Longterm Care

Longterm Care

Longterm Care

After liver transplantation survival increases and metabolic complications become increasingly prevalent. Hepatologists,

primary care physicians (PCPs), and surgeons are the ones who are responsible for the long term care of liver recipients 1 year after the liver transplantation according to 66% respondents. Liver Transplant surgeons say that metabolic complications are common,

but a lot of them also strongly state it that hypertension, chronic renal insufficiency, diabetes mellitus, and bone disease are well controlled.

Majority of these surgeons who have had an experience of performing liver transplant indicate that ideally PCPs should be managing the patients’ hypertension, diabetes and bone disease.

But they say that actuality, PCPs are responsible for managing these conditions in further less frequent numbers.

Therefore, metabolic complications are common but not well controlled after the transplant, and most surgeons feel that PCPs should have a more active role in the management of complications like these.

Approximately 6000 liver transplants are performed each year in India. Over the years, survival after liver transplantation has gone one to significantly improve, with around survival rates being 86.9% and 73.6%, respectively.

 

Here are some guidelines that can help in the long term care of liver transplant recipients. These include clinical issues, reoccurring diseases, and immunosuppressive medications

 

Clinical Issues

 

Cellular Rejection: This is known as acute rejection, which occurs in approximately 15 to 25% of the patients. Although this is most likely to develop within the first few months after the liver transplant, it can occur at any given time.

 

Rejection is associated with fever and malaise; But, there are no clinical signs and it is diagnosed by routine blood work. A rising level of enzymes is a sign of rejection.

Along with potential noncompliance, other complications that this bring up can include CMV disease, reoccurring of primary disease, biliary stricture and it can lead to drug toxicity.

Also, patients who have hepatitis C a lot of times have wide fluctuations in enzymes after the liver transplant.

A lot of time a liver biopsy is advised in this group in order to be able distinguish hepatitis c virus from rejection.

The most definitive diagnostic aid  is liver biopsy. If rejection is confirmed it has to be treated with immunosuppression and the target dose range has to be increased.

There are time when high-dose over 10 -14 days is needed. The level of liver enzymes has to improve within 5 days although it might not be in the normal range.

 

  • Infection: Infection is common in the patient who has been immune-suppressed. General good hygiene like washing hand and avoiding individuals who have infectious symptoms help a lot. Work-up and treatment is very similar to non-transplant patients.

 

  • Bile Duct Strictures: This occurs early or late after transplant, and are generally identified by a spike in alkaline phosphatase. There is also rise in AST and ALT. Strictures can develop because of many reasons like narrowing of anastomotic, ischemic injury because of blood flow changes in the recipient,
  • Obesity: Obesity is considered to be the growing problem after liver transplantation. Obesity brings along with itself cardiac diseases, diabetic diseases, hyperlipidemia and steatohepatitis

 

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