45. Long-Term Management of the Liver Transplant Patient

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Timothy M. McCashland MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch45

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

McCashland, T. M. (2011) Long-Term Management of the Liver Transplant Patient, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch45

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

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Keywords:

  • Long-term care;
  • preventive care;
  • metabolic syndrome;
  • bone disease;
  • renal dysfunction;
  • de novo malignancy;
  • liver transplantation

Summary

The long-term survival of patients post liver transplantation includes management of key medical problems to reduce morbidity and mortality. Preventive care with vaccination for hepatitis A and B, pneumococcal infections, and yearly influenza is mandatory. Metabolic syndrome (obesity, hyperlipidemia, diabetes mellitus) is rising and the associated cardiovascular risk is a main concern. A yearly evaluation of weight with counseling, use of statins, and a tight control of blood sugars should be undertaken to improve these cardiovascular risks. Bone disease is common and improves with proper diet and medications. Renal dysfunction remains a major problem post liver transplant with up to 20% incidence within 10 years. Careful evaluation of medical problems and immunosuppression may help. Lastly, diligent screening and surveillance is required to diagnosis de novo malignancy post liver transplantation.