Management of liver tx recipient - a primer for non-transplant doctors

[Guest guest]

Review

article: medical management of the liver transplant recipient - a primer for

non-transplant doctors

Authors:

SETHI, A.; STRAVITZ, R. T.  Publisher: Blackwell Publishing

Source:

Alimentary

Pharmacology & Therapeutics, Volume 25, Number 3,

February 2007

Summary

Background -

Survival

10 years after orthotopic liver

transplantation now approaches 65%. Consequently, community doctors must manage

the metabolic and neoplastic complications of orthotopic liver transplantation in an ageing population.

Aims -  To review common

sources of morbidity and mortality in long-term orthotopic

liver transplantation recipients, and to make evidence-based recommendations

regarding their management.

Methods

- Pertinent studies and reviews were identified by literature search through PubMed. Where evidence-based

recommendations could not be gleaned from the literature, expert opinion was

obtained from syllabi of national meetings.

Results

- The two most common causes of morbidity and mortality in orthotopic

liver transplantation recipients are atherosclerotic vascular disease and de novo malignancy. The

pathogenesis of many complications begins before orthotopic

liver transplantation, and many are potentially modifiable. Most

complications, however, can be directly ascribed to immunosuppressive agents. Despite improvements in our understanding of the

pathogenesis and epidemiology of the metabolic and neoplastic

complications of orthotopic liver transplantation,

remarkably few randomized-controlled studies exist to define their optimal

management.

Conclusions

-  Orthotopic

liver transplantation recipients experience and succumb to the same afflictions

of old age as non-transplant patients, but with greater frequency and at an

earlier age. Most recommendations regarding

surveillance for, and treatment of, medical complications of orthotopic liver transplantation remain based upon expert

opinion rather than evidence-based medicine.

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas