors such as obesity and diabetes mellitus, are highly prevalent in all solid organ transplant populations and negatively impact allograft and patient survival. Even when the metabolic syndrome is not present prior to transplantation, weight gain and the metabolic syndrome can develop following transplantation with negative outcomes. A second growing concern following transplantation is the development of late malignancies. The strongest risk factors include pretransplant conditions such as tobacco use, excess alcohol use, and idiopathic inflammatory bowel disease. In select populations, continued tobacco use following transplantation is disappointingly high. De-novo carcinomas in renal and hepatic allografts are also likely to be a growing concern. SUMMARY: The metabolic syndrome and malignancies are important causes of morbidity and mortality following solid organ transplantation. Continued work is needed to fully understand the magnitude of the risks as well as methods of intervention.