Long-term care of liver transplant recipients and who should be responsible?
Pavel Trunečka1
+ Affiliation
Summary
Currently, liver transplantation is the treatment of choice of for end stage liver disease, some metabolic disorders, fulminant hepatic failure, and selected primary and secondary liver tumours. This treatment is broadly available for patients in need in the Czech Republic with overall excellent long-term survival based on specific indication and the recipient’s age. The high-quality life-long follow-up necessary for achieving good results is currently provided mostly by transplant centres. With the rising number of liver transplant recipients and, their aging and rising polymorbidity, this praxis is unsustainable. Therefore, close cooperation between transplant centres and primary care physicians, and redefinition of responsibilities during the follow-up is needed. Patients with community diseases, frequent metabolic complications of immunosuppression (arterial hypertension, metabolic syndrome, coronary heart disease, dyslipidaemia, bone disease, etc.) as well as many acute disorders should be served locally. Preventive measures should be cared of by the primary care physician (family physician or internist) with guidance from transplant professionals. Meanwhile, specific complications related to transplant procedure, immunological complications of liver transplantation, and disease recurrence should remain in the hands of transplant clinicians, but local practitioners should have some insight into the most frequent complications of transplantation treatment. Improvement in communication between transplant centres and local professionals as well as systematic education of patients and primary care clinicians will assist to further improvement and sustainability of post-transplantation care of liver transplant recipients.
Keywords
liver transplantation, post-transplant complications, immunosuppression, primary careTo read this article in full, please register for free on this website.
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Literature
1. National Institutes of Health Consensus Development Conference: liver transplantation. R I Med J 1984; 67(2): 73– 76.
2. Adam R, Karam V, Cailliez V et al. 2018 annual report of the European Liver Transplant Registry (ELTR) – 50-year evolution of liver transplantation. Transpl Int 2018; 31(12): 1293– 1317. doi: 10.1111/ tri.13358.
3. Herzer K, Sterneck M, Welker MW et al. Current challenges in the post‐transplant care of liver transplant recipients in germany. J Clin Med 2020; 9(11): 3570. doi: 10.3390/ jcm9113570.
4. McCashland TM. Posttransplantation care: role of the primary care physician versus transplant center. Liver Transpl 2001; 7(Suppl 1): S2– S12. doi: 10.1053/ jlts.2001.28513.
5. Heller JC, Prochazka AV, Everson GT et al. Long-term management after liver transplantation: primary care physician versus hepatologist. Liver Transpl 2009; 15(10): 1330– 1335. doi: 10.1002/ lt.21786.
6. Singh S, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87(8): 779– 790. doi: 10.1016/ j. mayocp.2012.02.021.
7. Astarcıoglu I, Egeli T, Gulcu A et al. Vascular complications after liver transplantation. Exp Clin Transplant 2023; 21(6): 504– 511. doi: 10.6002/ ect.2018.0240.
8. Delgado-Moraleda JJ, Ballester-Vallés C, Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation. Insights Imaging 2019; 10(1): 78. doi: 10.1186/ s13244-019-0759-x.
9. Seehofer D, Eurich D, Veltzke-Schlieker W et al. Biliary complications after liver transplantation: old problems and new challenges. Am J Transpl 2013; 13(2): 253– 265. doi: 10.1111/ ajt. 12034.
10. Moy BT, Birk JW. A review on the management of biliary complications after orthotopic liver transplantation. J Clin Transl Hepatol 2019; 7(1): 61– 71. doi: 10.14218/ JCTH.2018.00028.
11. Ossami Saidy RR, Kollar S, Czigany Z et al. Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation. Transpl Infect Dis 2024; 26(1): e14196. doi: 10.1111/ tid.14196.
12. Abad CL, Razonable RR. Mycobacterium tuberculosis after solid organ transplantation: a review of more than 2000 cases. Clin Transplant 2018; 32(6): e13259. doi: 10.1111/ ctr.13259.
13. Te H, Doucette K. Viral hepatitis: Guidelines by the American Society of Transplantation Infectious Disease Community of Practice. Clin Transplant 2019; 33(9): e13514. doi: 10.1111/ ctr.13514.
14. Lee BT, Fiel MI, Schiano TD. Antibody-mediated rejection of the liver allograft: an update and a clinico-pathological perspective. J Hepatol 2021; 75(5): 1203– 1216. doi: 10.1016/ j. jhep.2021.07.027.
15. Levitsky J, Goldberg D, Smith AR et al. Acute rejection increases risk of graft failure and death in recent liver transplant recipients. Clin Gastroenterol Hepatol 2017; 15(4): 584.e2– 593.e2. doi: 10.1016/ j. cgh.2016.07.035.
16. Demetris AJ, Bellamy C, Hübscher SG et al. 2016 comprehensive update of the Banff working group on liver allograft pathology: introduction of antibody-mediated rejection. Am J Transpl 2016; 16(10): 2816– 2835. doi: 10.1111/ ajt.13909.
17. Barshes NR, Goodpastor SE, Goss JA. Pharmacologic immunosuppression. Front Biosci 2004; 9: 411– 420. doi: 10.2741/ 1249.
18. Oka T, Yoshimura N. Immunosuppression in organ transplantation. Jpn J Pharmacol 1996; 71(2): 89– 100. doi: 10.1254/ jjp.71.89.
19. Weber ML, Ibrahim HN, Lake JR. Renal dysfunction in liver transplant recipients: evaluation of the critical issues. Liver Transplant 2012; 18(11): 1290– 1301. doi: 10.1002/ lt.23522.
20. Ojo AO, Held PJ, Port FK et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349(10): 931– 940. doi: 10.1056/ NEJMoa021744.
21. Sharma P, Bari K. Chronic kidney disease and related long-term complications after liver transplantation. Adv Chronic Kidney Dis 2015; 22(5): 404– 411. doi: 10.1053/ j. ackd.2015.06.001.
22. Konerman MA, Fritze D, Weinberg RL et al. Incidence of and risk assessment for adverse cardiovascular outcomes after liver transplantation: a systematic review. Transplantation 2017; 101(7): 1645– 1657. doi: 10.1097/ TP.0000000000001710.
23. Anastácio LR, Diniz KG, Ribeiro HS et al. Prospective evaluation of metabolic syndrome and its components among long-term liver recipients. Liver Int 2014; 34(7): 1094– 1101. doi: 10.1111/ liv.12495.
24. Madhwal S, Atreja A, Albeldawdi M et al. Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl 2012; 18(10): 1140– 1146. doi: 10.1002/ lt.23508.
25. Hejlova I, Honsova E, Sticova E et al. Prevalence and risk factors of steatosis after liver transplantation and patient outcomes. Liver Transpl 2016; 22(5): 644– 655. doi: 10.1002/ lt. 24393.
26. Richardson SH, Wong G, Garner E et al. Utility of glucagon-like peptide 1 receptor agonists as anti-obesity medications in liver transplant recipients. Liver Transpl 2024; 30(2): 226– 228. doi: 10.1097/ LVT.0000000000000233.
27. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol 2010; 53(1): 199– 206. doi: 10.1016/ j. jhep.2010.01.040.
28. Fatourou EM, Tsochatzis EA. Management of metabolic syndrome and cardiovascular risk after liver transplantation. Lancet Gastroenterol Hepatol 2019; 4(9): 731– 741. doi: 10.1016/ S2468-1253(19)30181-5.
29. Liarakos AL, Tentolouris A, Kokkinos A et al. Impact of glucagon-like peptide 1 receptor agonists on peripheral arterial disease in people with diabetes mellitus: a narrative review. J Diabetes Complications 2023; 37(2): 108390. doi: 10.1016/ j. jdiacomp.2022.108390.
30. Delman AM, Ammann AM, Shah SA. The current status of virus-positive liver transplantation. Curr Opin Organ Transplant 2021; 26(2): 160– 167. doi: 10.1097/ MOT.00000000000 00850.
31. Park JS, Gayam V, Pan CQ. Review article: preventing hepatitis B graft infection in hepatitis B patients after liver transplantation: immunoglobulin vs anti-virals. Aliment Pharmacol Ther 2020; 52(6): 944– 954. doi: 10.1111/ apt.15999.
32. Visseren T, Erler NS, Polak WG et al. Recurrence of primary sclerosing cholangitis after liver transplantation – analysing the European Liver Transplant Registry and beyond. Transpl Int 2021; 34(8): 1455– 1467. doi: 10.1111/ tri.13925.
33. Kerkar N, Vergani D. De novo autoimmune hepatitis – is this different in adults compared to children? J Autoimmun 2018; 95: 26– 33. doi: 10.1016/ j. jaut.2018.10.023.
34. Visseren T, Darwish Murad S. Recurrence of primary sclerosing cholangitis, primary biliary cholangitis and auto-immune hepatitis after liver transplantation. Best Pract Res Clin Gastroenterol 2017; 31(2): 187– 198. doi: 10.1016/ j. bpg.2017.04.004.
35. Haldar D, Kern B, Hodson J et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: a European Liver Transplant Registry study. J Hepatol 2019; 71(2): 313– 322. doi: 10.1016/ j. jhep.2019.04.011.
36. Faure S, Herrero A, Jung B et al. Excessive alcohol consumption after liver transplantation impacts on long-term survival, whatever the primary indication. J Hepatol 2012; 57(2): 306– 312. doi: 10.1016/ j. jhep.2012.03.014.
37. Bajer L, Slavcev A, Macinga P et al. Risk of recurrence of primary sclerosing cholangitis after liver transplantation is associated with de novo inflammatory bowel disease. World J Gastroenterol 2018; 24(43): 4939– 4949. doi: 10.3748/ wjg.v24.i43.4939.
38. Abdelrahim M, Esmail A, Abudayyeh A et al. Transplant oncology: an emerging discipline of cancer treatment. Cancers (Basel) 2023; 15(22): 5337. doi: 10.3390/ cancers15225337.
39. Burra P, Shalaby S, Zanetto A. Long-term care of transplant recipients: de novo neoplasms after liver transplantation. Curr Opin Organ Transplant 2018; 23(2): 187– 195. doi: 10.1097/ MOT.0000000000000499.
40. Lam K, Coomes EA, Nantel-Battista M et al. Skin cancer screening after solid organ transplantation: survey of practices in Canada. Am J Transpl 2019; 19(6): 1792– 1797. doi: 10.1111/ ajt.15224.
41. Zaffiri L, Chambers ET. Screening and management of PTLD. Transplantation 2023; 107(11): 2316– 2328. doi: 10.1097/ TP.0000000000004577.
42. Kim A, Waldron O, Daoud D et al. Comparative Review of Standardized Incidence Ratio of Nonlymphoid, De Novo Malignancies After Liver Transplant Versus After Kidney Transplant. Exp Clin Transplant 2024; 22(8): 600– 606. doi: 10.6002/ ect.2024.0136.