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Special Considerations for Long-Term Survivors After Solid Organ Transplantation

Chapter

Abstract

Survival from solid organ transplantation has improved markedly over the last few decades due to progress in surgical techniques, newer antibiotics, and more effective immunosuppression. While short-term complications have decreased with improved management there remains an important focus on the long-term complications. These long-term complications include both infectious and non-infectious issues which will limit further improvement in graft and patient survival. The infectious causes mostly include community-acquired bacterial and viral infections. The metabolic and cardiovascular complications are prominent amongst non-infectious causes of long-term morbidity being driven by additional risk factors like effects of immunosuppression that increase the risk for hypertension, obesity, renal failure, and diabetes. Chronic immunosuppression leads to a higher incidence of most malignancies particularly skin cancers and these neoplastic processes appear to have an accelerated course in this population. Post-transplant lymphoproliferative disorder is a neoplasm related to EBV infection that is unique to the immunosuppressed population. A systematic health maintenance regimen which includes vaccinations, management of cardiovascular risk factors, and cancer screening will ensure that the long-term transplant survivors will be able to avoid significant morbidity and mortality from these complications.

Keywords

Immunosuppression Post-transplant lymphoproliferative disorder (PTLD) Organ transplant Photocarcinogenesis Cytomegalovirus Allograft dysfunction 

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Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  • Hakim Azfar Ali
    • 1
  • Scott M. Palmer
    • 2
  • Oriol Manuel
    • 3
  1. 1.Lung Transplant, Division of Pulmonary, Allergy and Critical CareDuke University HospitalDukeUSA
  2. 2.Department of MedicineDuke University Medical CenterDukeUSA
  3. 3.Infectious Diseases Service and Transplantation CenterUniversity Hospital of Lausanne, CHUVLausanneSwitzerland

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