The Medical clinics of North America
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Med. Clin. North Am. · May 2016
Review Case ReportsDiabetes Care After Transplant: Definitions, Risk Factors, and Clinical Management.
Patients who undergo solid organ transplantation may have preexisting diabetes mellitus (DM), develop new-onset DM after transplantation (NODAT), or have postoperative hyperglycemia that resolves shortly after surgery. Although insulin is usually used to control hyperglycemia in the hospital, following discharge most of the usual diabetes oral and parenteral medications can be used in treatment. However, when there are comorbidities such as impaired kidney or hepatic function, or heart disease, special precautions may be necessary. In addition, drug-drug interactions, such as drugs interacting with CYP3A4 enzyme pathway, require additional consideration because of possible interaction with immunosuppressive drug metabolism.
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Med. Clin. North Am. · May 2016
ReviewThe ABCs of Immunosuppression: A Primer for Primary Care Physicians.
Immunosuppression use for prevention of allograft recognition/rejection has evolved to reflect an expanded understanding of the immune system, as well as a fine tuning of the goals of therapy. Immunosuppression in organ transplantation represents a balance between the desire to improve the health status of an individual affected by chronic conditions versus not imposing an unintended immunodeficiency leading to iatrogenic morbidity/mortality. This article discusses the selection and general dosing of immunosuppression in organ allograft recipients to allow providers to be comfortable in monitoring immunosuppressive therapy long term and the associated, expected posttransplant complications in allograft recipients.
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Med. Clin. North Am. · May 2016
ReviewManagement of the Liver Transplant Recipient: Approach to Allograft Dysfunction.
Liver transplant (LT) recipients are living longer than ever today and many will experience some form of allograft dysfunction. The common causes of allograft dysfunction vary significantly depending on the timing since LT. ⋯ The most common differential diagnoses by time period after LT, and diagnostic and management considerations, are highlighted. Collaboration and comanagement of LT recipients between primary care and the transplant hepatologist is essential for optimizing recipient and allograft outcomes.
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Med. Clin. North Am. · May 2016
Review Historical ArticleLiver and Kidney Transplantation: A Half-Century Historical Perspective.
This article describes the evolution of solid organ kidney and liver transplantation and expounds on the challenges and successes that the early transplant researchers and clinicians encountered. The article highlights the surgical pioneers, delves into the milestones of enhanced immunosuppression protocols, discusses key federal legislative and policy changes, and expounds on the ongoing disparities of organ supply and demand and the need for extended criteria and live donor organs to combat these shortages. Finally, recent changes in organ allocation and distribution policies are discussed. The authors also spotlight novel interventions that will further revolutionize abdominal transplantation in the next 50 years.
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Med. Clin. North Am. · May 2016
ReviewDe Novo Malignancies After Transplantation: Risk and Surveillance Strategies.
De novo malignancies are one of the leading causes of late mortality after liver and kidney transplantation. Nonmelanoma skin cancer is the most common malignancy, followed by posttransplant lymphoproliferative disorder and solid organ tumors. ⋯ In this review, the authors summarize risk factors and outcomes of frequently encountered de novo malignancies after liver and kidney transplantation to stratify recipients at highest risk. Future efforts in prospectively validated, cost-effective surveillance strategies that improve survival of these complex patients are greatly needed.