| Diabetes mellitus |
-
•
Immunosuppressive drug modulation is recommended including early tapering of steroids, and minimisation of CNIs by adding anti-metabolites or mTORi.
-
•
The use of oral anti-diabetic drugs such as metformin, rosiglitazone, pioglitazone and sulfonylureas can be considered alone or in association with insulin to minimise its use.
-
•
GLP-1 RAs and DPP-4 inhibitors are now routinely used in solid organ transplanted patients; however, attention must be paid to their interactions with immunosuppressive therapy.
-
•
In patients not achieving therapeutic goals, insulin remains the therapy of choice.
|
| Obesity |
-
•
Lifestyle modification should include healthy diet and regular mild to moderate physical activity.
-
•
No data are available on pharmacological treatments in the post-LT setting.
-
•
When lifestyle modifications are not effective bariatric surgery can be considered, with sleeve gastrectomy preferred to Roux-en-Y gastric bypass.
-
•
Endoscopic bariatric therapy is a potential new approach for obese patients after LT.
|
| Dyslipidaemia |
-
•
Lifestyle modification is the first-line treatment, although this condition is usually refractory to dietary interventions.
-
•
In patients not responding to lifestyle modifications, statins represent the first-line option.
-
•
Attention should be paid to interactions between statins and immunosuppressive drugs.
-
•
Fibrates can be considered when statins are not tolerated.
-
•
Attention should be paid to the development of myopathy.
-
•
Omega-3 fish oil can be beneficial for isolated post-LT hypertriglyceridaemia.
|
| Arterial hypertension |
-
•
Lifestyle modification, such as low-sodium diet and cessation of smoking, is the first-line treatment.
-
•
Modulation of immunosuppressive therapy is necessary with minimisation of CNIs by adding anti-metabolites or mTORi.
-
•
In patients without proteinuria, dihydropyridine calcium channel blockers represent the first choice.
-
•
Otherwise ACE inhibitors or angiotensin II receptor blockers can be considered.
-
•
Beta-blockers find their primary indication when heart decompensation or arrhythmia are present.
|
| Cardiovascular disease |
-
•
Patients with specific risk factors, such as age >55 years old, male sex, diabetes mellitus and kidney failure, should be adequately monitored in the post-LT period.
-
•
In patients presenting specific risk factors, a cardiovascular follow-up with echocardiography at 6, 12, and 24 months after LT can be suggested.
|
| Kidney dysfunction |
-
•
In patients presenting with CKD at LT, immunosuppressive minimisation strategies should be used, alongside interventions to prevent/treat metabolic complications, such as diabetes and hypertension.
|
