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Overview of care of the adult kidney transplant recipient

Authors
Anil Chandraker, MD, FASN, FRCP
Melissa Y Yeung, MD, FRCPC
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Kidney transplantation is the treatment of choice for end-stage renal disease [1]. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis [2-4]. However, patients require close follow-up after transplantation since they are on complex immunosuppressive regimens that render them susceptible to infection, malignancy, and cardiovascular disease (CVD). In addition, patients often have multiple comorbidities due to, or as a cause of, their underlying end-stage renal disease.

Whereas patients are generally followed by a transplant specialist for the first three to six months following transplant, thereafter they may be seen primarily by a general nephrologist or internist who is often able to address existing comorbidities. Whether a patient is followed by a transplant nephrologist, general nephrologist, or internist often depends upon the availability of services in proximity to the patient. While many believe that transplant nephrologists should be directly involved in the care of transplant recipients for the life of the graft, this is often not practical. However, communication between the internist or community-based nephrologist and the transplant center is important for optimal care of the patient.

This topic reviews the general medical care of the kidney transplant recipient including recommendations for monitoring allograft function and minimizing the risk of infections, malignancies, bone disease, CVD, and diabetes. Common medical problems encountered after transplantation are also discussed.

Maintenance immunosuppressive therapy, allograft dysfunction, and patient survival following transplantation are discussed separately. (See "Maintenance immunosuppressive therapy in renal transplantation in adults" and "Chronic renal allograft nephropathy" and "Patient survival after renal transplantation".)

Specific complications of transplantation are discussed separately. (See "Cyclosporine and tacrolimus nephrotoxicity" and "Pharmacology of cyclosporine and tacrolimus", section on 'Side effects' and "Infection in the solid organ transplant recipient" and "Differential diagnosis of infection following renal transplantation" and "Clinical manifestations, diagnosis, and management of cytomegalovirus disease in kidney transplant recipients" and "Clinical manifestations and diagnosis of BK virus-induced (polyomavirus-induced) nephropathy in kidney transplantation" and "Hepatitis B virus infection in renal transplant recipients" and "Hepatitis C infection in kidney transplant candidates and recipients" and "Epidemiology, clinical manifestations, and diagnosis of post-transplant lymphoproliferative disorders" and "Hypertension after renal transplantation" and "Lipid abnormalities after renal transplantation" and "New-onset diabetes after transplant (NODAT) in renal transplant recipients" and "Persistent hyperparathyroidism after renal transplantation" and "Bone disease after renal transplantation" and "Anemia and the renal transplant recipient" and "Erythrocytosis following renal transplantation" and "Development of malignancy following solid organ transplantation" and "Hyperuricemia and gout in renal transplant recipients".)

                                        
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Literature review current through: Sep 2017. | This topic last updated: Jun 30, 2017.
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