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Review
. 2020 May 14;26(18):2138-2154.
doi: 10.3748/wjg.v26.i18.2138.

Medical management of metabolic and cardiovascular complications after liver transplantation

Chiara Becchetti  1 , Melisa Dirchwolf  1 , Vanessa Banz  2 , Jean-François Dufour  1
Affiliations
Review

Medical management of metabolic and cardiovascular complications after liver transplantation

Chiara Becchetti et al. World J Gastroenterol. .

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

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Conflict of interest statement

Conflict-of-interest statement: Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Proposal of a treatment algorithm for diabetes mellitus type II in liver transplant recipients. GLP-1 RA: Glucagon-like peptide-1 receptor agonist; SGLT2 inhibitors: Sodium-glucose cotransporter type 2; DPP-4l: Inhibitors of dipeptidyl peptidase 4; NASH: Non-alcoholic steatohepatitis; NAFLD: Non-alcoholic fatty liver disease.
Figure 2
Figure 2
Proposal of a treatment algorithm for low-density lipoprotein cholesterol lowering strategy in liver transplant recipients. 1Class of recommendation: IIa; level of evidence: B, according to 2019 ESC/EAS Guidelines for the management of dyslipidaemias[118]. 2Class of recommendation: IIb; level of evidence: C, according to 2019 ESC/EAS Guidelines for the management of dyslipidaemias[118]. LDL-C: Low-density lipoprotein cholesterol.
See this image and copyright information in PMC

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