Solid Organ Transplantation

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Abstract

As patients live longer with functioning allografts, the prevalence of solid organ transplant recipients will continue to increase, thus making it likely that many primary care providers will treat patients with an organ transplant. As the population of living transplant recipients grows, primary care providers will increasingly play a key role in the long-term management of transplant recipients. The introductory case presentation and discussion aim to educate the primary care provider about common medical problems experienced by transplant recipients, to provide some fundamental knowledge of immunosuppressive medications and their drug interactions, and to highlight key issues when comanagement with the transplant sub-subspecialist is indicated. Though the chapter focuses on kidney transplantation, the issues can be related to liver and cardiac transplant recipients with some caveats.

Keywords

Transplantation Solid organ transplant Transplant recipients End-stage kidney disease Transition of care 
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References

  1. 1.
    US Renal Data System (USRDS). USRDS 2014 Annual Report: Atlas of Chronic Kidney Disease and End Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2014.Google Scholar
  2. 2.
    Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, et al. OPTN/SRTR 2013 annual data report: kidney. Am J Transplant. 2015;15(Suppl 2):1–34.CrossRefPubMedGoogle Scholar
  3. 3.
    Kasiske BL, Anjurn S, Shah R, Skogen J, Kandaswamy C, Danielson B, O’Shaughnessy E, et al. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Pedraza F, Roth D. Medical management of the kidney transplant recipient. Prim Care Clin Office Pract. 2014;41(4):895–906.CrossRefGoogle Scholar
  5. 5.
    K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43:S1–S290.Google Scholar
  6. 6.
    Chobanian AV, Bakris GL, Black HR, Cushman W, Green L, Izzo J, Jones D, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. Am J Transplant. 2009;9(Suppl 3):S1–S157.Google Scholar
  8. 8.
    Toprak A, Koc M, Tezcan H, Ozener IC, Oktay A, Akoglu E. Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients. J Hum Hypertens. 2003;17:239–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Ibernon M, Moreso F, Sarrias X, Grinyo J, Fernandez-Real J, Ricart W, Seron D. Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation. Nephrol Dial Transplant. 2012;27:2089–95.CrossRefPubMedGoogle Scholar
  10. 10.
    Lakkis J, Weir MR. Treatment-resistant hypertension in the transplant recipient. Semin Nephrol. 2014;34(5):560–70.CrossRefPubMedGoogle Scholar
  11. 11.
    Wadei HM, Textor SC. Hypertension in the kidney transplant recipient. Transplant Rev. 2010;24:105–20.CrossRefGoogle Scholar
  12. 12.
    Lexicomp Online®. Hudson, Ohio: Lexi-Comp, Inc.; April 04, 2016.Google Scholar
  13. 13.
    Davidson J, Wilkinson A, Dantal J, Dotta, F, Haller, H, Hernandez, D, Kasiske, B, et al. International Expert Panel. New-onset diabetes after transplantation: 2003 international consensus guidelines. Proceedings of an international expert panel meeting Barcelona, Spain, 19 February 2003. Transplantation 2003;75(10, Suppl):SS3–SS24.Google Scholar
  14. 14.
    Padiyar A, Akoum FH, Hricik DE. Management of the kidney transplant recipient. Prim Care Clin Office Pract. 2008;35(3):433–50.CrossRefGoogle Scholar
  15. 15.
    Schaefer HM. Long-term management of the kidney transplant recipient. Blood Purif. 2012;33:205–11.CrossRefPubMedGoogle Scholar
  16. 16.
    Soleimanpour SA, Crutchlow MF, Ferrari AM, Raum JC, Groff DN, Rankin MM, et al. Calcineurin signaling regulates human islet (beta)-cell survival. J Biol Chem. 2010;285:40050–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ajabnoor MA, El-Naggar MM, Elayat AA, Abdulrafee A. Functional and morphological study of cultured pancreatic islets treated with cyclosporine. Life Sci. 2007;80:345–55.CrossRefPubMedGoogle Scholar
  18. 18.
    Flechner SM, Glyda M, Cockfield S, Grinyó J, Legendre Ch, Russ G, et al. The ORION study: comparison of two sirolimus-based regimens versus tacrolimus and mycophenolate mofetil in renal allograft recipients. Am J Transplant. 2011;11:1633–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Galindo RJ, Fried M, Breen T, Tamler R. Hyperglycemia management in patients with post-transplantation diabetes. Endocr Pract. 2016;22(4):454–65.CrossRefPubMedGoogle Scholar
  20. 20.
    Barlow AD, Nicholson ML, Herbert TP. Evidence for rapamycin toxicity in pancreatic β-cells and a review of the underlying mechanisms. Diabetes. 2013;62:2674–82.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011;34(6):1431–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ghisdal L, Van Laecke S, Abramowicz MJ, VanHolder R, Abramowicz D. New-onset diabetes after renal transplantation: risk assessment and management. Diabetes Care. 2012;35(1):181–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Vanrenterghem YF, Claes K, Montagnino G, Fieuws S, Maes B, Villa M, et al. Risk factors for cardiovascular events after successful renal transplantation. Transplantation. 2008;85:209–16.CrossRefPubMedGoogle Scholar
  24. 24.
    Kasiske B, Cosio FG, Beto J, Bolton BM, Chavers R, Grimm R, Levin A, 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 disease outcomes quality initiative. Am J Transplant. 2004;4(Suppl 7):13–53.CrossRefPubMedGoogle Scholar
  25. 25.
    Navaneethan SD, Perkovic V, Johnson DW, Nigwekar SU, Craig JC, Strippoli GF. HMG CoA reductase inhibitors (statins) for kidney transplant recipients. Cochrane Database Syst Rev. 2009;2:CD005019.Google Scholar
  26. 26.
    Holdaas H, Fellstrom B, Jardine AG, Holme I, Nyberg G, Fauchald P, Gonhagen-Riska C, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicenter, randomized, placebo-controlled trial. Lancet. 2003;361(9374):2024–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Ebeling PR. Approach to the Patient with Transplantation-Related Bone Loss. J Clin Endocrinol Metab. 2009;94:1483–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Ebeling PR. Transplantation osteoporosis. Curr Osteoporos Rep. 2007;5:29–37.CrossRefPubMedGoogle Scholar
  29. 29.
    Nisbeth U, Lindh E, Ljunghall S, Backman U, Fellstrom B. Increased fracture rate in diabetes mellitus and females after renal transplantation. Transplantation. 1999;67(9):1218–22.CrossRefPubMedGoogle Scholar
  30. 30.
    Abbott KC, Ogelsby RJ, Hypolite IO, Kirk AD, Ko CW, Welch PG, et al. Hospitalizations for fractures after renal transplantation in the United States. Ann Epidemiol. 2001;11(7):450–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Nikkel LE, Hollenbeak CS, Fox EJ, Uemura T, Ghahramani N. Risk of fractures after renal transplantation in the United States. Transplantation. 2009;87(12):1846–51.CrossRefPubMedGoogle Scholar
  32. 32.
    Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int. 2007;18(10):1319–28.CrossRefPubMedGoogle Scholar
  33. 33.
    Kuroki Y, Kaji H, Kawano S, Kanda F, Takai Y, Kajiwaka M, et al. Short-term effects of glucocorticoid therapy on biochemical markers of bone metabolism in Japanese patients: a prospective study. J Bone Miner Metab. 2008;26(3):271–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Guistani A, Mazziotti G, Canalis E. Growth hormone, insulin-like growth factors, and the skeleton. Endocr Rev. 2008;29(5):535–9.CrossRefGoogle Scholar
  35. 35.
    Mazziotti G, Giustina A. Glucocorticoids and the regulation of growth hormone secretion. Nat Rev Endocrinol. 2013;9(15):265–76.CrossRefPubMedGoogle Scholar
  36. 36.
    Epstein S. Post-transplantation bone disease: the role of immunosuppressive agents and the skeleton. J Bone Miner Res. 1996;11(1):1–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Nikkel LE, Mohan S, Zhang A, McMahon DJ, Boutroy S, Dube G, et al. Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. Am J Transplant. 2012;12:649–59.CrossRefPubMedGoogle Scholar
  38. 38.
    Bergua C, Torregrosa JV, Fuster D, Gutierrez-Dalmau A, Oppenheimer F, Campistol JM. Effect of cinacalcet on hypercalcemia and bone mineral density in renal transplanted patients with secondary hyperparathyroidism. Transplantation. 2008;86:413–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Josephson MA, Schumm LP, Chiu MY, Marshall C, Thistlethwaite JR, Sprague SM. Calcium and calcitriol prophylaxis attenuates post transplant bone loss. Transplantation. 2004;78:1233–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Sullivan PM, William A, Tichy EM. Hyperuricemia and gout in solid-organ transplant: update in pharmacological management. Prog Transplant. 2015;25(3):263–70.CrossRefPubMedGoogle Scholar
  41. 41.
    Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, Pillinger MH, et al. 2012 American College of Rheumatology guidelines for the management of gout. Arthritis Care Res. 2012;64(10):1431–61.CrossRefGoogle Scholar
  42. 42.
    Danovitch GM. Handbook of kidney transplantation. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.Google Scholar
  43. 43.
    Krajewski CM, Geetha D, Gomez-Lobo V. Contraceptive options for women with a history of solid-organ transplantation. Transplantation. 2013;95(10):1183–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Josephson MA, McKay DB. Women and Transplantation: fertility, sexuality, pregnancy, contraception. Adv Chronic Kidney Dis. 2013;20(5):433–40.CrossRefPubMedGoogle Scholar
  45. 45.
    Krajewski C, Sucato G. Reproductive health care after transplantation. Best Pract Res Clin Obstet Gynaecol. 2014;28:1222–34.CrossRefPubMedGoogle Scholar
  46. 46.
    Brosens I, Brosens J, Benagiano G. The risk of obstetrical syndromes and solid organ transplantation. Best Pract Res Clin Obstet Gynaecol. 2014;28:1211–21.CrossRefPubMedGoogle Scholar
  47. 47.
    Katabathina V, Menias CO, Pickhardt P, Lubner M, Prasad S. Complications of immunosuppressive therapy in solid organ transplantation. Radiol Clin N Am. 2016;54:303–19.CrossRefPubMedGoogle Scholar
  48. 48.
    Grulich AE, Vajdic CM. The epidemiology of cancers in human immunodeficiency virus infection and after organ transplantation. Semin Oncology. 2015;42(2):247–57.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Pediatric Nephrology and Hypertension, Department of PediatricsUniversity of South Carolina School of Medicine - Palmetto Richland Children’s HospitalColumbiaUSA
  2. 2.Departments of Internal Medicine and PediatricsMount Sinai Medical CenterNew YorkUSA
  3. 3.New YorkUSA

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