From the Guidelines
After a liver transplant, patients may experience several potential side effects, including kidney problems, high blood pressure, diabetes, high cholesterol, osteoporosis, and increased cancer risk, primarily due to immunosuppressant drugs like tacrolimus and cyclosporine. These side effects can be managed with regular monitoring through blood tests and follow-up appointments. According to 1, the use of tacrolimus is associated with a reduced risk of rejection and mortality compared to cyclosporine. However, both drugs can cause nephrotoxicity, neurotoxicity, and other side effects.
Some of the common side effects of immunosuppressant drugs include:
- Kidney problems
- High blood pressure
- Diabetes
- High cholesterol
- Osteoporosis
- Increased cancer risk, particularly skin cancer and lymphoma
- Neurological effects like tremors, headaches, and confusion
- Fatigue, weakness, and mood changes during recovery
- Weight gain due to both medications and improved appetite after transplant
As noted in 1, the dosage of these drugs is highly individualized and based on trough levels, which should be monitored closely to minimize the risk of adverse effects. Additionally, the use of generic immunosuppressive therapy should be done with caution, as the bioequivalence of these drugs may not be fully established, as mentioned in 1.
It is essential to weigh the benefits and risks of immunosuppressant drugs and to closely monitor patients for potential side effects, as stated in 1. Regular follow-up appointments and blood tests can help detect and manage these complications early, improving the patient's quality of life and reducing the risk of morbidity and mortality.
From the FDA Drug Label
The most common adverse reactions (≥40%) observed in tacrolimus-treated liver transplant patients are: tremor, headache, diarrhea, hypertension, nausea, abnormal renal function, abdominal pain, insomnia, paresthesia, anemia, pain, fever, asthenia, hyperkalemia, hypomagnesemia, and hyperglycemia Adverse reactions reported in ≥15% in tacrolimus patients (combined trial results) are presented below for the two controlled trials in liver transplantation Based on reported adverse reaction terms related to decreased renal function, nephrotoxicity was reported in approximately 40% and 36% of liver transplantation patients receiving tacrolimus in the U. S. and European randomized trials.
The potential side effects after a liver transplant include:
- Gastrointestinal symptoms: diarrhea, nausea, vomiting, abdominal pain
- Neurological symptoms: tremor, headache, insomnia, paresthesia
- Cardiovascular symptoms: hypertension, hyperkalemia, hypomagnesemia
- Metabolic symptoms: hyperglycemia, anemia, asthenia
- Renal symptoms: abnormal renal function, nephrotoxicity
- Infections: fever, serious bacterial infections
- Other symptoms: pain, fever, back pain, ascites, peripheral edema, pleural effusion, dyspnea, atelectasis, pruritus, rash 2
From the Research
Potential Side Effects After Liver Transplant
The potential side effects after a liver transplant can be significant and may include:
- Diabetes [(3,4)]
- Hypercholesterolemia [(3,4,5)]
- Hypertension [(3,4)]
- Nephrotoxicity 4
- Dyslipidemia 4
- Modification to the cardiovascular-risk profile 4
- Neurotoxicity 3
- Edema 5
- Mouth ulcerations 5
Immunosuppressive Therapy Side Effects
Immunosuppressive therapy, which is necessary to prevent rejection of the transplanted liver, can also have significant side effects, including:
- Dose-related toxicity 6
- Narrow therapeutic windows 6
- Opportunistic infections 6
- Depression 6
- Alcohol relapse 6
Specific Medication Side Effects
Specific immunosuppressive medications can have unique side effects, such as: