Journal of General Internal Medicine

, Volume 25, Issue 7, pp 731–740 | Cite as

Primary Care of the Renal Transplant Patient

  • Gaurav Gupta
  • Mark L. Unruh
  • Thomas D. Nolin
  • Peggy B. Hasley
Original Research


There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60–65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP’s perspective. Medical management issues related to immunosuppressive medications are also briefly discussed.

Key words

renal transplantation kidney transplantation transplantation primary care primary care physicians 



We would like to thank Dr. Christine Wu for her help in the preparation of this manuscript.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Gaurav Gupta
    • 1
  • Mark L. Unruh
    • 2
    • 3
  • Thomas D. Nolin
    • 2
    • 3
    • 4
  • Peggy B. Hasley
    • 2
    • 5
  1. 1.Nephrology Division, Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Renal-Electrolyte DivisionUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Department of Pharmacy and TherapeuticsUniversity of Pittsburgh Medical CenterPittsburghUSA
  5. 5.Division of General Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

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