Posttransplantation care: Role of the primary care physician versus transplant center

McCashland, Timothy M.

doi:10.1053/jlts.2001.28513

Cited by 30 publications

(33 citation statements)

References 71 publications

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“…Hepatologists, PCPs, and transplant surgeons were primarily responsible for the overall care of liver recipients 1 year or more after liver transplantation according to 66%, 24.1%, and 8.4% of respondents, respectively. These results are similar to those reported in studies by McCashland3 and Shiffman and Rockey 4…”

Section: Discussionsupporting

confidence: 92%

“…There are no specific guidelines for the treatment of cardiovascular complications in liver recipients, it is unknown whether or not recipients are receiving adequate management, and what group of providers can best deliver optimal care for these conditions has been debated. Although primary care physicians (PCPs) claim to be comfortable managing the care of liver recipients, transplant hepatologists usually assume these patients' overall care 3, 4. Hepatologists may not be as comfortable as internists in managing cardiovascular complications and may not do as good a job as PCPs in managing these complications.…”

mentioning

confidence: 99%

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Long-term management after liver transplantation: Primary care physician versus hepatologist

Heller¹,

Prochazka²,

Everson³

et al. 2009

Liver Transpl

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As long-term survival after liver transplantation increases, metabolic complications are becoming increasingly prevalent. Given concerns about which group of providers should be managing liver recipients and how well metabolic complications are managed, we administered a postal survey to 280 transplant hepatologists to determine attitudes, perceptions, and practice patterns in the management of metabolic complications after transplantation. The response rate was 68.2%. There was great variation in patterns of practice across the United States with respect to the number of posttransplant clinics, clinic format, and number of recipients cared for per week. Hepatologists, primary care physicians (PCPs), and surgeons were primarily responsible for the overall care of liver recipients 1 year or more after liver transplantation according to 66%, 24%, and 8% of respondents, respectively. Hepatologists felt that metabolic complications were common, but few strongly agreed that hypertension (33.3%), chronic renal insufficiency (3.8%), diabetes mellitus (8.8%), dyslipidemia (11.1%), and bone disease (12.8%) were well controlled. The majority of hepatologists indicated that ideally PCPs should be managing recipients' hypertension, diabetes mellitus, dyslipidemia, and bone disease (78.8%, 63.1%, 78.3%, and 72.5%), but they felt that in actuality, PCPs were managing these conditions less frequently (45.4%, 51.4%, 44.6%, and 38%). In conclusion, metabolic complications are perceived to be common but not well controlled post-transplant, and most hepatologists feel that PCPs should take a more active role in the management of these complications. Future studies are needed to identify barriers to care in the treatment of metabolic complications post-transplant with the goal of improving long-term morbidity and mortality. Liver See Editorial on Page 1162Approximately 6000 liver transplants are performed each year in the United States. Since the era of liver transplantation began in 1963, survival after liver transplantation has significantly improved, with overall 1-and 5-year patient survival rates of 86.9% and 73.6%, respectively.1 As long-term survival increases, cardiovascular complications are emerging as major causes of morbidity and mortality. The negative impact of cardiovascular disease on liver transplant recipients has only recently been addressed; recent data indicate that accelerated cardiovascular disease is second only to malignancy as a cause of late mortality in liver transplant patients. 2As more transplant recipients survive into their first and second decades post-transplant, it is likely that more will develop metabolic complications such as hypertension (HTN), chronic renal insufficiency (CRI), diabetes mellitus (DM), dyslipidemia (LIPIDS), obesity,

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Long-term management after liver transplantation: Primary care physician versus hepatologist

Heller¹,

Prochazka²,

Everson³

et al. 2009

Liver Transpl

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“…Thus, many patients start seeing their primary care physicians (PCPs) within 6 months of transplant. 6 PCPs may play a pivotal role in the prevention of morbidity and mortality in the transplant population by appropriate and timely management of many chronic medical diseases. Immunosuppressants and other common drugs prescribed for KTRs affect both the incidence as well as the response to therapy for these medical problems.…”

Section: Introductionmentioning

confidence: 99%

Primary Care of the Renal Transplant Patient

et al. 2010

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There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60-65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP's perspective. Medical management issues related to immunosuppressive medications are also briefly discussed.

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“…Sie dienen dem Ziel, transplantationstypische Komplikationen wie Abstoûung, Infektionen, Gefäûund Gallengangsprobleme sowie Schwierigkeiten in der medikamentösen Immunsuppression frühzeitig zu erkennen und gezielt behandeln zu können. Die Nachsorge erfolgt in der Regel interdiziplinär und umfasst betreuende Hausärzte, Chirurgen, Internisten und Radiologen [35].…”

Section: Transplantationsnachsorgeunclassified

Lebertransplantation in Deutschland

Wolff

Kalff²,

Schwarz³

et al. 2003

Zentralbl Chir

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As in other western countries the major challenge of liver transplantation in Germany is to expand the number of liver transplantations in respect to the increasing disparity of qualified patients on the waiting list and the still static availability of brain death donor organs. The problem of death on the waiting list has become overt since the German transplantation law has been installed, which has changed the former center-oriented to a patient-oriented allocation weighting waiting time over medical urgency criteria. The more liberal acceptance of so called marginal cadaveric donor livers will probably impair further improvements in the acute and long-term outcome of liver transplantation. This problem can be partially compensated by the use of novel surgical techniques, such as splitting a donor liver to be transplanted into two adult recipients or, more commonly and safe, into an adult and one child. Another alternative to increase the donor pool is living donor liver transplantation, which was first introduced for pediatric recipients but is now increasingly used in adults. In 2001, a constant number of 757 liver transplantations were performed in Germany, including 12.5 % living donor transplantations. Recently, general guidelines for the selection of patients with end-stage liver disease and acute liver failure have been published by the Bundesärztekammer. Additional developments have contributed to improve the results of liver replacement including individualized immunosuppression strategies and novel treatment options to avoid recurrent viral disease following transplantation.

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Posttransplantation care: Role of the primary care physician versus transplant center

Cited by 30 publications

References 71 publications

Long-term management after liver transplantation: Primary care physician versus hepatologist

Long-term management after liver transplantation: Primary care physician versus hepatologist

Primary Care of the Renal Transplant Patient

Lebertransplantation in Deutschland

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