General health management and long-term care of the renal transplant recipient.
The steady improvement in short-term success rates in renal transplant patients has translated into better long-term success rates and a large number of patients with long-functioning renal transplants. The necessity for the lifelong administration of immunosuppressive medications to prevent rejection, coupled with the presence in many patients of a variety of other medical problems dating from the period of renal insufficiency prior to the time of renal transplantation, has created a large group of patients with a unique and complex set of long-term medical care needs. Due to the constraints of managed care, considerations of geography, or patient preference, the long-term care of an increasing number of renal transplant recipients has shifted away from the transplant center to the community-based nephrologist or internist. For optimal care to be delivered, it is important that the physicians managing these patients be cognizant of the complex and interacting medical issues involved in their care. Appropriate management can significantly prolong the life of the allograft as well as that of the patient. Guidelines for understanding and managing some of the more important and common general medical problems facing the long-term renal transplant recipient (eg, infectious complications, cardiovascular disease, hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease, dental care, preventive care) are addressed in this section.
Cohen
D
D
Columbia Presbyterian Hospital, New York, NY 10032, USA. djc5@columbia.edu
Galbraith
C
C
D000553:Ambulatory Care; D001847:Bone Diseases / Q000453:epidemiology / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000276:immunology / Q000534:rehabilitation* / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000458:organization & administration*; D008403:Mass Screening / Q000458:organization & administration; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D011314:Preventive Health Services; D012307:Risk Factors