[Management after transplantation].
In this review non-organ specific issues are discussed concerning the outpatient management ofpatients after solid organ transplantation. It is essential to identify and treat cardiovascular risk factors in order to lower the burden of morbidity and mortality in these patients. Prevention and therapy of transplantation-related bone diseases is another important goal of the medical care. The incidence of certain malignant tumours and infections is increased after transplantation. Both, infections and malignancy, decrease the long-term survival after transplantation. Beside potential graft rejection, malignancy and infections should always be included in the differential diagnosis in patients with altered general condition or unclear symptoms. A synopsis of the most important malignant tumours in respect of their incidence, etiology and behaviour is given. The time course of infections and the different germ spectra in relation to the time after transplantation is shown. It is useful to know the properties of the immunosuppressive drugs and their side effects. Without knowledge of the most important interactions between immunosuppressive drugs and other medications patients' graft and life is at risk due to potential rejections or intoxications. In this regard, all new medications should be checked to exclude relevant interactions. Vaccination is useful to prevent infectious diseases. Indications and contraindications of vaccination in the setting of transplantation are discussed. The aim of the long-term follow-up after organ transplantation is to create a base for a long survival of the grafts and the patients themselves with the best quality of life.
Mayr
M
M
Abteilung für Transplantationsimmunologie und Nephrologie, Universitätsspital Basel, Basel. mmayr@uhbs.ch
D000553:Ambulatory Care / Q000379:methods; D001847:Bone Diseases / Q000209:etiology / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009369:Neoplasms / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D014180:Transplantation / Q000009:adverse effects* / Q000379:methods*