Health Maintenance
Following
Liver Transplantation

Health maintenance issues are a priority for the liver transplant physicians working in conjunction with the primary care physicians who take care of liver transplant recipients. Along with general preventive medicine, primary care management issues specifically related to transplant recipients include obesity, high cholesterol, high blood pressure, diabetes, osteoporosis, and screening for cancer.

Diligent routine health practices should be applied to the transplant patient including routine annual physical exam, age appropriate screening for high cholesterol, high blood pressure, breast cancer, colon cancer, cervical cancer, and diabetes.

One of the most common problems after transplantation is significant weight gain and obesity. Many factors contribute to this, including medications which may stimulate appetite, a reinvigorated sense of well being, and fewer diet restrictions. Appropriate dietary counseling and an exercise program should be initiated.

Hyperlipidemia, or elevated cholesterol and triglyceride levels, is found in up to 30% of liver recipients. The causes of hyperlipidemia are varied and can include obesity, medication side effects and pre-transplant related risk factors. Treatment of obesity and diabetes, as well as dietary and lifestyle modifications are the first line measures. If cholesterol levels do not improve with these measures, medications to treat high cholesterol like the so called "statins" can be safely prescribed. Potential side effects like muscle pain and liver toxicity are uncommon, but should be monitored.

Hypertension, or high blood pressure, is seen in 55-85% of patients after transplant, which can be attributed partly to the immunosuppressive medications, especially tacrollimus or cyclosporine. In the majority of cases, medication is required to control the blood pressure although the choice of medication may be individualized, but medication interactions may occur, therefore immunosuppression medication levels need to be closely followed.

Diabetes is common in cirrhotic patients prior to transplant, which in turn predisposes them to post transplant diabetes. Immunosuppressives, as well as corticosteroids are important exacerbating factors. Treatment of diabetes in post liver transplant patients is based on diet, lifestyle modification, obesity reduction, and the addition of insulin or oral diabetes medication may be indicated.

Osteoporosis is common in cirrhotics due to various factors such as calcium and vitamin D deficiency including low muscle mass, immobility, and long term corticosteroid use. After transplantation bone density screening may be considered. If osteoporosis is present, aggressive treatment with calcium, vitamin D and bisphosphomates should be prescribed.

Skin cancer, lymphoma, and throat and mouth cancers may be more common in the post liver transplant population. Routine examination and screening should be performed by the primary care physician and gastroenterologist, along with the transplant team.

Recipients beyond 6 months post liver transplant should be vaccinated for influenze, pneumococcus, and tetanus. Live vaccines like measles, mumps, rubella, and live oral polio vaccine should not be given.

To keep your marriage brimming with love,
whenever you're wrong, admit it;
whenever you're right, shut up.
--- Ogden Nash

Slimmer Summer - Continued from Page 1

• Leaner meats: Pick leaner cuts of meat such as top sirloin (3 ounces of which has 183 calories and 9g fat) rather than fatty cuts like beef short-ribs (400 calories and 36g fat). Other good choices: beef round (184 calories and 8g fat) and pork loin (206 calories and 12g fat).
• Grill fruits and vegetables: Eat fresh fruits and vegetables, you'll not only save on calories and fat but load up on nutrients. Brush vegetables lightly with olive oil and sprinkle with fresh herbs before grilling. Char fruit on the barbecue for dessert. Pineapple and pears develop a caramel-like flavor when grilled.
• Better barbecued chicken: It wouldn't feel like summer without barbecued chicken, but you shouldn't eat the fatty skin, so remove it. Try grilled skinless breasts, too. Rub chicken breasts with your favorite fresh herbs and a touch of olive oil and lemon.
• Skinny seafood: Why not skip the beef and try fish instead? Fish is lower in fat and calories (a 3 ounce serving of salmon instead of sirloin saves you 73 calories and 8g fat). When grilling fish on the barbecue use a fish rack or wrap in foil.
• Slender sides: Often it's not the main course but the sides that do you in at a barbecue. Potato and macaroni salad are loaded with mayonnaise. Opt for healthier sides like green and bean salads, raw vegetables with low-calorie, low-fat dips, and fresh grilled vegetables.
• Easy-on-the-waistline Mexican food: Mexican food can make a healthy meal if you know what to eat. Some Mexican dishes can wreak havoc on the best-laid plans. A single serving of nachos and cheese has 346 calories and 19g fat, and that's only an appetizer! Skip it and order lower-calorie entree options such as fajitas or arroz con pollo.

  Toppings can be a disaster too. A tablespoon of sour cream has 26 calories and 3g fat. Ask for it on the side, and use just a little. Better yet, pass on the sour cream and use a heavy hand on the salsa, which is loaded with flavor and vitamins but has only 5 calories per tablespoon. Choose soft tacos, because crispy tacos and tostadas are fried. Corn tortillas are also lower in calories than flour ones. Lastly, hold the cheese and you'll decrease your calories and fat even more. Each quarter-cup serving of shredded cheese has 114 calories and 9g fat.

Please enjoy your summer, eat smarter and healthier, be happy and have a great time in the "good ol summer time" with family and friends.