Vaccination, screening for malignancy, and health maintenance of the livertransplant recipient

Transplant recipients are highly motivated to maintain their recovered heal th status and are generally compliant with pharmacotherapy and medical foll ow-up. As well as routine blood tests and monitoring of immunosuppressant d rug levels, recipients require immunization updates and regular screening f or malignancy, diabetes, hypertension, hyperlipidemia, and ophthalmologic c omplications. Little information is available about the consistent implemen tation of these health maintenance strategies in this population. A telepho ne survey of liver transplant recipients was conducted using a 20-item ques tionnaire. It was designed to assess the frequency and adequacy of health m aintenance screening, immunizations, and screening tests for malignancy, wh ich are specific to the liver transplant population. We contacted 60 liver recipients transplanted at our institution between 1992 and 1996. The mean age of the patients (31 men and 29 women) was 48 years (range, 42-56 years) . Before transplantation. pneumococcal and hepatitis B vaccination occurred in 13% and 18%, respectively. After transplantation. 27% had received pneu mococcal vaccination and none had received primary vaccination for hepatiti s B. Forty eight percent received yearly influenza vaccination. Of 60 quest ioned recipients, 2 were aware of their varicella exposure status or a poss ible need for varicella immunoglobulin if a primary exposure to chickenpox were to occur. Two were aware of the need for the recipient's children or g randchildren who were undergoing polio vaccination to receive an inactivate d intramuscular polio preparation. Yearly screening for dermatologic or ora l malignancies was provided to only 40% of patients. Physician-performed br east examination or screening mammograms was done in 38% of the surveyed wo men. Eleven percent of the women had received a gynecologic examination wit h a cervical cytologic examination within the prior 2 years. Of the male re cipients, 68% received either digital prostate examination or serum prostat e specific antigen determinations or both. Of 60 recipients. 30 had had eit her flexible sigmoidoscopy or colonoscopy within the previous 2 years. Year ly dental examinations were performed on 75% of patients, and more than 90% had at least yearly blood pressure and weight determinations. Of 60 patien ts, 41 were aware of cholesterol and lipid profiles having been performed w ithin the past 2 years. Ophthalmologic screening was performed in 83% Of su rveyed recipients. This survey suggests: that routine health maintenance ma nagement is less than optimal in this population. Follow-up based on a stan dard protocol may improve the health care of these patients.