Intensive care management of liver transplanted patients

Table 1 Side effects and toxicity of the commonly used immunosuppressive agents

Agent	Side Effect/Toxicity	Agent	Side Effect/Toxicity
Cyclosporine A	Hypertension	Antilymphocyte globulin	Leukopenia/Thrombocytopenia
	Neurotoxicity(tremor, paresthesias,		Systemic symptoms
	Headache, confusion, seizures)
	Nephrotoxicity
	Hepatotoxicity
	Hyperkalemia/Hypomagnesemia
	Gastric atony, nausea, vomiting
	Gingival hyperplasia, hypertrichosis
Tacrolimus (FK 506)	Hypertension, dyspnea, palpitations	OKT3	Non-cardiogenic pulmonary edema
	Headache, tremor, paresthesias, seizures, focal neurological deficits		Encephalopathy/Aseptic meningitis
	Nephrotoxicity, hyperkalemia		Systemic symptoms
	Glucose intolerance, nausea, vomiting
	thrombocytopenia
Glucocorticoids	Hypertension/Fluid retention	Mycophenolate mofetil (MMF)	Hypertension
	Psychosis, mood changes		Hyperkalemia/Hypophosphatemia
	Glucose intolerance		Anemia
	Adrenal suppression		Arrhythmias (tachycardia)
	Electrolyte abnormalities		Muscle weakness
	Peptic ulcerations, pancreatitis
	Osteoporosis, myopathy, aseptic necrosis
Sirolimus	Bone marrow suppression (thrombocytopenia, anemia, leukopenia), hyperlipidemia, peripheral edema, and poor wound healing	IL-2R basiliximab [simulect], daclizumab [zenapax]	Rashes, fever, and gastrointestinal symptoms

Table 2 Early post-operative complications following OLTx

Graft dysfunction	Rejection	Vascular thrombosis
Primary nonfunction	Hyperacute	Hepatic artery thrombosis
Preservation injury	Acute	Portal vein thrombosis
Small for size syndrome
Neurologic complications	Biliary complications	Electrolyte disturbances
Encephalopathy	Stricture	Hyponatremia
Seizure	Leaks	Hypocalcemia
Coma	Obstruction	Hyperkalemia
Psychosis	Dilation	Hypokalemia
Aphasia		Hypophospharemia
Tremors		Hypoglycaemia
Anoxic-ischemic events		Hyperglycemia
Central pontine myelinolysis		Hypomagnesium
Gastrointestinal	Drug interactions	Pneumonia
Ileus	Interference with CYP3A4	Renal dysfunction
Ulcer		Atelectasis
Bleeding		Infections
Diarrhea		Bleeding and coagulopathy

OLTx: liver transplantation.