Primary Care of the Transplant Patient

 

Summary Recommendations for the Primary Care of Solid Organ Transplant Recipients

Medications

1. Check for possible drug interactions of all new medications prescribed.

2. Check immunosuppressant levels 48 to 72 hours after initiation of any new medication expected to affect levels.

Hypertension

1. Target blood pressure is <130/<80 mm Hg for renal and liver transplant recipients and for other transplant recipients with renal disease or other cardiac risk equivalents.

2. The choice of blood pressure agents should be influenced by comorbid conditions, the pathophysiology of hypertension in transplant recipients, and drug effects on immunosuppressant levels.

Hyperlipidemia

1. The target LDL is <100 mg/dL for renal transplant recipients.

2. In the absence of data, PCPs should consider treating other transplant recipients to a target LDL of <100 mg/dL.

3. Statins should be used as first-line therapy.

4. Special attention should be paid to the increased risk of myopathy associated with statin use in the transplant population.

Diabetes

1. Recommendations of the American Diabetic Association should be applied to the transplant population.

Malignancy

1. Transplant recipients should be considered at high risk for all malignancies.

2. PCPs should consider shorter screening intervals.

3. Annual dermatological examinations should screen for skin malignancies.

4. Sunblock with an SPF of 60 or greater should be applied daily to sun-exposed skin surfaces.

5. Patients with newly diagnosed malignancy should be considered for a reduction in immunosuppressants.

Immunizations

1. All patients preparing for transplantation should receive immunizations against tetanus, diphtheria, pertussis, Streptococcus pneumoniae, hepatitis A and hepatitis B.

2. After transplantation, booster immunization should be provided for influenza, tetanus, diphtheria, Streptococcus pneumoniae, and hepatitis A and B.

Contraception

1. Women of child-bearing age should be counseled about the need for contraception after transplantation.

2. Low-dose oral contraceptive agents should be considered for women who have diabetes, hypertension, or hyperlipidemia and do not have contraindications for their use.

3. Women should be counseled about the decrease in contraceptive efficacy of intrauterine devices after transplantation.

ScienceDirect - The American Journal of Medicine : Primary Care of the Transplant Patient