Continuing management of liver transplant patients after discharge

The management of liver transplant patients after discharge is a complex balance between immunosuppression and the side-effects and toxicity of such medications. The Queensland Liver Transplant Service (QLTX) has performed 72 transplants in 67 patients; 49 patients (73%) are alive. The actuarial 1-year survival rate is 72%. Death after the first year in patients transplanted for benign HBsAg negative disease has not occurred. The most common technical complications are biliary stenosis and hepatic artery thrombosis. Long-term immunosuppression is with cyclosporin and low dose prednisolone. Regular trough cyclosporin levels and liver function tests are vital. The most limiting side-effect of cyclosporin is nephrotoxicity. Constant vigilance, aggressive investigation, and management of pyrexia and biochemical liver dysfunction by the primary care physician in consultation with the transplant team will ultimately determine long-term outcome. The principles and important details of the management of these patients by the QLTX are presented as a guide to referring practitioners.