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Long-Term Metabolic Complications Posttransplantation

Controversies in Management

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Liver Transplantation

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Approximately 4,500 transplants are performed each year in the United States. Advances in organ preservation and surgical technique and in the management of immunosuppression have significantly improved survival. Short-term survival is excellent. As long-term survival increases, cardiovascular complications are emerging as a major cause of morbidity and mortality. Hypertension, dyslipidemia, and diabetes mellitus all are increased in liver transplant recipients and occur at an earlier age than in the general population. As a result, they not only contribute to cardiovascular disease but also impact liver recipients’ quality of life. Although primary care physicians claim to be comfortable in managing the care of liver recipients, transplant hepatologists usually assume these patients’ overall health care. Many questions, however, need to be addressed regarding whom, in fact, is managing these metabolic complications and the adequacy of management. Ultimately, a novel health delivery system for liver recipients will need to be developed with the goal of improvement of quality of care.

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References

  1. Annual report of the U.S. Scientific Registry for Transplant Recipients and the Organ and Procurement and Transplantation Network Transplant Data: 1989–1998. U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation, Rockville, MD. UNOS, Richmond, VA.

    Google Scholar 

  2. Bostom AD, Brown RS, Cosio FG, et al. Prevention of post-transplant cardiovascular disease: Report and recommendations of an ad hoc group. Am J Transpl 2002; 2:491–500.

    Article  Google Scholar 

  3. Everson GT, Trouillot T, Wachs M, et al. Early steroid withdrawal in liver transplantation is safe and beneficial. Liver Transpl Surg 1999; 5(Suppl 1):S48–S57.

    Google Scholar 

  4. Stegall MD, Everson G, Schroter G, Bilir B, Karrer F, Kam I. Metabolic complications after liver transplantation. Transplantation 1995; 60:1057–60.

    PubMed  CAS  Google Scholar 

  5. Stegall MD, Everson GT, Schroter G, et al. Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss. Transpl Surg 1997; 25:173–7.

    CAS  Google Scholar 

  6. Zeier M, Mandelbaum A, Ritz E. Hypertension in the transplanted patient. Nephron 1998; 80:257–68.

    Article  PubMed  CAS  Google Scholar 

  7. Lucey MR, Abdelmalek MF, Gagliardi R, et al. A comparison of tacrolimus and cyclosporine in liver transplantation: Effects on renal function and cardiovascular risk status. Am J Transpl 2005; 5:1111–9.

    Article  CAS  Google Scholar 

  8. Trotter JF, Wachs ME, Trouillot TE, et al. Dyslipidemia during sirolimus therapy in liver transplant recipients occurs with concomitant cyclosporine but not tacrolimus. Liver Transpl 2001; 7:401–8.

    Article  PubMed  CAS  Google Scholar 

  9. Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 348:931–40.

    Article  Google Scholar 

  10. Brown RS, Lombardero M, Lake JR. Outcome of patients with renal insufficiency undergoing liver or liver-kidney transplantation. Transplantation 1996; 62:1788–93.

    Article  PubMed  Google Scholar 

  11. Rimola A, Gavaler JS, Schade RR, el-Lankany S, Starzl TE, Van Thiel DH. Effects of renal impairment on liver transplantation. Gastroenterology 1987; 93:148–56.

    PubMed  CAS  Google Scholar 

  12. Porayko MK, Gonwa TA, Klintmalm GB, Wiesner RH. Comparing nephrotoxicity of FK 506 and cyclosporine regimens after liver transplantation: Preliminary results from U.S. Multicenter Trial. Transpl Proc 1995; 27:1114–6.

    CAS  Google Scholar 

  13. Fried LF, Shlipak MG, Crump C, et al. Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 2003; 4:1364–72.

    Article  Google Scholar 

  14. Shlipak MG, Heindenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan, MB. Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med 2002; 137:555–62.

    PubMed  Google Scholar 

  15. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: A new paradigm. Am J Kidney Dis 2000; 35(Suppl 1):S117–S131.

    Google Scholar 

  16. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42:1206–52.

    Article  PubMed  CAS  Google Scholar 

  17. Sheiner PA, Magliocca JF, Bodian CA, et al. Long-term medical complications in patients surviving ≥ 5 years after liver transplant. Transplantation 2000; 69:781–9.

    Article  PubMed  CAS  Google Scholar 

  18. National Kidney Foundation Work Group. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: A report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transpl 2004; 4:13–53.

    Google Scholar 

  19. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486–97.

    Google Scholar 

  20. Munoz SJ, Doems RO, Moritz MJ, Martin P, Jarrell BE, Maddrey WC. Hyperlipidemia and obesity after orthotopic liver transplantation. Transpl Proc 1991; 23:1480–3.

    CAS  Google Scholar 

  21. Gisbert C, Prieto M, Berenguer M, et al. Hyperlipidemia in liver transplant recipients: Prevalence and risk factors. Liver Transpl Surg 1997; 3:416–23.

    Article  PubMed  CAS  Google Scholar 

  22. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12 years cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16:434–44.

    Article  PubMed  CAS  Google Scholar 

  23. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20:1183–97.

    Google Scholar 

  24. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160–7.

    Google Scholar 

  25. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transpl 2003; 3:178–85.

    Article  Google Scholar 

  26. Khalili M, Lim JW, Bass N, Ascher NL, Roberts JP, Terrault NA. New onset diabetes mellitus after liver transplantation: The critical role of hepatitis C infection. Liver Transpl 2004; 10:349–55.

    Article  PubMed  Google Scholar 

  27. Davidson JA, Wilkinson A. New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines: An endocrinologist's view. Diabetes Care 2004; 27:805–12.

    Article  PubMed  Google Scholar 

  28. Trail KC, McCashland TM, Larse JL, et al. Morbidity in patients with posttransplant diabetes mellitus following orthotopic liver transplantation. Liver Transpl Surg 1996; 2:276–83.

    Article  PubMed  CAS  Google Scholar 

  29. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 1998; 15:539–53.

    Article  CAS  Google Scholar 

  30. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: Findings from the Third National Health and Nutrition Examination Survey. JAMA 2002; 287:356–9.

    Article  PubMed  Google Scholar 

  31. DeFronzo RA, Ferrannini E. Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14:173–94.

    Article  PubMed  CAS  Google Scholar 

  32. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288:2709–16.

    Article  PubMed  Google Scholar 

  33. Everhart JE, Lombardero M, Lake JR, Wiesner RH, Zetterman RK, Hoofnager JH. Weight change and obesity after liver transplantation: Incidence and risk factors. Liver Transpl Surg 1998; 4:285–96.

    Article  PubMed  CAS  Google Scholar 

  34. Guckelberger O, Mutzke F, Glanemann M, et al. Validation of cardiovascular risk scores in a liver transplant population. Liver Transpl 2006; 12:394–401.

    Article  PubMed  Google Scholar 

  35. Diamond T, Stiel D, Wilkinson M, Riche J, Posen S. Osteoporosis and skeletal fractures in chronic liver disease. Gut 1990; 31:82–7.

    Article  PubMed  CAS  Google Scholar 

  36. Monegal A, Navasa M, Guanabens N, et al. Bone disease after liver transplantation: A long-term prospective study of bone mass changes, hormonal status and histomorphometric characteristics. Osteoporosis Int 2001; 12:484–92.

    Article  CAS  Google Scholar 

  37. Compston JE. Osteoporosis after liver transplantation. Liver Transpl 2003; 9:321–30.

    Article  PubMed  Google Scholar 

  38. Hay JE. Osteoporosis in liver diseases and after liver transplantation. J Hepatol 2003; 38:856–86.

    Article  PubMed  Google Scholar 

  39. Segal E, Baruch Y, Kramsky R, Raz B, Tamir A, Ish-Shalom S. Predominant factors associated with bone loss in liver transplant patients after prolonged post-transplantation period. Clin Transpl 2003; 17:13–9.

    Article  Google Scholar 

  40. Smallwood GA, Burns D, Fasola CG, Steiber AC, Heffron TG. Relationship between immunosuppression and osteoporosis in an outpatient liver transplant clinic. Transpl Proc 2005; 37:1910–1.

    Article  CAS  Google Scholar 

  41. Hardinger KL, Ho B, Schnitzler MA, et al. Serial measurements of bone density at the lumbar spine do not predict fracture risk after liver transplantation. Liver Transpl 2003; 9:857–62.

    Article  PubMed  Google Scholar 

  42. Crawford BAL, Kam C, Pavlovic J, et al. Zoledronic acid prevents bone loss after liver transplantation. Ann Intern Med 2006; 144:239–48.

    PubMed  CAS  Google Scholar 

  43. McCashland TM. Posttransplantation care: Role of primary care physician versus transplant center. Liver Transpl 2001; 7:S2–S12.

    Article  PubMed  CAS  Google Scholar 

  44. Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 1998; 338:1516–20.

    Article  PubMed  CAS  Google Scholar 

  45. Forman LM, Osborne JC, Everson GT. Long-term management after liver transplantation: Primary care physician vs. hepatologist? Am J Transpl 2006; p. 2031A.

    Google Scholar 

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  1. Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, CO

    Lisa M. Forman (MD)

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  1. Lisa M. Forman
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    © 2009 Humana Press, a part of Springer Science+Business Media, LLC

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    Forman, L.M. (2009). Long-Term Metabolic Complications Posttransplantation. In: Trotter, J., Everson, G. (eds) Liver Transplantation. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60327-028-1_8

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    • DOI: https://doi.org/10.1007/978-1-60327-028-1_8

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    • Publisher Name: Humana Press

    • Print ISBN: 978-1-58829-793-8

    • Online ISBN: 978-1-60327-028-1

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