Primary recurrence after liver transplantation Etiology: Primary recurrence after liver transplantation includes tumor recurrence, recurrence of hepatitis B and C, primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and recurrence of autoimmune liver disease. Diagnosis and differential diagnosis: Risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma include the choice of surgical timing, biological characteristics of the tumor, preoperative tumor treatment, postoperative immunosuppressive use and prophylactic treatment. Regular imaging surveillance and tumor marker screening can help early detection. After liver transplantation for end-stage liver disease caused by viral hepatitis and autoimmune liver disease, recurrence of the original disease may also occur after surgery. Complications: Recurrence of the original disease may lead to transplantation liver damage, which may eventually develop into cirrhosis, liver failure and various complications of end-stage liver disease before transplantation. Treatment prognosis: Liver transplantation patients with hepatocellular carcinoma account for about 45% of liver transplantation cases performed in China each year, and postoperative tumor recurrence is the most important factor affecting the long-term prognosis of liver transplantation. According to the analysis of China Liver Transplant Registry (CLTR), the survival rates of liver transplant patients with liver cancer in China at 1 year and 3 years after surgery are: 75% and 59.4%, respectively, which are significantly lower than the survival rates of liver transplant patients with benign liver disease. Among liver transplant patients in China, about 80% are patients with hepatitis B-related end-stage liver disease. After hepatitis B liver transplantation, the recurrence rate of hepatitis B is 70%-100% if no preventive program is taken; the recurrence rate of hepatitis B with high-dose HBIG alone reaches 20%-30%, while the recurrence rate of hepatitis B with lamivudine alone reaches 13%-45%. With the application of nucleoside analogs combined with human hepatitis B immunoglobulin (HBIG), the recurrence rate of hepatitis B after liver transplantation has been significantly reduced. At present, nucleoside analogs combined with low-dose hepatitis B immune globulin (HBIG) are basically used as a preventive regimen in China. For patients with long-term survival and stable disease after liver transplantation, hepatitis B vaccination can be tried. Hepatitis C patients have a high rate of hepatitis C recurrence after liver transplantation. Histologically confirmed recurrence of hepatitis C occurs in 50% to 80% of patients in the first year after liver transplantation, with the earliest clinical recurrence of hepatitis C occurring on day 9 after transplantation. In addition, the course of hepatitis C recurrence after transplantation progresses more rapidly than the general hepatitis C infection, with reoccurrence of cirrhosis reported in 9% to 28% of patients 5 years after transplantation. There are many reasons for the rapid progression of hepatitis C relapse after liver transplantation, including HCV genotype, viral load, immunogenetic background of the recipient, and the use of conventional immunosuppressive agents. To date there are no specific treatment options to prevent hepatitis C recurrence after liver transplantation. The anti-Hepatitis C virus treatment regimen after liver transplantation is pegylated interferon combined with ribavirin, but the clinical results are not very satisfactory. The long-term application of postoperative ribavirin is not tolerated by many patients due to the severe hypersplenism in liver transplant patients, which also affects the therapeutic effect. Preventive care: Patients after liver transplantation should be followed up regularly, have regular checkups, and take health care products with caution.