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World J Gastroenterol. Mar 28, 2016; 22(12): 3315-3324
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3315
Lipids in liver transplant recipients
Anna Hüsing, Iyad Kabar, Hartmut H Schmidt
Anna Hüsing, Iyad Kabar, Hartmut H Schmidt, Department of Transplant Medicine, University Hospital Münster, 48149 Münster, Germany
Author contributions: Hüsing A, Kabar I and Schmidt HH analyzed the literature and wrote the paper.
Conflict-of-interest statement: The authors declare no conflict of interest in publication of the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hartmut H Schmidt, MD, Professor of Medicine, Department of Transplant Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A14, 48149 Münster, Germany. hepar@ukmuenster.de
Telephone: +49-251-8357770 Fax: +49-251-8357771
Received: November 30, 2015
Peer-review started: December 1, 2015
First decision: December 21, 2015
Revised: January 19, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: March 28, 2016
Abstract

Hyperlipidemia is very common after liver transplantation and can be observed in up to 71% of patients. The etiology of lipid disorders in these patients is multifactorial, with different lipid profiles observed depending on the immunosuppressive agents administered and the presence of additional risk factors, such as obesity, diabetes mellitus and nutrition. Due to recent improvements in survival of liver transplant recipients, the prevention of cardiovascular events has become more important, especially as approximately 64% of liver transplant recipients present with an increased risk of cardiovascular events. Management of dyslipidemia and of other modifiable cardiovascular risk factors, such as hypertension, diabetes and smoking, has therefore become essential in these patients. Treatment of hyperlipidemia after liver transplantation consists of life style modification, modifying the dose or type of immunosuppressive agents and use of lipid lowering agents. At the start of administration of lipid lowering medications, it is important to monitor drug-drug interactions, especially between lipid lowering agents and immunosuppressive drugs. Furthermore, as combinations of various lipid lowering drugs can lead to severe side effects, such as myopathies and rhabdomyolysis, these combinations should therefore be avoided. To our knowledge, there are no current guidelines targeting the management of lipid metabolism disorders in liver transplant recipients. This paper therefore recommends an approach of managing lipid abnormalities occurring after liver transplantation.

Keywords: Liver transplantation, Dyslipidemia, Lipid management, Immunosuppression, mTOR-inhibition, Treatment

Core tip: Lipid disorders after liver transplantation are common and can significantly increase the risk of cardiovascular events in liver transplant recipients. Furthermore, dyslipidemia may also impair graft function and survival. Therefore management of dyslipidemia is of great importance in preventing cardiovascular diseases and graft dysfunction in these patients. Knowledge of the different manifestations of lipid disorders after liver transplantation, the role of immunosuppressive agents and of drug-drug interactions is therefore essential for management and follow-up of these patients.