Long Term Follow-up of Liver Transplant Recipients: Considerations for Non-transplant Specialists

Abstract

Patient and liver graft survival rates have improved significantly in the last decades, leading to complications mainly related to long-term immunosuppression. Prevention of, screening for metabolic syndrome, cardiovascular disease, de novo diabetes mellitus, renal dysfunction, and malignancies and their management are mandatory due to important causes of morbidity and mortality in this patient population. Quality of life (QoL) and functional benefits are clearly better compared to preoperative status; however, post-liver transplantation (LT) complications may impair and alter QoL scores. Individualized immunosuppression managed by transplant physicians and collaboration with other non-transplant specialists for recognition and treatment of medical complications and comorbidities after LT is the key to enhanced QoL and life expectancy of this patient population.

Genetic and Life Style Risk Factors for Recurrent Non-alcoholic Fatty Liver Disease Following Liver Transplantation

“…The influence of immunosuppression on the development of MS and NAFLD after LT was extensively discussed in other papers (55,56) and will not be in the focus of this review. Weight loss through diet, lifestyle modifications, pharmacological agents or bariatric surgery is linked with resolution of NASH and improvement in liver fibrosis, and should be implemented in overweight LT recipients, with an objective of 7-10% decrease in body weight (30). An early diagnosis of MS will restraint associated comorbidities, thereby reducing the risk of cardiovascular events.…”

“…However, possible side effects are mentioned such as neuropsychiatric disorders, cardiovascular comorbidities, and drug-drug interactions that could limit their use. There are no known interactions with posttransplant immunosuppressants, but there are no data on the use of phentermine-topiramate following post-solid organ transplant setting (30).…”

“…There is no specific immunosuppression strategy that has been shown to be useful in preventing weight gain after LT; however, immunosuppression should be tailored to diminish to minimum the risk of metabolic complications (30).…”

“…Fibrates can be also safely used in patients with high triglyceridemia levels over 600 mg/dL, but caution is required when co-administrated with statins due to high risk of myotoxicity and renal dysfunction. For patients with hypertriglyceridemia, fish oil can be used with minimal side effects except potential increase of low-density lipoprotein level (18,30).…”