Long-term care for a patient following liver transplantation from a perspective of a family physician
Anna Mrzljak, Ana Jelić, Lucija Franušić, Robert Likić, Zlata Ožvačić Adžić
Croatia is among the leading countries in the world according to the liver transplants rates. Owing to the longer post-transplant survival, the need for long-term care for patients is increasing, with an increasing proportion of care being provided by family physicians. Late complications after liver transplantation include a wide range of metabolic disorders that occur in a significant percentage of patients: diabetes (up to 30%), dyslipidemia (45–69%), hypertension (50–90%), obesity (up to 40%), osteoporosis (37%), hyperuricemia (14–47%), while the occurrence of certain malignant diseases remains up to four times higher than in the non-transplant population. Cardiovascular disease and malignancies are the leading causes of long-term mortality following liver transplantation. In addition to other risk factors, immunosuppressive drugs: calcineurin inhibitors, antimetabolites and mTOR inhibitors contribute significantly to the development of these complications. Furthermore, in 22–33% of patients after liver transplantation, some form of mood disorder develops, most commonly anxiety and depression. Prevention, recognition, and management of complications after liver transplantation are the key to improving long-term outcomes. The aim of this review paper is to address the issue of long-term care for patients after liver transplantation in primary care.