Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity


  • Adrian Reuben MBBS, FRCP

    Corresponding author
    1. From the Liver Service and Liver Transplant Program, Medical University of South Carolina, Charleston, SC
    • 210 Clinical Science Bldg, 96 Jonathan Lucas St, PO Box 250327, Charleston, SC 29425. Telephone: 843-792-6901; FAX: 843-792-5187
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Key Points

  • 1As long-term survival improves after liver transplantation, cardiovascular complications are emerging as a major cause of late morbidity and mortality. It seems reasonable to correct the potentially reversible cardiovascular risk factors of diabetes, hyperlipidemia, and obesity, in addition to hypertension.
  • 2The results of liver transplantation in diabetics are acceptable in terms of morbidity, mortality, and prevalence of posttransplant diabetes, but the poor outcomes described in some series suggest that more extensive testing for macro- and microvascular disease may become necessary.
  • 3The management of diabetes in liver transplant recipients is not substantially different from its management in nontransplant patients, except that steroid reduction or withdrawal and minimizing doses of calcineurin inhibitors are beneficial.
  • 4Hyperlipidemia occurs in all solid-organ transplantation, with prevalence rates the lowest for liver transplant recipients. Following liver transplantation, between 15% and 40% of recipients on average have increased plasma cholesterol levels and about 40% have hypertriglyceridemia. Dietary changes, weight reduction, exercise and statins are the mainstays of therapy.
  • 5Retrospective studies suggest that long-term survival of obese recipients after liver transplantation does not differ from nonobese recipients. Posttransplant weight gain occurs in most recipients, and approximately two thirds become overweight. The management of posttransplant obesity is similar to that in nontransplant settings.