Mối quan tâm ban đầu về việc ngày càng xấu đi của chức năng thận có vẻ vô căn cứ và những loại thuốc này là hiệu quả và được dung nạp tốt như thuốc chẹn kênh canxi. Bệnh nhân cần được theo dõi cho tăng kali máu và hypomagnesemia. • Các thuốc khác: Thuốc lợi tiểu nên được sử dụng để kiểm soát | Management of the Liver Transplant Patient 97 confer additional benefit by preventing left ventricular hypertrophy a risk factor for cardiovascular disease. Initial concerns regarding worsening of renal function seem unfounded and these drugs are as effective and as well tolerated as calcium channel blockers. Patients should be monitored for hyperkalemia and hypomagnesemia. Other drugs Diuretics should be used to control peripheral edema or as second-line antihypertensives. The centrally acting sympatholytics such as clonidine are considered third-line agents against post-transplant hypertension. Hyperlipidemia Epidemiology See Table 1. Sirolimus causes a dose-dependant increase in triglycerides rather than in cholesterol. Pathogenesis The mechanism whereby serum cholesterol levels are increased after liver transplantation is unclear. Clinical Management Review immunosuppression Dietary modification rarely successful in isolation in the post-liver transplant setting. HMG CoA-reductase inhibitors statins . Diabetes Mellitus Diabetes mellitus is seen in 20-30 of liver transplant recipients. This arises from a combination of pre-liver transplant diabetes 13 in one study and true post-liver transplant diabetes. This compares to less than 4 in the general population. Pathogenesis Corticosteroids increase insulin resistance. Calcineurin inhibitors The calcineurin inhibitors increase insulin resistance injure pancreatic islet cells and impair insulin secretion. Tacrolimus and cyclosporin are associated with an increased incidence of diabetes. The effect may be transient. Chronic hepatitis C infection may potentiate the risk or severity of diabetes mellitus. Clinical Management General diabetic liver allograft recipients should be managed in the same way as diabetic patients in the general population with lifestyle modification and drug therapy as needed. Modification of immunosuppressive protocol where possible corticosteroids should be withdrawn and calcineurin inhibitor
