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DOI: 10.1177/1522162803256722 © 2003 SAGE Publications Medical Management of the Liver Transplant PatientUniversity of Pennsylvania Health Systems, aburke{at}mail.med.upenn.edu The medical consequences of long-term immunosuppression are far-reaching. They include systemic hypertension, hyperlipidemia, diabetes mellitus, obesity, renal insufficiency, infection, osteoporosis, osteopenia, and malignancy. Systemic hypertension is managed by drug therapy, weight loss, and sodium restriction. Calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II antagonists, and diuretics may be used. Diabetes mellitus occurs in 20% to 30% of liver transplant recipients. Renal insufficiency is common and often precedes transplantation. Serum creatinine concentrations > 1.6 mg/dl are found in more than 75% of liver transplant recipients after 3 years of follow-up. Treatment of renal insufficiency includes minimizing calcineurin inhibitors, avoiding other nephrotoxic drugs, control of hypertension, and control of diabetes mellitus. With regard to osteoporosis and osteopenia, bone turnover is greatly increased after transplantation due to excessive osteoclastic activity. Bone loss increases rapidly in the first 3 months after transplantation. Atraumatic vertebral fractures have been reported in up to 30% of patients within 6 months posttransplant. Treatment is based on z-scores. Morbidity includes insomnia, lassitude, cosmetic concerns, musculoskeletal pain, seizures, headache, and fine tremor. In females of child-bearing age, conception and pregnancy must also be managed.
Key Words: liver transplantation • systemic hypertension • renal insufficiency
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