ABSTRACT
Primary biliary cholangitis (PBC) is a rare autoimmune disease characterized by intralobular bile duct destruction. Patients typically present with generalized symptoms including fatigue and pruritis, and less commonly, manifestations of lipid deposition including xanthomas and xanthelasmas. We report a case of a 31-year-old female with PBC-associated cirrhosis who had cutaneous xanthelasmas and diffuse gastric xanthomas secondary to hyperlipidemia and lipoprotein X that completely resolved following liver transplantation. While gastric xanthomas have been reported in patients with PBC previously, to our knowledge, this is the first case report of diffuse gastric xanthomas secondary to PBC reported to resolve following liver transplantation, suggesting that liver transplantation is curative for gastric xanthomatosis in patients with PBC-related cirrhosis.
Subject(s)
Cholangitis , Liver Cirrhosis, Biliary , Xanthomatosis , Adult , Autoantibodies , Cholangitis/diagnosis , Female , Humans , Lipoprotein-X , Liver Cirrhosis, Biliary/complications , Xanthomatosis/etiologyABSTRACT
INTRODUCTION: Liver transplantation is a life-changing event for patients and survival following transplantation has improved significantly since the first transplantation in 1967. Following liver transplantation, patients face a unique set of healthcare management decisions including transplantation-specific complications, recurrence of primary liver disease, as well as metabolic and malignancy concerns related to immunosuppression. As more patients with liver disease receive transplantation and live longer, understanding and managing these patients will require not only transplant specialist but also local subspecialist and primary care physicians. AREAS COVERED: This review covers common issues related to the management of patients following liver transplantation including immunosuppression, liver allograft dysfunction, metabolic complications, as well as routine health maintenance such as immunizations and cancer screening. EXPERT OPINION: Optimizing medical care for patients following liver transplant will benefit from ensuring all providers, not just transplant specialist, have a basic understanding of the common issues encountered in the post-transplant patient. This review provides an overview of common healthcare concerns and management options for patients following liver transplantation.
Subject(s)
Aftercare , Immunosuppressive Agents/adverse effects , Liver Diseases/surgery , Liver Transplantation , Metabolic Diseases/etiology , Skin Neoplasms/etiology , Allografts/physiopathology , Anastomotic Leak/etiology , Bile Ducts/surgery , Drug Interactions , Graft Rejection/immunology , Humans , Immunosuppression Therapy , Kidney Diseases/etiology , Kidney Diseases/physiopathology , Liver Transplantation/adverse effects , Postoperative Period , Recurrence , Thrombosis/etiologyABSTRACT
Drug-induced liver injury (DILI) is an uncommon but significant cause of liver injury and need for liver transplant. DILI in the setting of chronic liver disease (CLD) is poorly understood. Clinical features of patients presenting with DILI in the setting of CLD are similar to those without CLD with the exception of a higher incidence of diabetes among those with CLD and DILI. Diagnosis of DILI in CLD is difficult because there are no objective biomarkers and current causality assessments have not been studied in this population. Differentiating DILI from exacerbation of underlying liver disease is even more challenging.
