Received: 15 January 2001 Accepted: 26 January 2001 Published online: 15 September 2001 © Springer-Verlag 2001 Abstract Background and aims: To analyze the incidence, clinical fea- tures, expansion rate of, and clinical approach to abdominal aortic aneu- rysm in patients who had undergone orthotopic liver transplantation. To our knowledge, this is the first report on this issue in liver transplant recip- ients. Patients/Methods: Among 172 patients undergoing 185 liver transplantations at our institution over the last 10-year period, we identified three patients (1.7%) with infrarenal aortic aneurysm. They had all undergone routine pre-liver trans- plant ultrasonography screening for aortic aneurysm. Results: All three patients were symptom free at the time of the discovery of a mild infra- renal abdominal enlargement before (n=2) and after liver transplantation (n=1), and were closely monitored by ultrasonography in the follow-up period (3.1–4.3 years). The mean aneurysm expansion rate was 0.73 cm/year. All patients under- went aneurysm repair after their aneurysm expanded significantly un- der observation, with a mean diame- ter of 5.1 cm at the time of repair. All three patients are alive and well (median follow-up: 19 months). Conclusions: Our data suggest that careful ultrasonographic surveillance is warranted in any liver transplant recipient, because of the apparent propensity for a more rapid aneu- rysm expansion and potentially ag- gressive course than in the untrans- planted population. Early repair of the infrarenal aneurysm is recom- mended in transplant recipients, giv- en that excellent perioperative and late outcomes can be achieved. Keywords Liver transplantation · Small abdominal aortic aneurysm repair · Immunosuppressive regimen Langenbeck’s Arch Surg (2001) 386:426–429 DOI 10.1007/s004230100247 ORIGINAL ARTICLE Enzo Ballotta Roberto Merenda Emanuele Mion Giuseppe Da Giau Abdominal aortic aneurysm in liver transplant recipients Introduction Abdominal aortic aneurysm (AAA) in orthotopic solid organ transplant patients is a condition well known in the medical literature [16, 14, 13, 3, 12, 10, 1, 11]. The ma- jority of AAAs are reported to develop in orthotopic heart transplant (OHT) recipients, with a significantly higher incidence in patients who underwent OHT for ischemic heart disease than for other indications, empha- sizing the susceptibility of this patient population to the extracardiac manifestation of the complications of atherosclerotic disease [16, 14, 13, 12, 1]. Moreover, al- though the true incidence is not well documented – be- cause most reports tend to focus on strategies for provid- ing perioperative renal graft protection – AAA has also been discovered in patients who have undergone renal transplant [10], whereas only one case of AAA has been reported after lung transplantation [11], and none, to date, after orthotopic liver transplantation (OLT). This report describes our experience with three asymptomatic AAAs detected in OLT recipients. To our knowledge, it is the first paper regarding this issue in OLT survivors. Since the natural history of all AAAs in transplant recipients appears to be characterized by a more rapid growth and a greater likelihood of symptom- atic presentation than in the untransplanted population E. Ballotta ( ✉ ) Section of Vascular Surgery, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Policlinico Universitario, Via N. Giustiniani, 2, 35128, Padova, Italy e-mail: enzo.ballotta@unipd.it Tel.: +39-49-821-2239 Fax: +39-49-821-2254 G. Da Giau Section of Vascular Surgery, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Padova, Italy R. Merenda · E. Mion Division of General Surgery, Liver Transplantation Center, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Padova, Italy