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  • Review Article
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Keys to long-term care of the liver transplant recipient

Key Points

  • Cancer screening regimens are recommended for liver transplant recipients to compensate for the increased risk of certain malignancies

  • Improved risk factor management is necessary to reduce and prevent cardiovascular and renal disease in the liver transplant recipient

  • Treatment of recurrent viral hepatitis can improve long-term graft and patient survival

  • Pregnancy after transplantation is considered a 'high-risk pregnancy' and therapeutic adjustments are necessary to accommodate pregnancy-related issues in transplant recipients

  • The use of oral contraceptives in liver transplant recipients depends on allograft function and certain drugs might be contraindicated

  • Transplant recipients are at a higher risk of acquiring infections than healthy individuals; vaccination is therefore highly recommended, ideally before immunosuppression is started

Abstract

Improvements in overall survival early after liver transplantation result in a growing number of patients with the potential for long-term survival. Data available on long-term survival, to date, reflect the situation of patients who received their liver transplant during a very different health-care era. Translating these data into the current medical era of liver transplantation is an important task, as a better understanding of aspects associated with morbidity and mortality is fundamental in improving the long-term outcome of liver transplant recipients. Malignancy screening, optimal treatment of recurrent disease and adequate management of metabolic disease are crucial contributions to advance patient care. In this Review, data specific to the liver transplant recipient will be evaluated and, in the absence of sufficient evidence at this time, recommendations and guidelines for the general population on management of long-term concerns will be assessed for their applicability after liver transplantation. In addition, other preventive strategies relating to pregnancy, contraception and vaccination are reviewed in detail.

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Figure 1: Improvements in overall survival after adult (age >18 years) liver transplantation from 1987–2012 with follow-ups until Dec 31th, 2013.
Figure 2: The prevalence of metabolic risk factors and metabolic syndrome in liver transplant recipients.
Figure 3: Post-transplantation renal function measured by iothalamate clearance.
Figure 4: Algorithm depicting the management of patients after liver transplantation.

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Watt, K. Keys to long-term care of the liver transplant recipient. Nat Rev Gastroenterol Hepatol 12, 639–648 (2015). https://doi.org/10.1038/nrgastro.2015.172

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