Long-term management of the renal transplant recipient: Optimizing the relationship between the transplant center and the community nephrologist

Rapid growth in the number of kidney transplant recipients along with impro ved viability of transplanted organs and increased patient survival have al l led to the need for effective long-term management of these patients. The increasing numbers of transplants and the duration of posttransplant medic al care can overwhelm the resources of a transplant center. These factors h ighlight the need for optimizing the relationship between the transplant ce nter and the community nephrologist. There are several factors that affect the timing for transitioning patients from the transplant center to the com munity nephrologist and no standard timing has yet been established. Contin ued management of pretransplant comorbid conditions is important as are mon itoring for adverse effects of failure of immunosuppressive therapy and the development of posttransplant complications. An array of testing that can be useful in monitoring these patients as well as the suggested frequency f or their use are reviewed. Guidelines for the optimal interaction between t he transplant center and the community nephrologist are provided to include circumstances concerning adjustment or conversion of immunosuppressive med ications, evidence of allograft dysfunction, and the development of maligna ncy. (C) 2001 by the National Kidney Foundation, Inc.