Medical care for kidney and liver transplant recipients:
Gespeichert in:
| Weitere Verfasser: | , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pennsylvania
Elsevier
[2016]
|
| Schriftenreihe: | Medical clinics of North America
volume 100, number 3 (May 2016) |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | xviii Seiten, Seite 435-645 Illustrationen |
| ISBN: | 9780323444712 |
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| 245 | 1 | 0 | |a Medical care for kidney and liver transplant recipients |c editors David A. Sass, Alden M. Doyle |
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Datensatz im Suchindex
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| adam_text | Titel: Medical care for kidney and liver transplant recipients
Autor: Sass, David A
Jahr: 2016
Medical Care for Kidney and Liver Transplant Recipients
Contents
Foreword: Medical Care for Kidney and Liver Transplant Recipients xv
Edward R. Bollard
Preface: Long-Term Care of the Abdominal Organ Transplant Recipient: Pearls for
the Primary Care Provider xvii
David A. Sass and Alden M. Doyle
Liver and Kidney Transplantation: A Half-Century Historical Perspective 435
David A. Sass and Alden M. Doyle
This article describes the evolution of solid organ kidney and liver trans-
plantation and expounds on the challenges and successes that the early
transplant researchers and clinicians encountered. The article highlights
the surgical pioneers, delves into the milestones of enhanced immunosup-
pression protocols, discusses key federal legislative and policy changes,
and expounds on the ongoing disparities of organ supply and demand
and the need for extended criteria and live donor organs to combat these
shortages. Finally, recent changes in organ allocation and distribution pol-
icies are discussed. The authors also spotlight novel interventions that will
further revolutionize abdominal transplantation in the next 50 years.
From Child-Pugh to Model for End-Stage Liver Disease: Deciding Who Needs a
Liver Transplant 449
Sheela S. Reddy and Jesse M. Civan
This article reviews the historical evolution of the liver transplant organ allo-
cation policy and the indications/contraindications for liver transplant, and
provides an overview of the liver transplant evaluation process. The article
is intended to help internists determine whether and when referral to a liver
transplant center is indicated, and to help internists to counsel patients
whose initial evaluation at a transplant center is pending.
Renal Transplantation in Advanced Chronic Kidney Disease Patients 465
Mythili Ghanta and Belinda Jim
Kidney transplantation is the best option for patients with end-stage kid-
ney disease. It is associated with better quality of life, lower medical costs,
less hospitalization, and improved survival compared with wait-listed pa-
tients who remain on dialysis. Timely referral for transplantation is essential
to reap the maximal benefit and should begin in the advanced chronic kid-
ney disease stage prior to starting dialysis. Shortage of donor organs re-
mains the biggest challenge to transplantation. With the improved
success of kidney transplantation, candidate acceptance criteria continue
to broaden. This article provides an overview of the pretransplantation
multidisciplinary evaluation process detailing the factors that determine
transplant candidacy.
xii Contents
Management of the Liver Transplant Recipient: Approach to Allograft Dysfunction 477
Jonathan M. Fenkel and Dina L. Halegoua-DeMarzio
Liver transplant (LT) recipients are living longer than ever today and many
will experience some form of allograft dysfunction. The common causes of
allograft dysfunction vary significantly depending on the timing since LT.
Most allograft abnormalities are manageable with minimally invasive pro-
cedures, medications, and lifestyle modification. The most common differ-
ential diagnoses by time period after LT, and diagnostic and management
considerations, are highlighted. Collaboration and comanagement of LT
recipients between primary care and the transplant hepatologist is essen-
tial for optimizing recipient and allograft outcomes.
Acute and Chronic Allograft Dysfunction in Kidney Transplant Recipients 487
Ryan J. Goldberg, Francis L. Weng, and Praveen Kandula
Allograft dysfunction after a kidney transplant is often clinically asymptom-
atic and is usually detected as an increase in serum creatinine level with
corresponding decrease in glomerular filtration rate. The diagnostic evalu-
ation may include blood tests, urinalysis, transplant ultrasonography,
radionuclide imaging, and allograft biopsy. Whether it occurs early or later
after transplant, allograft dysfunction requires prompt evaluation to deter-
mine its cause and subsequent management. Acute rejection, medication
toxicity from calcineurin inhibitors, and BK virus nephropathy can occur
early or later. Other later causes include transplant glomerulopathy, recur-
rent glomerulonephritis, and renal artery stenosis.
The ABCs of Immunosuppression: A Primer for Primary Care Physicians 505
Gregory Malat and Christine Culkin
Immunosuppression use for prevention of allograft recognition/rejection
has evolved to reflect an expanded understanding of the immune system,
as well as a fine tuning of the goals of therapy. Immunosuppression in or-
gan transplantation represents a balance between the desire to improve
the health status of an individual affected by chronic conditions versus
not imposing an unintended immunodeficiency leading to iatrogenic
morbidity/mortality. This article discusses the selection and general dosing
of immunosuppression in organ allograft recipients to allow providers to be
comfortable in monitoring immunosuppressive therapy long term and the
associated, expected posttransplant complications in allograft recipients.
Managing Cardiovascular Risk in the Post Solid Organ Transplant Recipient 519
Mrudula R. Munagala and Anita Phancao
Solid organ transplantation is an effective treatment for patients with end-
stage organ disease. The prevalence of cardiovascular diseases (CVD) has
increased in recipients. CVD remains a leading cause of mortality among
recipients with functioning grafts. The pathophysiology of CVD recipients
is a complex interplay between preexisting risk factors, metabolic
sequelae of immunosuppressive agents, infection, and rejection. Risk
modification must be weighed against the risk of mortality owing to rejec-
tion or infection. Aggressive risk stratification and modification before and
after transplantation and tailoring immunosuppressive regimens are
Contents xiii
essential to prevent complications and improve short-term and long-term
mortality and graft survival.
Diabetes Care After Transplant: Definitions, Risk Factors, and Clinical Management 535
Amisha Wallia, Vidhya llluri, and Mark E. Molitch
Patients who undergo solid organ transplantation may have preexisting
diabetes mellitus (DM), develop new-onset DM after transplantation (NO-
DAT), or have postoperative hyperglycemia that resolves shortly after sur-
gery. Although insulin is usually used to control hyperglycemia in the
hospital, following discharge most of the usual diabetes oral and paren-
teral medications can be used in treatment. However, when there are co-
morbidities such as impaired kidney or hepatic function, or heart disease,
special precautions may be necessary. In addition, drug-drug interactions,
such as drugs interacting with CYP3A4 enzyme pathway, require addi-
tional consideration because of possible interaction with immunosuppres-
sive drug metabolism.
De Novo Malignancies After Transplantation: Risk and Surveillance Strategies 551
lliana Doycheva, Syed Amer, and Kymberly D. Watt
De novo malignancies are one of the leading causes of late mortality after
liver and kidney transplantation. Nonmelanoma skin cancer is the most
common malignancy, followed by posttransplant lymphoproliferative dis-
order and solid organ tumors. Immunosuppression is a key factor for can-
cer development, although many other transplant-related and traditional
risk factors also play a role. In this review, the authors summarize risk fac-
tors and outcomes of frequently encountered de novo malignancies after
liver and kidney transplantation to stratify recipients at highest risk. Future
efforts in prospectively validated, cost-effective surveillance strategies
that improve survival of these complex patients are greatly needed.
Metabolic Bone Disease in the Post-transplant Population: Preventative and
Therapeutic Measures 569
Johan Daniel Nel and Sol Epstein
Post-transplant bone disease contributes significantly to patients
morbidity and mortality after transplantation and has an impact on their
quality of life. This article discusses the major contributors to mechanisms
causing bone loss, highlighting the role of preexisting disease in both kid-
ney and liver failure and contributions from glucocorticoids and calcineurin
inhibitors. Suggested monitoring and investigations are reviewed as well
as treatment as far as the current literature supports, emphasizing the dif-
ference between kidney and liver recipients.
Infectious Complications and Vaccinations in the Posttransplant Population 587
William G. Greendyke and Marcus R. Pereira
Infections remain a major cause of mortality and morbidity after both kid-
ney and liver transplantation, and internists increasingly play a major role in
diagnosing and treating these infections. Because of immunosuppression,
solid organ transplant recipients do not often demonstrate classic signs
xiv Contents
and symptoms of infection and have a broader variety of common and
opportunistic infections, many of which are generally more difficult to diag-
nose and treat. Although these patients have many risk factors for infec-
tion, a major determinant is the time after transplant as it relates to
levels of immunosuppression, healing, and hospital or environmental
exposures.
Selection and Postoperative Care of the Living Donor 599
Dianne LaPointe Rudow and Karen M. Warburton
Live organ donors typically consult their primary care providers when
considering live donation and then return for follow-up after surgery and
for ongoing primary care. Live liver and kidney transplants are performed
routinely as a method to shorten the waiting time for a recipient, provide
a healthy organ for transplant, and increase recipient survival. Careful
medical and psychosocial evaluation of the potential donor is imperative
to minimize harm. This evaluation must be performed by an experienced
live donor medical team. Routine health care with careful attention to
weight maintenance, cardiovascular health, and prevention of diabetes
and hypertension is paramount.
Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ
Transplantation 613
Swati Rao, Mythili Ghanta, Michael J. Moritz, and Serban Constantinescu
This article reviews the salient features of functional recovery, health-
related quality of life (HR-QOL), and reproductive health, with special
emphasis on pregnancy outcomes in kidney and liver recipients. Trans-
plantation results in improved functional status and HR-QOL. Addressing
factors that limit the optimal rehabilitation of transplant recipients can
improve transplant outcomes. After successful transplantation, there is a
rapid return of fertility, warranting counseling regarding contraception.
Practitioners should be aware of the teratogenic potential of mycophenolic
acid products. Posttransplant pregnancies are high risk, with increased in-
cidences of hypertension, preeclampsia, and prematurity. Most pregnan-
cies in kidney and liver recipients have successful maternal and newborn
outcomes.
Index
631
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