A Patient with a Liver Transplant and Abdominal Pain

Rejection of a liver transplant can present with hepatosplenomegaly, abdominal pain, pruritus, scleral icterus, or changes in stool consistency and color. Initial management of liver transplant patients with fever and transaminitis should include labs, imaging, and empiric broad-spectrum IV antibiotics. Such a presentation can indicate rejection, cholangitis, hepatic artery or portal vein thrombosis, infection, or PTLD. Transfer to a specialized transplantation center is strongly recommended.