Long-term Management of the Liver Transplant Patient: Recommendations for the Primary Care Doctor

These guidelines are intended to provide a bridge between transplant centers and primary care physicians in the long-term management of the liver transplant patient. The guidelines were published in: American Journal of Transplantation 2009; 9:1988-2003

Post-Transplant Continuing Care Form for Kidney Recipients

This form has been developed by the AST Kidney Pancreas Committee to aid transplant specialists when referring their patients back to the community-based physician. The form serves as a general guide on the care of the post-transplant kidney recipient.

It is recommended that this two-page document be printed as a two-sided, single sheet form.

Download the Post-Transplant Continuing Care Form for Kidney Recipients (PDF) here.

When to Contact the Transplant Center:

AST Guidelines for Non-transplant Physicians Caring for Heart and/or Lung Transplant Recipients

These guidelines should not replace guidelines provided by programs to patients or providers, but can supplement or substitute for program guidelines at transplant center discretion.

Please Contact the Transplant Center for the Following Conditions:

• GENERAL
  1. Hospitalization
  2. Change in medication (addition or deletion of a medication), including the addition of any antibiotic, antifungal, or antiviral therapy for confirmed or presumed infection.
  3. Hypotension or unexplained drop in systolic of 20 from baseline
  4. Increase in resting heart rate >10 over baseline
  5. Fever >=101º F or any unexplained fever >= 100.5º F for >= 48 hours
  6. 2 or more lb. weight gain in 1 week.
  7. Unexplained weight loss of > 5 lbs.
  8. Elective surgery
• CARDIOPULMONARY
  1. Increased shortness of breath
  2. Pneumonia
  3. Any respiratory infection in a lung transplant patient
  4. Syncope
  5. Chest pain other than musculoskeletal
  6. Decline of > 10% FEV1 in lung transplant patients
• GASTROINTESTINAL
  1. Abdominal pain other than constipation or gas
  2. Nausea, vomiting or diarrhea
• NEUROLOGIC
  1. Cerebral vascular event
  2. Seizure
  3. Mental status changes

Medical care of heart and/or lung transplant patients is unique because of

1. The possibility of acute and/or chronic rejection
2. Chronic immunosuppression with its associated risk for infection and malignancy,
3. The toxicities and drug interactions of anti-rejection medications
4. The modification of presenting signs and symptoms by anti-rejection medications (such as steroids masking abdominal findings in an acute abdomen).
5. Graft specific issues such as tricuspid regurgitation and painless ischemia in heart recipients and airway strictures and hyperexpansion of native lung in lung transplant recipients.

Because of the unique management issues of thoracic transplant recipients we recommend:

1. All changes in ant-rejection medications should be made by the transplant center.
2. Please call the transplant center for any of the conditions above.
3. Contact the transplant center for the addition or elimination of medications. Changes of some medications may affect anti-rejection medication levels.
4. Please do not hesitate to contact the transplant center for any issue related to the care of a heart or lung transplant patient. A thoracic transplant physician or their coverage should always be available to help you. We very much appreciate your help and the opportunity to remain involved in the care of this patient.
    

Approved by the AST Executive Committee on December 22, 2008