Posttransplant Complications: Renal, Cardiovascular, Diabetes, and Obesity

With improving surgical technique and perioperative care, liver transplant recipients will continue to survive longer and longer. After the first year of transplantation, the risk of mortality is largely based on the development of renal disease and metabolic syndrome, including hypertension, hyperlipidemia, diabetes, and obesity. Mechanistically, these complications can be a result of immunosuppressive medications as well as a return to poor dietary and exercise regimens posttransplant. Renal injury is almost exclusively a result of calcineurin toxicity over time, and new strategies are in place, utilizing mammalian target of rapamycin inhibitors to minimize this risk. Cardiovascular complications can also be spurred on by immunosuppressive medications, and close monitoring and treatment with standard agents are required in the recipient. Diabetes is perhaps the most feared medical complication posttransplant, as it carries a higher risk of mortality. It is also impacted by many of the different immunosuppressive regimens. Finally, novel strategies are being researched to appropriately treat the obese patient pre- and post liver transplant. This review contains 1 figure, 2 tables, and 52 references. Key Words: complications, diabetes, everolimus, immunosuppression, liver transplant, medical, metabolic syndrome, obesity, posttransplant, renal disease, tacrolimus.