MANAGEMENT OF THE CARDIAC TRANSPLANT RECIPIENT - ROLES OF THE TRANSPLANT CARDIOLOGIST AND PRIMARY-CARE PHYSICIAN

Cardiac transplantation has become an accepted treatment for selected patients with end-stage heart failure. Despite a successful transplant , denervated transplanted hearts respond differently to cardiac drugs than nontransplanted hearts. The treatments for bradycardia, tachycard ia, and hypotension are different than for nontransplanted hearts. Des pite the improvement in long-term survival, a number of complications may occur posttransplantation. These complications include, allograft rejection, infection, allograft coronary artery disease, and malignanc y. Additionally, posttransplant patients may have complications from t he immunosuppressive agents cyclosporine, prednisione, and azathioprin e. Such complications include drug interactions with commonly prescrib ed medications, hypertension, hyperlipidemia, osteoporosis, and gastro intestinal complications. The. purpose of this article is to discuss t he management of the cardiac transplant recipient as it relates to the aforementioned complications. Management of the cardiac transplantati on patient by the primary care physician will also be discussed, inclu ding indications for consultation by the primary care physician with t he transplant center.