Medical management of metabolic and cardiovascular complications after liver transplantation

Abstract

Liver transplantation represents the only curative option for patients with end-stage liver disease, fulminant hepatitis and advanced hepatocellular carcinoma. Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period, long-term survival is hampered by the lack of improvement in survival in the late post transplantation period (over 5 years after transplantation). The main etiologies for late mortality are malignancies and cardiovascular complications. The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components (arterial hypertension, dyslipidemia, obesity, renal injury, etc.). These comorbidities result from a combination of pre-liver transplant features, immunosuppressive agent side-effects, changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle. In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation, as well as proposing management strategies.

Keywords: Solid organ transplantation, Hypertension, New-onset diabetes after transplantation, Obesity, Orthotopic liver transplantation, Post-transplantation metabolic syndrome

Core tip: Recently there has been an increasing interest in extra hepatic-related complications after liver transplantation because they widely affect late morbidity and mortality. Metabolic and cardiovascular diseases and de novo neoplasia are considered to be among the main complications affecting long- and mid-term prognosis after liver transplantation. In this review, we will assess the prevalence of metabolic and cardiovascular complications after liver transplantation, their impact on post-transplant morbidity and mortality, and the optimal medical management currently available.