Long-term Care of the Adult Liver Transplant Recipient.
J Clin Exp Hepatol
; 12(6): 1547-1556, 2022.
Article
em En
| MEDLINE
| ID: mdl-36340310
ABSTRACT
While outcomes after liver transplantation have increased over the last two decades, this is primarily as a consequence of a reduction in early deaths and survival of those who survive the first 6 months has not significantly changed. Causes of premature death and graft loss include cardiovascular disease, renal impairment, malignancy and some infections. As the number of transplant recipients increase, care is being given by primary and secondary care clinicians. Management of the well patient is crucially dependent on careful assessment and where appropriate intervention, especially of cardiovascular risk - such as advice about avoidance of weight gain; management of hypertension, hyperlipidaemia and diabetes; and provision of appropriate lifestyle advice. Other interventions include surveillance for de novo malignancies, active management of immunosuppressive regimen with the need to tailor immunosuppression to the individual. Prompt investigation of abnormalities of liver function is essential. Immune-mediated graft damage still occurs but is less common as a cause for graft loss. Adherence is sometimes an issue, especially in teenagers and young adults, and should be considered and support given where needed. Immunisations (avoiding live and attenuated vaccines) should be encouraged. Recurrence of disease remains an issue, and some interventions (such as appropriate use of antiviral therapy for those grafted with viral hepatitis, use of ursodeoxycholic acid for those grafted for primary biliary cholangitis or long-term steroids for those grafted for autoimmune disease) may improve and maintain graft function. Close collaboration between recipient and the attending clinicians in primary, secondary and tertiary care and close attention to modifiable conditions will lead to improved outcomes.
CMV, Cytomegalovirus; CNI, Calcineurin inhibitor; DRR-4i, dipeptidyl peptidase-4 inhibitor; GLP 1RA, glucagon-like peptide-1 receptor agonists; HBIG, Hepatitis B Immunoglobulin; HBV, Hepatitis B Virus; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus; LDL-C, Low-density lipoprotein cholesterol; LT, Liver transplant; MDRD, Modification of Diet in Renal Disease; MRC, Magnetic resonance cholangiography; NAFLD, Non-alcoholic fatty liver disease; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NODAT, New onset diabetes after transplant; NUC, Nucleos(t)ide analogues; PBC, Primary Biliary Cholangitis; PSC, Primary Sclerosing Cholangitis; SGLT2i, sodiumglucose cotransporter 2 inhibitors; SRTR, Scientific Registry of Transplant Recipients; TMPT, Thiopurine S-methyltransferase; USA, United States of America; cardiovascular disease; follow-up; liver transplant; mRNA, messenger Ribonucleic acid; mTORi, mammalian Target of rapamycin inhibitor; malignancy; recurrent disease
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
J Clin Exp Hepatol
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido