Incidence of adverse events with HMG‐CoA reductase inhibitors in liver transplant patients

Martin, Jill E.; Cavanaugh, Teresa M.; Trumbull, Leslie; Bass, Maryetta; Weber, Fredrick L.; Aranda-Michel, Jaime; Hanaway, Michael J.; Rudich, Steven M.

doi:10.1111/j.1399-0012.2007.00780.x

Cited by 45 publications

(31 citation statements)

References 27 publications

(33 reference statements)

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“…Statins have been used commonly in solid organ transplant recipients for decades and are well tolerated [77]. Pravastatin is the most studied and used statin in post-transplant patients due to its metabolism not requiring the P450 enzyme system, but many of the other statins (atorvastatin, simvastatin, lovastatin, cerivastatin and fluvastatin) are used frequently in transplant patients.…”

Section: Dyslipidemiamentioning

confidence: 99%

Metabolic syndrome and liver transplantation: A review and guide to management

Watt

Charlton

2010

Journal of Hepatology

195

153

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Metabolic syndrome is common among liver transplant recipients before and after transplantation. The components of metabolic syndrome are often exacerbated in the post-transplant period by transplant specific factors, such as immunosuppression, and are strong predictors of patient morbidity and mortality. Many aspects of the metabolic syndrome are modifiable. Early recognition, prevention and treatment of post-transplant hypertension, obesity, dyslipidemia and diabetes may impact long-term post-transplant survival. Further study into the prevention and management of these issues in the transplant patient are needed.

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Section: Dyslipidemiamentioning

confidence: 99%

Metabolic syndrome and liver transplantation: A review and guide to management

Watt

Charlton

2010

Journal of Hepatology

195

153

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“…Thus, an effect on muscle injury recovery could be expected; however, reports of direct toxicity of tacrolimus and everolimus to skeletal muscle are very rare (90,224,264). An important drug interaction is seen with cyclosporin A or tacrolimus or sirolimus, all which can lead to an acute skeletal muscle injury including rhabdomyolysis (5,182) in the setting of the lipid lowering statin drugs.…”

Section: Medicationsmentioning

confidence: 99%

Exercise Limitation Following Transplantation

Williams

McKenna

2012

Comprehensive Physiology

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Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid‐organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in o 2 peak is seen (typically renal and liver 65%‐80% with heart and/or lung 50%‐60% of predicted). Those with the lowest o 2 peak pretransplant have the lowest o 2 peak posttransplant. Overall very few patients have a o 2 peak in the normal range. Investigation of the cause of the reduction of o 2 peak has identified many factors pre‐ and posttransplant that may contribute. These include organ‐specific factors in the otherwise well‐functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of o 2 peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure‐skeletal muscle dysfunction. © 2012 American Physiological Society. Compr Physiol 2:1937‐1979, 2012.

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“…Initiation of pharmacological therapy should be considered in all patients with persistent posttransplant dyslipidemia. HMG-CoA inhibitors (statins), which are well tolerated in solid organ recipients [47], are safe and efficacious in recipients with both elevations in cholesterol and triglycerides. Pravastatin (20 mg/day) is the most studied in transplant recipients and has the theoretical advantage that its metabolism is independent of cytochrome P450.…”

Section: Dyslipidemiamentioning

confidence: 99%

An Update of Liver Transplantation for Nonalcoholic Steatohepatitis

Thomason

Charlton

2015

Curr Hepatology Rep

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Nonalcoholic steatohepatitis (NASH), obesity, and the metabolic syndrome are highly prevalent before and after liver transplantation, with NASH currently the second most common indication. This review considers established and new aspects of liver transplantation for NASH. NASH is one of many sequelae of obesity and most frequently occurs on a background of the metabolic syndrome. While recurrence of steatosis is common, recurrence of NASH with advanced stages of fibrosis is unusual, with graft loss due to recurrence of NASH cirrhosis occurring with a frequency of less than 5 %. In contrast, the components of the metabolic syndrome, which are important predictors of posttransplant outcomes, are nearly ubiquitous following liver transplantation and are exacerbated by factors such as immunosuppression. As many aspects of the metabolic syndrome are modifiable, screening for and treating complications of obesity and minimization of immunosuppression are cornerstones of optimizing outcomes for transplant recipients with NASH. The optimal approach to immunosuppression, the role of bariatric surgery, and nutritional and pharmacotherapy of NASH in liver transplant recipients are evolving rapidly. Overall, a minimalist approach to immunosuppression is advised.

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Incidence of adverse events with HMG‐CoA reductase inhibitors in liver transplant patients

Abstract: Overall, there was a general tolerability with a low incidence of adverse events, no incidence of severe complications, and no alterations in liver function tests in the study population with the use of LLA.

Cited by 45 publications

References 27 publications

Metabolic syndrome and liver transplantation: A review and guide to management

Metabolic syndrome and liver transplantation: A review and guide to management

Exercise Limitation Following Transplantation

An Update of Liver Transplantation for Nonalcoholic Steatohepatitis

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