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Additional file 1: Figure S1. Englisch translation of digital quality management document. QM documents are prospectively collected on the day of discharge and validated daily by a group of senior consultant surgeons. It includes the indication for surgical treatment (blue), complications which occurred during the inpatient stay (red) and the necessary procedure for complication management (green). Complications are classified either as medical or organizational. Medical complications are further classified into renal, post pancreatic surgery, central nervous system, post vascular surgery, cardiovascular, systemic, or surgical site infections, bleeding, post organ transplantation, pulmonary, gastrointestinal, and hepatobiliary complications. Finally, complications are classified according to Clavien-Dindo.

Background/Aims Long-term survival of liver transplant recipients is endangered by tumorigenesis at different sites. Little is known about primary de novo tumors developing in the graft. Methods We analyzed the follow-up data of 2731 liver recipients that were transplanted between 1988 and 2019 at our institution (Charité - Universitätsmedizin Berlin, Department of Surgery). All cases with new intrahepatic tumors during follow-up were identified. Results A total of nine patients were diagnosed at a median of 16 years (range, 2-24 years) after surgery. Eight patients presented with hepatocellular carcinoma (HCC), and one patient presented with epithelioid hemangioendothelioma (EHE). All eight HCC patients had a recurrence of the initial disease that had caused liver failure before transplantation. This was associated with viral reinfection with either HCV or HBV in seven cases. Of the nine patients, three underwent surgical resection and only one patient was alive at data abstraction. Conclusion Intrahepatic de novo neoplasms in the liver graft need to be considered in the long-term follow-up of liver recipients and were strongly associated with recurrent viral hepatitis in our study. Although prognosis of this rare complication is generally poor, patients may benefit from surgical resection of localized disease.

Additional file 1. Shows complete data of the mechanical experiment including stress-strain curves and negative control images for histological staining.