Our Summary

Liver transplantation has greatly improved survival rates for patients with severe liver disease and liver cancer. However, heart disease is a common cause of death in these patients that is not related to the transplanted liver. This is partly due to an increased rate of metabolic risk factors after transplantation, including obesity, high blood pressure, abnormal cholesterol levels, and diabetes. These factors make up what is known as metabolic syndrome. The prevalence of this syndrome is expected to increase as more older patients receive transplants, as metabolic risk factors become more common in the general population, and as more patients undergo transplantation for non-alcoholic fatty liver disease. Patients with pre-existing diabetes or obesity are especially at risk and may benefit from closer monitoring and more aggressive treatment of these risk factors. If initial treatments are not effective, adjustments to the drugs used to suppress the immune system and prevent rejection of the transplanted liver may help, although this must be done carefully to avoid increasing the risk of transplant failure.

FAQs

  1. Why is heart disease a common cause of death in patients who’ve had a liver transplant?
  2. What is metabolic syndrome and why is it expected to become more common in patients undergoing liver transplantation?
  3. What adjustments can be made for patients whose treatments aren’t effective in managing metabolic risk factors post liver transplant?

Doctor’s Tip

It is important for patients who have undergone a liver transplant to maintain a healthy lifestyle, including regular exercise and a balanced diet, to help reduce the risk of developing metabolic syndrome and other complications. Additionally, it is crucial to attend all follow-up appointments with your healthcare team and adhere to any prescribed medications to ensure the long-term success of your transplant.

Suitable For

Patients who are typically recommended for liver transplant include those with end-stage liver disease, liver cancer, acute liver failure, or certain genetic liver disorders. These patients must meet specific criteria, including having a life expectancy of less than two years without a transplant and not having any other medical conditions that would significantly decrease the chances of a successful transplant. Additionally, patients must be able to undergo the rigorous evaluation process and commit to the lifelong medical management and follow-up care required after transplantation.

Timeline

Before the liver transplant:

  1. Patient is diagnosed with severe liver disease or liver cancer.
  2. Patient undergoes extensive medical evaluations and testing to determine if they are a suitable candidate for a liver transplant.
  3. Patient is placed on the transplant waiting list and waits for a suitable donor liver to become available.
  4. Patient may experience worsening symptoms of their liver disease, such as fatigue, jaundice, and fluid retention.

After the liver transplant:

  1. Patient undergoes surgery to receive the new liver.
  2. Patient is closely monitored in the hospital for complications and signs of rejection.
  3. Patient may experience side effects from the immunosuppressant medications used to prevent rejection of the new liver.
  4. Patient undergoes regular follow-up appointments and monitoring to ensure the new liver is functioning properly.
  5. Patient may need to make lifestyle changes, such as following a special diet and exercising regularly, to support the health of the transplanted liver.
  6. Patient may experience improvements in their overall health and quality of life following the transplant.

What to Ask Your Doctor

  1. What is the success rate of liver transplant surgeries at your hospital?
  2. How long will I have to wait for a donor liver?
  3. What are the potential risks and complications of liver transplant surgery?
  4. What is the recovery process like after a liver transplant?
  5. How will my immune system be affected by the transplant and what medications will I need to take?
  6. What lifestyle changes will I need to make after the transplant?
  7. How often will I need to have follow-up appointments and tests after the transplant?
  8. What are the signs of rejection of the transplanted liver and what should I do if I experience them?
  9. How will my pre-existing medical conditions, such as diabetes or obesity, be managed after the transplant?
  10. What support services are available for liver transplant patients and their families?

Reference

Authors: Kim NG, Sharma A, Saab S. Journal: Best Pract Res Clin Gastroenterol. 2020 Jun-Aug;46-47:101683. doi: 10.1016/j.bpg.2020.101683. Epub 2020 Sep 12. PMID: 33158470