May 16, 2023

The development of pyogenic liver abscess (PLA) after liver transplant is rare. Studies have commonly reported hepatic artery thrombosis and biliary tract pathologies as risk factors for PLA formation. Whilst other modifiable etiologies include diabetes and immunosuppression. This is a case of a 71-year-old male with a history of hepatitis B, diabetes mellitus, and hepatocellular carci noma who presented with PLA formation 14 years and 21 years after successful liver transplantation without biliary tract recon struction. Post-transplant biliary cholangiopathy and hepatic ar tery thrombosis were not present in both instances. Intravenous antibiotics and abscess drainage were performed for both PLAs with complete resolution. This case highlights the importance of early recognition of liver abscess and management of diabetes mellitus glycemic control, immunosuppressive drugs, and periop erative antibiotics prophylaxis to prevent future PLA formation in post-liver transplant patients.