The American Journal of Medicine
Volume 123, Issue 3 , Pages 205-212 , March 2010

Primary Care of the Transplant Patient

  • Peggy B. Hasley, MD, MHSc

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Peggy B. Hasley, MD, MHSc, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213
  • ,
  • Robert M. Arnold, MD

References 

  1. Trends in organ donation and transplantation in the United States, 1996-2005. In: 2006 Annual Report of the Organ Procurement and Transplant Network and the Scientific Registry of Transplant Recipients. Rockville, MD: Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2006;p. I1–I12
  2. Pruthi J, Medkiff KA, Esrason KT, et al. Analysis of causes of death in liver transplant recipients who survived more than 3 years. Liver Transpl. 2001;7:811–815
  3. Roe RL. The anti-inflammatory agents used in rheumatic disorders. Prim Care. 1975;2:259–273
  4. Franklin J, Lunt M, Bunn D, et al. Risk and predictors of infection leading to hospitalization in a large primary care derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis. 2007;66:308–312
  5. Van Staa TP, Leufkens HG, Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res. 2001;16:581–588
  6. Grant CC, Duggan AK, Santosham M, DeAngelis C. Oral prednisone as a risk factor for infections in children with asthma. Arch Pediatr Adolesc Med. 1996;150:58–63
  7. Starzl TE, Klintmalm GB, Porter KA, et al. Liver transplantation with use of cyclosporine A and prednisone. N Engl J Med. 1981;305:266–269
  8. Klino T, Hatanaka H, Hashimoto M, et al. FK-506, a novel immunosuppressant isolated from a Streptomyces (I. Fermentation, isolation, and physicochemical and biological characteristics). J Antibiot (Tokyo). 1987;40:1249–1255
  9. Pritchard D. Sourcing a chemical succession for cyclosporine from parasites to human pathogens. Drug Discov Today. 2005;10:688–691
  10. Liu J, Farmer J, Lane WS, et al. Calcineurin is a common target of cyclophilin-cyclosporin A and FKBP-FK506 complexes. Cell. 1991;66:807–815
  11. Woodruffe R, Yao G, Meads C, et al. Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study. Health Technol Assess. 2005;9:1–194
  12. K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease. www.kidney.org/Professionals/kdoqi/guidelines_bp/guide_10.htmAccessed December 11, 2009
  13. Bromberg JS, Grossman RA. Care of the organ transplant recipient. J Am Board Fam Pract. 1993;6:563–576
  14. Brozena SC, Johnson MR, Ventura H, et al. Effectiveness and safety of diltiazem or lisinopril in treatment of hypertension after heart transplantation (Results of a prospective, randomized multicenter trial). J Am Coll Cardiol. 1996;27:1707–1712
  15. McGuire BM, Rosenthal P, Brown CC, et al. Long-term management of the liver transplant patient: recommendations for the primary care physician. Am J Transpl. 2009;9:1988–2003
  16. Galioto A, Semplicini A, Zanus G, et al. Nifedipine versus carvedilol in the treatment of de novo arterial hypertension after liver transplant: results of a controlled clinical trial. Liver Transpl. 2008;14:1020–1028
  17. Tylicki L, Biedunkiewicz B, Chamienia A, et al. Randomized placebo controlled study on the effects of losartan and carvedilol on albuminuria in transplant recipients. Transplantation. 2006;18:52–56
  18. Van den Dorpel MA, Zietse R, Ijzermans JN, Weimar W. Prophylactic isradipine treatment after kidney transplantation: a prospective double-blind placebo-controlled randomized trial. Transplant Int. 1994;7(Suppl 1):270–274
  19. Midtvedt K, Ihlen H, Hartmann A, et al. Reduction of left ventricular mass by lisinopril and nifedipine in hypertensive renal transplant recipients: a prospective randomized double-blind study. Transplantation. 2001;72:107–111
  20. Hernandez D, Lacalzada J, Salido E, et al. Regression of left ventricular hypertrophy by lisinopril after renal transplantation: role of ACE gene polymorphism. Kidney Int. 2000;58:889–897
  21. Hausberg M, Barenbrock M, Hohage H, et al. ACE inhibitor versus beta-blocker for the treatment of hypertension in renal allograft recipients. Hypertension. 1999;33:862–868
  22. Mourad G, Ribstein J, Mimran A. Converting-enzyme inhibitor versus calcium antagonist in cyclosporine-treated renal transplants. Kidney Int. 1993;43:419–425
  23. Rahn KH, Barenbrock M, Fritschka E, et al. Effect of nitrendipine on renal function in renal-transplant patients treated with cyclosporine: a randomised trial. Lancet. 1999;354:1415–1420
  24. van Riemsdijk IC, Mulder PG, de Fijter JW, et al. Addition of isradipine (Lomir) results in a better renal function after kidney transplantation: a double-blind, randomized, placebo-controlled, multi-center study. Transplantation. 2000;70:122–126
  25. Madsen JK, Sorensen SS, Hansen HE, Pedersen EB. The effect of felodipine on renal function and blood pressure in cyclosporine-treated renal transplant recipients during the first three months after transplantation. Nephrol Dial Transplant. 1998;13:2327–2334
  26. McDiarmid SV, Gornbein JA, Fortunat M, Saikali D. Serum lipid abnormalities in pediatric liver transplant patients. Transplantation. 1992;53:109–115
  27. Munoz SJ, Deems RO, Mortiz MJ. Hyperlipidemia and obesity after liver transplantation. Transplant Proc. 1991;23(1Pt 2):1480–1483
  28. Stegall MD, Everson G, Schroter G, et al. Metabolic complications after liver transplant: diabetes, hypercholesterolemia, hypertension and obesity. Transplantation. 1995;60:1057–1060
  29. Munoz SJ. Hyperlipidemia and other coronary risk factors after orthotopic liver transplantation: pathogenesis, diagnosis and management. Liver Transplant Surg. 1995;1(5 Suppl 1):29–38
  30. Aakhus S, Dahl K, Wideroe TE. Hyperlipidemia in renal transplant recipients. J Intern Medical. 1996;239:407–415
  31. Gonyea JE, Anderson CF. Weight change and serum lipoproteins in recipients of renal allografts. Mayo Clin Proc. 1992;67:653–657
  32. Brown JH, Murphy BG, Douglas AF, et al. Influence of immunosuppressive therapy on lipoprotein (a) and other lipoproteins following renal transplantation. Nephron. 1997;75:277–282
  33. Moore R, Thomas D, Morgan E, et al. Abnormal lipid and lipoprotein profiles following renal transplantation. Transplant Proc. 1993;25:1060–1061
  34. Ballantyne CM, Radovancevic B, Farmer JA, et al. Hyperlipidemia after heart transplantation: a report of a 6-year experience with treatment recommendations. J Am Coll Cardiol. 1992;19:1315–1321
  35. Kasiske B, Cosio FG, Beto J, et al. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Diseases Outcomes Quality Initiative. Am J Transplant. 2004;4(Suppl 7):13–53
  36. Moore RA, Callahan MF, Cody M, et al. The effect of the American Heart Association step one diet on hyperlipidemia following renal transplantation. Transplantation. 1990;49:60–62
  37. Barbagallo CM, Cefalu AB, Gallo S, et al. Effects of Mediterranean diet on lipid levels and cardiovascular risk in renal transplant recipients. Nephron. 1999;82:199–204
  38. Tonstad S, Holdas H, Gorbitz C, Ose L. Is dietary intervention effective in post-transplant hyperlipidemia?. Nephrol Dial Transplant. 1995;10:82–85
  39. Gomez G, Alvarez ML, Errasti F, et al. Fluvastatin in the treatment of hypercholesterolemia in renal transplantation. Transplant Proc. 1999;31:2326–2327
  40. Alvarez ML, Errasti P, Gomez G, et al. Effect of atorvastatin on the treatment of hypercholesterolemia after renal transplantation. Transplant Proc. 1999;31:2328–2329
  41. Yoshimura N, Oka T, Okamoto M, Ohmori Y. The effects of pravastatin on hyperlipidemia in renal transplant recipients. Transplantation. 1992;53:94–99
  42. Imagawa DK, Dawson S, Holt CD, et al. Hyperlipidemia after liver transplantation: natural history and treatment with the hydroxyl-methylglutaryl-coenzyme A reductase inhibitor pravastatin. Transplantation. 1996;62:934–942
  43. Imamura R, Ichimaru N, Moriyama T, et al. Long term efficacy of simvastatin in renal transplant recipients treated with cyclosporine or tacrolimus. Clin Transplant. 2005;19:616–621
  44. O'Rourke B, Barbier M, Mitchell AG, et al. Efficacy and safety of fluvastatin therapy for hypercholesterolemia after heart transplant: results of a randomized double blind placebo study. Int J Cardiol. 2004;94(2-3):235–240
  45. Vivekananthan K, Mehra MR, Uber PA, et al. Comparison of the efficacy and safety of pravastatin and simvastatin in heart transplantation. J Assoc Physicians India. 2002;50:682–684
  46. Magnani G, Carinci V, Magelli C, et al. Role of statins in the mangement of dyslipidemia after cardiac transplant: randomized controlled trial comparing the efficacy and the safety of atorvastatin with pravastatin. J Heart Lung Transplant. 2000;19:710–715
  47. Zambrana Garcia JL, Lopez Miranda J, Anguita Sancgez M, et al. A comparison of benzafibrate and lovastatin treatment at the usual doses in post-heart transplant hyperlipidemia. Rev Esp Cardiol. 1996;49:892–898
  48. Pfugfelder PW, Huff M, Oskalns R, et al. Cholesterol-lowering therapy after heart transplantation: a 12-month randomized trial. J Heart Lung Transplant. 1996;15:539–540
  49. Hidalgo L, Zambrana JL, Blanco-Molina A, et al. Lovastatin versus benzafibrate for hyperlipidemia treatment after heart transplantation. J Heart Lung Transplant. 1995;14:461–467
  50. Zachoval R, Gerbes AL, Schwandt P, Parhofer KG. Short-term effects of statin therapy in patients with hyperlipoproteinemia after liver transplantation: results of a randomized crossover trial. J Hepatol. 2001;35:86–91
  51. Renders L, Mayer-Kadner I, Koch C, et al. Efficacy and drug interactions of the new HMG-CoA reductase inhibitors cerivastatin and atorvastatin in CsA-treated renal transplant recipients. Nephrol Dial Transplant. 2001;16:141–146
  52. Santos AF, Keitel E, Bittar AE, et al. Safety and efficacy of simvastatin for hyperlipidemia in renal transplant recipients: a double-blind randomized, placebo-controlled study. Transplant Proc. 2001;33(1-2):1194–1195
  53. Lepre F, Rigby R, Hawley C, et al. A double-blind placebo controlled trial of simvastatin for the treatment of dyslipidaemia in renal allograft recipients. Clin Transplant. 1999;13:520–525
  54. Melchor JL, Gracida C. Treatment of hypercholesterolemia with fluvastatin in kidney transplant patients. Transplant Proc. 1998;30:2054–2057
  55. Castro R, Queiros J, Fonseca I, et al. Therapy of post renal transplantation hyperlipidaemia: comparative study with simvastatin and fish oil. Nephrol Dial Transplant. 1997;12:2140–2143
  56. Lal SM, Hewett JE, Petroski GF, et al. Effects of nicotinic acid and lovastatin in renal transplant patients: a prospective randomized, open-labeled crossover trial. Am J Kidney Dis. 1995;25:616–622
  57. Hanes DS, Nicholson PG, Raval DD, et al. A crossover comparison of the efficacy and safety of lovastatin and gemfibrozil in the treatment of hyperlipidemic organ transplant recipients. Am J Ther. 1997;4(2-3):85–91
  58. Kasiske BL, Tortorice KL, Heim-Duthoy KL, et al. Lovastatin treatment of hypercholesterolemia in renal transplant recipients. Transplantation. 1990;49:95–100
  59. Wenke K, Meiser B, Thiery J, et al. Simvastatin initiated early after heart transplantation. Circulation. 2003;107:93–97
  60. Kobashigawa JA, Katznelson S, Laks H, et al. Effect of pravastatin on outcomes after cardiac transplantation. N Engl J Med. 1995;333:621–627
  61. Holdaas H, Fellstrom P, Jardine AG, et al. Assessment of LEscol in Renal Transplantation (ALERT) Study Investigators Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicenter randomized placebo-controlled trial. Lancet. 2003;361(9374):2024–2031
  62. Buchanan C, Smith L, Corbett J, et al. A retrospective analysis of ezetimibe treatment in renal transplant recipients. Am J Transplant. 2006;6:770–774
  63. Corsini A. The safety of HMG-CoA reductase inhibitors in special populations at high cardiovascular risk. Cardiovasc Drugs Ther. 2003;17:265–285
  64. Blanco JJ, Herrero JI, Quiroga J, et al. Liver transplantation in cirrhotic patients with diabetes mellitus: midterm results, survival and adverse events. Liver Transpl. 2001;7:226–233
  65. Steinmuller TH, Stockmann M, Bechstein WO, et al. Liver transplantation and diabetes mellitus. Exp Clin Endocrinol Diabetes. 2000;108:401–405
  66. Reuben A. Long-term management of the liver transplant patient: diabetes, hyperlipidemia, and obesity. Liver Transpl. 2001;7(11 Suppl 1):S13–S21
  67. Chien YS, Chen YT, Chuang CH, et al. Incidence and risk factors of new-onset diabetes after renal transplantation. Transplant Proc. 2008;40:2409–2411
  68. Martinez-Dolz L, Almenar L, Martinez-Ortiz L, et al. Predictive factors for development of diabetes mellitus post-heart transplant. Transplant Proc. 2005;37:4064–4066
  69. Summary of revisions for the 2009 Clinical Practice Recommendations. Diabetes Care. 2009;32(Suppl 1):S3–S5
  70. Vicenti F, Friman S, Scheuermann E, et al. Results of an international randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant. 2007;7(6):1506–1514
  71. U.S. Preventive Services Task Force, eds. The Guide to Clinical Preventive Services 2006: Recommendations of the United States Preventive Services Task Force. Alexandria, VA: International Medical Publishing Inc; 2006;
  72. Ringash J Canadian Task Force on Preventive Health Care. Preventive Health Care, 2001 Update: screening mammography among women aged 40-49 years at average risk of breast cancer. CMAJ. 2001;164:469–476
  73. American Cancer Society guidelines for early detection of cancer. http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp
  74. London NJ, Farmery SM, Will EJ, Davison AM, Lodge JPA. Risk of neoplasia in renal transplant patients. Lancet. 1995;346:403–406
  75. Euvard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348:1681–1691
  76. Amital A, Shitrit D, Raviv Y, et al. Development of malignancy following lung transplantation. Transplantation. 2006;81:547–551
  77. Adami J, Gabel H, Lindelof B, et al. Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer. 2003;89:1221–1227
  78. Penn I. Incidence and treatment of neoplasia after transplantation. J Heart Lung Transplant. 1993;12:S328–S336
  79. Webb MC, Compton F, Andrews PA, Koffman CG. Skin tumors posttransplantation: a retrospecitve analysis of 28 years experience at a single centre. Transplant Proc. 1997;29:828–830
  80. Mihalov ML, Gattuso P, Abraham K, Holmes EW, Reddy V. Incidence of post-transplant malignancy among 674 solid-organ-transplant recipients at a single center. Clin Transplant. 1996;10:248–255
  81. Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56:155–167
  82. Baccarani U, Adani GI, Montanaro AD, et al. De novo malignancies after kidney and liver transplantation: experience on 582 consecutive cases. Transplant Proc. 2006;38:1135–1137
  83. Haagsma EB, Hagens VE, Schaapveld M, et al. Increased cancer risk after liver transplantation: a population-based study. J Hepatol. 2001;34(1):84–91
  84. Vajdic CM, McDonald SP, McCredie MRE, et al. Cancer incidence before and after kidney transplantation. JAMA. 2006;296(23):2823–2831
  85. Adamson R, Obispo E, Dychter S, et al. High incidence and clinical course of aggressive skin cancer in heart transplant patients: a single center study. Transplant Proc. 1998;30:1124–1126
  86. Veness MJ, Quinn DI, Ong CS, et al. Aggressive cutaneous malignancies following cardiothoracic transplantation: the Australian experience. Cancer. 1999;85:1758–1764
  87. Espana A, Martinez-Gonzalez MA, Garcia-Granero M, et al. A prospective study of incident nonmelanoma skin cancer in heart transplant recipients. J Invest Dermatol. 2000;115:1158–1160
  88. McGregor JM, Berkhout RJ, Rozycka M, et al. p53 mutations implicate sunlight in post-transplant skin cancer irrespective of human papillomavirus status. Oncogene. 1997;15:1737–1740
  89. Sheil AG. Cancer in immune-suppressed organ transplant recipients: aetiology and evolution. Transplant Proc. 1998;30:2055–2057
  90. Ulrich C, Jurgensen JS, Degen A, et al. Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study. BJD. 2009;161(Suppl 3):78–84
  91. Kontoyiannis DP, Rubin RH. Infection in the organ transplant recipient (An overview). Infect Dis Clin North Am. 1995;9:811–822
  92. Blumberg EA, Albano C, Pruett T, et al. The immunogenicity of influenza virus vaccine in solid organ transplant recipients. Clin Infect Dis. 1996;22:295–302
  93. Burbach G, Bienzle U, Stark K, et al. Influenza vaccination in liver transplant recipients. Transplantation. 1999;67:753–755
  94. Soesman NMR, Rimmelzwaan GF, Nieuwkoop NJ, et al. Efficacy of influenza vaccination in adult liver transplant recipients. J Med Virol. 2000;61:85–93
  95. Arslan M, Wiesner RH, Poterucha JJ, et al. Hepatitis A antibodies in liver transplant recipients: evidence for loss of immunity post-transplantation. Liver Transpl. 2000;6:191–195
  96. Gunther M, Stark K, Neuhaus R, et al. Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients. Transplantation. 2001;71:477–490
  97. Gunther M, Neuhaus R, Bauer T, et al. Immunization with adjuvant hepatitis B vaccine in liver transplant recipients: antibody decline and booster vaccination with conventional vaccine. Liver Transpl. 2006;12:316–319
  98. McCashland TM, Preheim LC, Gentry-Nielsen MJ. Pneumococcal vaccine response in cirrhosis and liver transplantation. J Infect Dis. 2000;181:757–760
  99. Blumberg EA, Brozena S, Stutman P, et al. Immunogenicity of pneumococcal vaccine in heart transplant recipients. Clin Infect Dis. 2001;32:307–310
  100. Magnani G, Falchetti E, Pollini G, et al. Safety and efficacy of two types of influenza vaccination in heart transplant recipients: a prospective randomized controlled study. J Heart Lung Transplant. 2005;24:588–592
  101. Mass K, Quint EH, Punch MR, Merion R. Gynecological and reproductive function after liver transplantation. Transplantation. 1996;62(4):476–479
  102. Holley J. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis. 1997;28:685–690
  103. Guazzelli CAF, Torloni MR, Sanches TF, et al. Contraceptive counseling and use among 197 female kidney transplant recipients. Transplantation. 2008;86:669–672
  104. Lessan-Pezeshki M, Ghazizadeh S, Khatami MR, et al. Fertility and contraceptive issues after kidney transplantation in women. Transplant Proc. 2004;36:1405–1406
  105. Jabiry-Zieniewicz Z, Bobrowska K, Kaminski P, et al. Low-dose hormonal contraception after liver transplantation. Transplant Proc. 2007;39:1530–1532
  106. Watnick S, Rueda J. Reproduction and contraception after kidney transplantation. Curr Opin Obstet Gynecol. 2008;20:308–312
  107. Zerner J, Doil KL, Drewry J, Leeber DA. Intrauterine contraceptive device failure in renal transplant patients. J Reprod Med. 1981;26:99–102

 Funding: None.

 Conflict of Interest: To our knowledge there is no conflict of interest, either financial or otherwise.

 Authorship: Both authors had access to the data and a role in writing this manuscript.

PII: S0002-9343(09)00961-9

doi: 10.1016/j.amjmed.2009.06.034

The American Journal of Medicine
Volume 123, Issue 3 , Pages 205-212 , March 2010