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Review article: medical management of the liver transplant recipient – a primer for non‐transplant doctors
Author(s) -
SETHI A.,
STRAVITZ R. T.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.03166.x
Subject(s) - medicine , liver transplantation , intensive care medicine , transplantation , orthotopic liver transplantation , malignancy , population , medical literature , epidemiology , surgery , pathology , environmental health
Summary Background Survival 10 years after orthotopic liver transplantation now approaches 65%. Consequently, community doctors must manage the metabolic and neoplastic complications of orthotopic liver transplantation in an ageing population. Aims To review common sources of morbidity and mortality in long‐term orthotopic liver transplantation recipients, and to make evidence‐based recommendations regarding their management. Methods Pertinent studies and reviews were identified by literature search through PubMed. Where evidence‐based recommendations could not be gleaned from the literature, expert opinion was obtained from syllabi of national meetings. Results The two most common causes of morbidity and mortality in orthotopic liver transplantation recipients are atherosclerotic vascular disease and de novo malignancy. The pathogenesis of many complications begins before orthotopic liver transplantation, and many are potentially modifiable. Most complications, however, can be directly ascribed to immunosuppressive agents. Despite improvements in our understanding of the pathogenesis and epidemiology of the metabolic and neoplastic complications of orthotopic liver transplantation, remarkably few randomized‐controlled studies exist to define their optimal management. Conclusions Orthotopic liver transplantation recipients experience and succumb to the same afflictions of old age as non‐transplant patients, but with greater frequency and at an earlier age. Most recommendations regarding surveillance for, and treatment of, medical complications of orthotopic liver transplantation remain based upon expert opinion rather than evidence‐based medicine.