Metabolic complications in liver transplant recipients.

The metabolic syndrome (MS), which includes obesity, dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease (CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease (NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.

Toxicidad pulmonar asociada a sirolimus en el trasplante hepático / Pulmonary toxicity associated with sirolimus therapy in liver transplantation

El sirolimus es un potente inmunosupresor de uso reciente, en principio en el trasplante renal pero con una utilización cada vez mayor en el trasplante de otros órganos sólidos, como el hígado, el corazón, el pulmón o el páncreas. Está indicado en las terapias de rescate y para reducir los efectos tóxicos secundarios de los inhibidores de la calcineurina. Sin embargo, se ha asociado con una grave toxicidad pulmonar, aunque infrecuente, y se han descrito casos de neumonitis intersticial, bronquiolitis obliterante con neumonía organizativa y proteinosis alveolar. Exponemos el caso de un paciente con trasplante hepático que presentó neumonitis intersticial asociada al uso de sirolimus

Sirolimus is a potent immunosuppressive drug that began to be used in the last few years. This drug was initially used in renal transplantation but its use in other solid organ transplantations such as liver, heart, lung and pancreas, has been increasing. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. However, this drug has been associated with infrequent but severe pulmonary toxicity and cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We present the case of a male liver transplant recipient who developed interstitial pneumonitis associated with sirolimus use

[Pulmonary toxicity associated with sirolimus therapy in liver transplantation]. / Toxicidad pulmonar asociada a sirolimus en el trasplante hepático.

Sirolimus is a potent immunosuppressive drug that began to be used in the last few years. This drug was initially used in renal transplantation but its use in other solid organ transplantations such as liver, heart, lung and pancreas, has been increasing. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. However, this drug has been associated with infrequent but severe pulmonary toxicity and cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We present the case of a male liver transplant recipient who developed interstitial pneumonitis associated with sirolimus use.