Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

914 Liver Transplantation

■cyclosporine

➣nephrotoxicity, neurotoxicity, hypertension, hyperkalemia,

hypercholesterolemia, gingival hyperplasia, hirsutism, lympho-

proliferative disorder

■tacrolimus

➣nephrotoxicity, neurotoxicity, hyperglycemia, diarrhea, allergic

reactions, lymphoproliferative disorder

■azathioprine

➣pancreatitis, bone marrow suppression, hepatotoxicity, chole-

stasis

■mycophenolate mofetil

➣neurotoxicity, neutropenia, gastrointestinal ulceration and

bleeding, lymphoproliferative disorder

sirolimus

infection, bone marrow suppression, hepatic artery throm-

bosis, hyperlipidemia, peripheral edema, hypertension

Immunosuppressive strategies in evolution

■early corticosteroid withdrawal (3–6 months); calcineurin-sparing

regiments (mycophenolate, sirolimus) when renal insufficiency

present

follow-up

Routine Outpatient Management

■outpatient clinic visits weekly initially then less frequently thereafter

■CBC, liver and kidney panel, immunosuppressant levels twice weekly

initially, then eventually monthly

complications and prognosis

Complications

■Early Post-OLT Complications

➣primary graft nonfunction (2–23%)

➣bleeding (10%)

➣biliary complications (10–25%)

➣hepatic artery thrombosis (<3% in adults and 10–18% in children)

➣acute cellular rejection (40–70%)

➣early infectious complications (67%)

■Late Post-OLT Complications

➣chronic ductopenic rejection

➣recurrence of hepatitis B (80–90% without prophylaxis; 10–20%

with lamivudine and hepatitis B immune globulin)