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Background: Liver transplantation is the standard of care for acute and chronic causes of end-stage liver disease. Advances in medical therapy and surgical techniques have led to improvement of patient and graft survival rates following orthotopic liver transplantation. However, the prevalence of posttransplant cardiovascular complications has been rising with increased life expectancy after liver transplantation. Aims: To determine the incidences, risk factors, and treatment for hypertension, hyperlipidaemia, diabetes, and obesity in the post-liver transplantation population. Methods: We performed a review of relevant studies available on the PubMed database that provided information on the incidence, risk factors and treatment for cardiovascular complications that develop in the post-liver transplantation population. Results: Current immunosuppressive agents have improved patient and graft survival rates. However, long-term exposure to these agents has been associated with development of systemic and metabolic complications including hypertension, hyperlipidaemia, diabetes mellitus and obesity. Cardiovascular disease remains one of the most common causes of death in liver transplant patients with functional grafts. Conclusions: Liver transplant recipients have a higher risk of cardiovascular complications compared with the nontransplant population. Post-transplant cardiac risk stratification and aggressive treatment of cardiovascular complications, including modification of risk factors and tailoring of immunosuppressive regimen, is imperative to prevent serious complications.Liver transplantation is the standard of care for acute and chronic causes of end-stage liver disease. Advances in medical therapy and surgical techniques have led to improvement of patient and graft survival rates following orthotopic liver transplantation (OLT), with 1-and 5-year patient survival rates of 84 and 67% respectively (1). However, the prevalence of medical complications such as hypertension, hyperlipidaemia, weight gain and diabetes has been rising along with increased life expectancy after liver transplantation (2). Liver transplant recipients have a higher risk of cardiovascular death and ischaemic events as compared with an age-and sex-matched population without liver transplant (3). This elevated cardiovascular event rate ranges from 9% at 5 years post-transplant (4) to 25% at 10 years post-transplant (5). Cardiovascular disease causes 21% of deaths among liver transplant patients with functioning grafts surviving more than 3 years (6) and remains a common cause of death in OLT patients (7).Post-OLT cardiovascular complications result from a combination of factors that include pre-existing disease before transplantation and chronic exposure to immunosuppressive agents following OLT (8). Current immunosuppressive regimens include a combination of a calcineurin inhibitor, such as cyclosporine or tacrolimus, along with corticosteroids, mycophenolate mofetil or sirolimus, and have been associated with both exacerbati...

Coccidioidomycosis is a systemic infection caused by the soil fungus Coccidioides immitis, which is endemic to the south-western United States. Manifestations range from flu-like illness to pneumonia and septic shock. Diagnosis may be delayed or missed in non-endemic areas because of the low index of suspicion. We describe a series of 23 patients with coccidioidomycosis at one institution in a non-endemic area. Diagnosis was often delayed. In two patients, the route of exposure could not be determined, but 20 patients had a history of residence or travel to endemic areas, and the remaining patient had an occupational history of exposure to fomites from an endemic region. Five patients were immunosuppressed. Most patients responded well to medical therapy, surgery, or both. Although coccidioidomycosis is rare in non-endemic areas, physicians must keep it in mind when evaluating patients who have traveled to endemic areas or who are immunosuppressed.

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