1365-2036/asset/olbannerleft.gif?v=1&s=45db8c78d1d41c404034f2eaf7587620d5727843)
1365-2036/asset/olbannerright.gif?v=1&s=45518840b7e2e59fcc9d74113b13f4474a604878)
Review article: medical management of the liver transplant recipient – a primer for non-transplant doctors
Article first published online: 8 JAN 2007
DOI: 10.1111/j.1365-2036.2006.03166.x
Additional Information
How to Cite
SETHI, A. and STRAVITZ, R. T. (2007), Review article: medical management of the liver transplant recipient – a primer for non-transplant doctors. Alimentary Pharmacology & Therapeutics, 25: 229–245. doi: 10.1111/j.1365-2036.2006.03166.x
Publication History
- Issue published online: 8 JAN 2007
- Article first published online: 8 JAN 2007
- Publication data Submitted 18 July 2006 First decision 4 August 2006 Resubmitted 31 August 2006 Accepted 20 September 2006
- Abstract
- Article
- References
- Cited By
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.