Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

1. As long-term survival improves after liver transplantation, cardiovascul ar complications are emerging as a major cause of late morbidity and mortal ity. It seems reasonable to correct the potentially reversible cardiovascul ar risk factors of diabetes, hyperlipidemia, and obesity, in addition to hy pertension. 2. The results of liver transplantation in diabetics are acceptable in term s of morbidity, mortality, and prevalence of posttransplant diabetes, but t he poor outcomes described in some series suggest that more extensive testi ng for macro- and microvascular disease may become necessary. 3. The management of diabetes in liver transplant recipients is not substan tially different from its management in nontransplant patients, except that steroid reduction or withdrawal and minimizing doses of calcineurin inhibi tors are beneficial. 4. Hyperlipidemia occurs in all solid-organ transplantation, with prevalenc e rates the lowest for liver transplant recipients. Following liver transpl antation, between 15% and 40% of recipients on average have increased plasm a cholesterol levels and about 40% have hypertriglyceridemia. Dietary chang es, weight reduction, exercise and statins are the mainstays of therapy. 5. Retrospective studies suggest that long-term survival of obese recipient s after liver transplantation does not differ from nonobese recipients. Pos ttransplant weight gain occurs in most recipients, and approximately two th irds become overweight. The management of posttransplant obesity is similar to that in nontransplant settings.