Skip to main content
  • Review article
  • Open access
  • Published:

Liver transplantation for nontransplant physicians

Abstract

Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists) keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.

References

  1. Pagadala M, Dasarathy S, Eghtesad B, McCullough AJ. Posttransplant metabolic syndrome: an epidemic waiting to happen. Liver transpl 2009; 15:1662–1670.

    Article  Google Scholar 

  2. Laish I, Braun M, Mor E, Sulkes J, Harif Y, Ben Ari Z, et al. Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events. Liver Transpl 2011; 17:15–22.

    Article  Google Scholar 

  3. Lucey MR, Terrault N, Ojo L, Hay JE, Neuberger J, Blumberg E, Teperman LW. Long-term management of the successful adult liver transplant: 2012 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:3–26.

    Article  Google Scholar 

  4. Algarem N, Sholkamy A, Alshazly M, Daoud A. New onset diabetes and hypertension as complications of liver transplantation. Transpl Proc 2014; 46:870–872.

    Article  CAS  Google Scholar 

  5. Pham PT, Pham PM, Pham SV, Pham PA, Pham PC. New onset diabetes after transplantation (NODAT): an overview. Diabetes, Metab Syndr Obes 2011; 4:175–186.

    Article  Google Scholar 

  6. Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transpl 2004; 4:583–595.

    Article  Google Scholar 

  7. Bigam DL, Pennington JJ, Carpentier A, Wanless IR, Hemming AW, Croxford R, et al. Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation. Hepatology 2000; 32:87–90.

    Article  CAS  Google Scholar 

  8. Moon JI, Barbeito R, Faradji RN, Gaynor JJ, Tzakis AG. Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: long-term follow up. Transplantation 2006; 82:1625–1628.

    Article  Google Scholar 

  9. Wilkinson A, Davidson J, Dotta F, Home PD, Keown P, Kiberd B, et al. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant 2005; 19:291–298.

    Article  Google Scholar 

  10. Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant 2004; 4:583–595.

    Article  Google Scholar 

  11. Dumortier J, Bernard S, Bouffard Y, Boillot O. Conversion from tacrolimus to cyclosporine in liver transplanted patients with diabetes mellitus. Liver Transpl 2006; 12:659–664.

    Article  Google Scholar 

  12. Sheiner PA, Magliocca JF, Bodian CA, Kim-Schluger L, Altaca G, Guarrera JV, et al. Long-term medical complications in patients surviving>or = 5 years after liver transplant. Transplantation 2000; 69:781–789.

    Article  CAS  Google Scholar 

  13. Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 57:331–341.

    Article  CAS  Google Scholar 

  14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJr, et al. for National Heart, Lung, and Blood Institute Joint National Committee on Prevention, DetectionEvaluation and Treatment of High Blood Pressure and National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560–2572.

    Article  CAS  Google Scholar 

  15. Neal DA, Tom BD, Luan J, Wareham NJ, Gimson AE, Delriviere LD, et al. Is there disparity between risk and incidence of cardiovascular disease after liver transplant?. Transplantation 2004; 77:93–99.

    Article  Google Scholar 

  16. Hoorn EJ, Walsh SB, McCormick JA, Fürstenberg A, Yang CL, Roeschel T, et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nat Med 2011; 17:1304–1309.

    Article  CAS  Google Scholar 

  17. Liu LU, Schiano TD. Long-term care of the liver transplant recipient. Clin Liver Dis 2007; 11:397–416.

    Article  Google Scholar 

  18. Desai S, Hong JC, Saab S. Cardiovascular risk factors following orthotopic liver transplantation: predisposing factors, incidence and management. Liv Int 2010; 30:948–957.

    Article  Google Scholar 

  19. Savvidaki E, Koukoulaki M, Benou A, Roumeliotou M, Fourtounas C, Kalliakmani P, et al. Ezetimibe is effective in the treatment of persistent hyperlipidemia of renal allograft recipients. Clin Nephrol 2011; 75:107–112.

    Article  CAS  Google Scholar 

  20. Richards J, Gunson B, Johnson J, Neuberger J. Weight gain and obesity after liver transplantation. Transpl Int 2005; 18:461–466.

    Article  Google Scholar 

  21. Bianchi G, Marchesini G, Marzocchi R, Pinna AD, Zoli M. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14:1648–1654.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  23. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol 2010; 53:199–206.

    Article  Google Scholar 

  24. Martin P, DiMartini A, Feng S, Brown Jr R, Fallon M. Evaluation for liver transplantation in adults: 2013 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014; 59:1144–1165.

    Article  Google Scholar 

  25. Fouad TR, Abdel-Razek WM, Burak KW, Bain VG, Lee SS. Prediction of cardiac complications after liver transplantation. Transplantation 2009; 87:763–770.

    Article  Google Scholar 

  26. Fraker TD Jr, Fihn SD2002 Chronic Stable Angina Writing Committee, American College of Cardiology, American Heart Association, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol 2007; 50:2264–2274.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amany AbdelMaqsod Sholkamy MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sholkamy, A.A. Liver transplantation for nontransplant physicians. Egypt J Intern Med 26, 139–144 (2014). https://doi.org/10.4103/1110-7782.148105

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.148105

Keywords