成人肝移植受者的长期管理
- Authors
- Paul J Gaglio, MD
Paul J Gaglio, MD
- Director: Hepatology Outreach
- Columbia University College of Physicians and Surgeons Center for Liver Disease and Transplantation
- NY Presbyterian Hospital-Columbia University Medical Center
- 622 West 168th Street PH 14 Room 202 F
- NY, NY 10032
- Scott J Cotler, MD
Scott J Cotler, MD
- Professor of Medicine
- Director, Division of Hepatology
- Loyola University Medical Center
- Section Editor
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
- Deputy Editor
- Anne C Travis, MD, MSc, FACG, AGAF
Anne C Travis, MD, MSc, FACG, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 吕国悦, 主任医师,教授
吕国悦, 主任医师,教授
- 吉林大学第一医院肝胆胰外科
引言
对于经适当选择的终末期肝病患者,肝移植是首选治疗方法。随着移植后长期生存情况得到改善,越来越多的患者在移植中心外接受保健,因此需要更加广泛熟悉此类患者人群中所见的并发症。临床医生在为肝移植术后患者进行保健时,通常会碰到若干医学问题,包括:
●急性或慢性排斥反应
●免疫抑制的并发症,包括高血压、肾功能不全、感染、恶性肿瘤、多种皮肤病变以及代谢疾病(如糖尿病、肥胖、高脂血症及骨病)
●胆道并发症
●原发性肝病的复发
Subscribers log in here
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2017-01-03.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- McCashland TM. Posttransplantation care: role of the primary care physician versus transplant center. Liver Transpl 2001; 7:S2.
- 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; 57:306.
- Lucey MR. Liver transplantation in patients with alcoholic liver disease. Liver Transpl 2011; 17:751.
- Torbenson M, Wang J, Nichols L, et al. Causes of death in autopsied liver transplantation patients. Mod Pathol 1998; 11:37.
- Chang FY, Singh N, Gayowski T, et al. Fever in liver transplant recipients: changing spectrum of etiologic agents. Clin Infect Dis 1998; 26:59.
- Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med 1998; 338:1741.
- Laish I, Braun M, Mor E, et al. Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events. Liver Transpl 2011; 17:15.
- Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol 2010; 53:199.
- Stegall MD, Everson G, Schroter G, et al. Metabolic complications after liver transplantation. Diabetes, hypercholesterolemia, hypertension, and obesity. Transplantation 1995; 60:1057.
- Textor SC, Canzanello VJ, Taler SJ, et al. Cyclosporine-induced hypertension after transplantation. Mayo Clin Proc 1994; 69:1182.
- Sheiner PA, Magliocca JF, Bodian CA, et al. Long-term medical complications in patients surviving > or = 5 years after liver transplant. Transplantation 2000; 69:781.
- Taler SJ, Textor SC, Canzanello VJ, et al. Loss of nocturnal blood pressure fall after liver transplantation during immunosuppressive therapy. Am J Hypertens 1995; 8:598.
- Textor SC, Canzanello VJ, Taler SJ, et al. Hypertension after liver transplantation. Liver Transpl Surg 1995; 1:20.
- Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 57:331.
- Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. European FK506 Multicentre Liver Study Group. Lancet 1994; 344:423.
- U.S. Multicenter FK506 Liver Study Group. A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation. N Engl J Med 1994; 331:1110.
- Canzanello VJ, Textor SC, Taler SJ, et al. Late hypertension after liver transplantation: a comparison of cyclosporine and tacrolimus (FK 506). Liver Transpl Surg 1998; 4:328.
- Stegall MD, Wachs ME, Everson G, et al. Prednisone withdrawal 14 days after liver transplantation with mycophenolate: a prospective trial of cyclosporine and tacrolimus. Transplantation 1997; 64:1755.
- Penninga L, Møller CH, Gustafsson F, et al. Tacrolimus versus cyclosporine as primary immunosuppression after heart transplantation: systematic review with meta-analyses and trial sequential analyses of randomised trials. Eur J Clin Pharmacol 2010; 66:1177.
- Neal DA, Tom BD, Luan J, et al. Is there disparity between risk and incidence of cardiovascular disease after liver transplant? Transplantation 2004; 77:93.
- Bigam DL, Pennington JJ, Carpentier A, et al. Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation. Hepatology 2000; 32:87.
- Navasa M, Bustamante J, Marroni C, et al. Diabetes mellitus after liver transplantation: prevalence and predictive factors. J Hepatol 1996; 25:64.
- AlDosary AA, Ramji AS, Elliott TG, et al. Post-liver transplantation diabetes mellitus: an association with hepatitis C. Liver Transpl 2002; 8:356.
- Saab S, Shpaner A, Zhao Y, et al. Prevalence and risk factors for diabetes mellitus in moderate term survivors of liver transplantation. Am J Transplant 2006; 6:1890.
- Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant 2004; 4:583.
- Lane JT, Dagogo-Jack S. Approach to the patient with new-onset diabetes after transplant (NODAT). J Clin Endocrinol Metab 2011; 96:3289.
- 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; 87:779.
- Pham PT, Pham PC, Lipshutz GS, Wilkinson AH. New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin North Am 2007; 36:873.
- Haddad EM, McAlister VC, Renouf E, et al. Cyclosporin versus tacrolimus for liver transplanted patients. Cochrane Database Syst Rev 2006; :CD005161.
- Trail KC, McCashland TM, Larsen JL, et al. Morbidity in patients with posttransplant diabetes mellitus following orthotopic liver transplantation. Liver Transpl Surg 1996; 2:276.
- Moon JI, Barbeito R, Faradji RN, et al. Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: Long-term follow up. Transplantation 2006; 82:1625.
- Younossi ZM, Stepanova M, Saab S, et al. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther 2014; 40:686.
- Stegall MD, Everson GT, Schroter G, et al. Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss. Hepatology 1997; 25:173.
- Wilkinson A, Davidson J, Dotta F, et al. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant 2005; 19:291.
- Dumortier J, Bernard S, Bouffard Y, Boillot O. Conversion from tacrolimus to cyclosporine in liver transplanted patients with diabetes mellitus. Liver Transpl 2006; 12:659.
- Poonawala A, Nair SP, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study. Hepatology 2000; 32:689.
- Bianchi G, Marchesini G, Marzocchi R, et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14:1648.
- Everhart JE, Lombardero M, Lake JR, et al. Weight change and obesity after liver transplantation: incidence and risk factors. Liver Transpl Surg 1998; 4:285.
- Munoz SJ, Deems RO, Moritz MJ, et al. Hyperlipidemia and obesity after orthotopic liver transplantation. Transplant Proc 1991; 23:1480.
- Canzanello VJ, Schwartz L, Taler SJ, et al. Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506). Liver Transpl Surg 1997; 3:1.
- Neal DA, Gimson AE, Gibbs P, Alexander GJ. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl 2001; 7:533.
- Campsen J, Zimmerman M, Shoen J, et al. Adjustable gastric banding in a morbidly obese patient during liver transplantation. Obes Surg 2008; 18:1625.
- Liu LU, Schiano TD. Long-term care of the liver transplant recipient. Clin Liver Dis 2007; 11:397.
- Muñoz SJ. Hyperlipidemia and other coronary risk factors after orthotopic liver transplantation: pathogenesis, diagnosis, and management. Liver Transpl Surg 1995; 1:29.
- Gisbert C, Prieto M, Berenguer M, et al. Hyperlipidemia in liver transplant recipients: prevalence and risk factors. Liver Transpl Surg 1997; 3:416.
- Moench C, Barreiros AP, Schuchmann M, et al. Tacrolimus monotherapy without steroids after liver transplantation--a prospective randomized double-blinded placebo-controlled trial. Am J Transplant 2007; 7:1616.
- Manzarbeitia C, Reich DJ, Rothstein KD, et al. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl 2001; 7:93.
- Roy A, Kneteman N, Lilly L, et al. Tacrolimus as intervention in the treatment of hyperlipidemia after liver transplant. Transplantation 2006; 82:494.
- McCune TR, Thacker LR II, Peters TG, et al. Effects of tacrolimus on hyperlipidemia after successful renal transplantation: a Southeastern Organ Procurement Foundation multicenter clinical study. Transplantation 1998; 65:87.
- Almutairi F, Peterson TC, Molinari M, et al. Safety and effectiveness of ezetimibe in liver transplant recipients with hypercholesterolemia. Liver Transpl 2009; 15:504.
- Savvidaki E, Koukoulaki M, Benou A, et al. Ezetimibe is effective in the treatment of persistent hyperlipidemia of renal allograft recipients. Clin Nephrol 2011; 75:107.
- http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/medeff/advisories-avis/prof/2005/ezetrol_hpc-cps-eng.pdf (Accessed on January 11, 2012).
- Madhwal S, Atreja A, Albeldawi M, et al. Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl 2012; 18:1140.
- Albeldawi M, Aggarwal A, Madhwal S, et al. Cumulative risk of cardiovascular events after orthotopic liver transplantation. Liver Transpl 2012; 18:370.
- Johnston SD, Morris JK, Cramb R, et al. Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation 2002; 73:901.
- Fouad TR, Abdel-Razek WM, Burak KW, et al. Prediction of cardiac complications after liver transplantation. Transplantation 2009; 87:763.
- Pruthi J, Medkiff KA, Esrason KT, et al. Analysis of causes of death in liver transplant recipients who survived more than 3 years. Liver Transpl 2001; 7:811.
- Vogt DP, Henderson JM, Carey WD, Barnes D. The long-term survival and causes of death in patients who survive at least 1 year after liver transplantation. Surgery 2002; 132:775.
- de Kroon L, Drent G, van den Berg AP, et al. Current health status of patients who have survived for more than 15 years after liver transplantation. Neth J Med 2007; 65:252.
- Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349:931.
- Corman SL, Coley KC, Schonder KS. Effect of long-term tacrolimus immunosuppression on renal function in liver transplant recipients. Pharmacotherapy 2006; 26:1433.
- Millis JM, McDiarmid SV, Hiatt JR, et al. Randomized prospective trial of OKT3 for early prophylaxis of rejection after liver transplantation. Transplantation 1989; 47:82.
- Marotta PJ. Renal-sparing protocols in liver transplantation. Liver Transplant 2009; 15(Suppl 2):S14.
- Teperman L, Moonka D, Sebastian A, et al. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial. Liver Transpl 2013; 19:675.
- Klintmalm GB, Gonwa TA. Nephrotoxicity associated with cyclosporine and FK506. Liver Transpl Surg 1995; 1:11.
- Manzia TM, De Liguori Carino N, Orlando G, et al. Use of mycophenolate mofetil in liver transplantation: a literature review. Transplant Proc 2005; 37:2616.
- Neff GW, Montalbano M, Slapak-Green G, et al. Sirolimus therapy in orthotopic liver transplant recipients with calcineurin inhibitor related chronic renal insufficiency. Transplant Proc 2003; 35:3029.
- Saliba F, De Simone P, Nevens F, et al. Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study. Am J Transplant 2013; 13:1734.
- Ladefoged SD, Andersen CB. Calcium channel blockers in kidney transplantation. Clin Transplant 1994; 8:128.
- Haagsma EB, Thijn CJ, Post JG, et al. Bone disease after orthotopic liver transplantation. J Hepatol 1988; 6:94.
- Watt KD, Pedersen RA, Kremers WK, et al. Long-term probability of and mortality from de novo malignancy after liver transplantation. Gastroenterology 2009; 137:2010.
- Vajdic CM, van Leeuwen MT. Cancer incidence and risk factors after solid organ transplantation. Int J Cancer 2009; 125:1747.
- Chak E, Saab S. Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review. Liver Int 2010; 30:1247.
- Higashi H, Yanaga K, Marsh JW, et al. Development of colon cancer after liver transplantation for primary sclerosing cholangitis associated with ulcerative colitis. Hepatology 1990; 11:477.
- Duvoux C, Delacroix I, Richardet JP, et al. Increased incidence of oropharyngeal squamous cell carcinomas after liver transplantation for alcoholic cirrhosis. Transplantation 1999; 67:418.
- Presser SJ, Schumacher G, Neuhaus R, et al. De novo esophageal neoplasia after liver transplantation. Liver Transpl 2007; 13:443.
- Finkenstedt A, Graziadei IW, Oberaigner W, et al. Extensive surveillance promotes early diagnosis and improved survival of de novo malignancies in liver transplant recipients. Am J Transplant 2009; 9:2355.
- Herrero JI, Alegre F, Quiroga J, et al. Usefulness of a program of neoplasia surveillance in liver transplantation. A preliminary report. Clin Transplant 2009; 23:532.
- Bonham CA, Dominguez EA, Fukui MB, et al. Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management. Transplantation 1998; 66:1596.
- Adams DH, Ponsford S, Gunson B, et al. Neurological complications following liver transplantation. Lancet 1987; 1:949.
- Singh N, Yu VL, Gayowski T. Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management. Medicine (Baltimore) 1994; 73:110.
- Ferreiro JA, Robert MA, Townsend J, Vinters HV. Neuropathologic findings after liver transplantation. Acta Neuropathol 1992; 84:1.
- Saner FH, Sotiropoulos GC, Gu Y, et al. Severe neurological events following liver transplantation. Arch Med Res 2007; 38:75.
- Vizzini G, Asaro M, Miraglia R, et al. Changing picture of central nervous system complications in liver transplant recipients. Liver Transpl 2011; 17:1279.
- Rifai K, Kirchner GI, Bahr MJ, et al. A new side effect of immunosuppression: high incidence of hearing impairment after liver transplantation. Liver Transpl 2006; 12:411.
- Rifai K, Bahr MJ, Cantz T, et al. Severe hearing loss after liver transplantation. Transplant Proc 2005; 37:1918.
- Neal DA, Tom BD, Gimson AE, et al. Hyperuricemia, gout, and renal function after liver transplantation. Transplantation 2001; 72:1689.
- Shibolet O, Elinav E, Ilan Y, et al. Reduced incidence of hyperuricemia, gout, and renal failure following liver transplantation in comparison to heart transplantation: a long-term follow-up study. Transplantation 2004; 77:1576.
- van den Berg-Emons R, van Ginneken B, Wijffels M, et al. Fatigue is a major problem after liver transplantation. Liver Transpl 2006; 12:928.
- Sorrell JH, Brown JR. Sexual functioning in patients with end-stage liver disease before and after transplantation. Liver Transpl 2006; 12:1473.
- Ho JK, Ko HH, Schaeffer DF, et al. Sexual health after orthotopic liver transplantation. Liver Transpl 2006; 12:1478.
- Christopher V, Al-Chalabi T, Richardson PD, et al. Pregnancy outcome after liver transplantation: a single-center experience of 71 pregnancies in 45 recipients. Liver Transpl 2006; 12:1138.
Top