Role of Primary Care in Transplant Patient Management

Section 1: Transplant Patient Management
What is the role of a primary care physician after intestinal transplant?
Due to the increase in intestinal and multivisceral transplants' success, more patients will be returning home and to their primary care providers for continued care. As more patients are expected to survive beyond the initial months after surgery, they can be expected to develop more conditions associated with their immunosuppressive therapy that primary care providers must identify, treat, or refer to a subspecialist if necessary.
What are common conditions associated with immunmosuppressive therapy?
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Hypertension
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Diabetes
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Hyperlipidemia
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Obesity
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Cardiovascular disease
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Cerebrovascular disease
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Osteoporosis
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Chronic kidney disease
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Cancer Screening- Immunosuppression is associated with the increased risk of malignancy; transplant patients have at least 2-3 times higher risk of developing cancer compared to the general population, thus following regular cancer screening guidelines is vital.
Fluid and Electrolyte Management
Stoma Closure
The intestinal patient’s stoma is usually closed 6-12 months post-transplant. The site usually heals on its own, but wound infection or intestinal obstruction can occasionally complicate the procedure.
Chronic Kidney Disease Post-Transplant
Dental Health Post-Transplant
It is recommended that transplant patients receive routine dental cleanings. Prior to any dental work or cleaning transplant patients should receive antibiotic prophylaxis to avoid potential infection.
Monitoring for Allograft Dysfunction
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Increased or decreased stomal output.
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Fever
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Vomiting or high gastric residuals.
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Abdominal pain or distention.
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Changes in stomal color or perfusion.
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Systemic viral or bacterial infection.
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Infective enteritis.
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PTLD
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Intestinal perforation.
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Intestinal obstruction.
Immunizations
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HPV
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Hepatitis A
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Hepatitis B
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Influenza (injectable form)
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Diphtheria toxoid
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Tetanus toxoid
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Pertussis
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Hemophilus influenza type B (Hib)
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Inactivated polio
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Pneumococcal
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Meningococcal
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Rabies
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Typhoid
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Japanese encephalitis virus
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Varicella
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Herpes zoster
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Intranasal live attenuated influenza
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MMR
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Oral polio
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Oral live attenuated typhoid
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Calmett-Guerin bacillus (BCG)
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Yellow Fever
Drug Interactions
Mental Health Post-Transplant
Primary care healthcare professionals can play a vital role in screening and periodic assessment of depression and anxiety in transplant patients. Depression may appear at any stage of the transplant due to psychological stressors, medications (such as steroids), or physiological disturbances. Patients who were depressed have been found to have decreased compliance, thus early identification and treatment is crucial to avoid any detriment to the graft or patient.
Section 2: Additional Resources
Journal Article: Primary Care of the Solid Organ Transplant Recipient
Journal Article: Pediatric intestinal and multivisceral transplantation.
Helpful Website: American Society of Transplantation