Transplantation

Definitive treatment for organ failure

Kidney, liver, heart, lung, pancreas

GP care for these patients before and long after organ transplantation in the community

Donation

Living donor

Disease donor – DBD, DCD

Compatibility testing

ABO, HLA, Crossmatching

Rejection

Hyperacute – minutes to hours

Acute – days to months

Chronic – months to years

GP needs to recognise graft dysfunction early

Immunosuppressive therapy

Lifelong and central to transplant success

Regimens – typically triple therapy

Calcinerurin inhibitor (Tacrolimus, cyclosporin -nephrotoxicity, neurotoxicity, hypertension

Antimetabolite (Mycophenolate mofetil, azathioprine – marrow suppression, cytopenia, GI upset)

Steroids – Prednisolone – DM, Osteoporosis, weight gain

GP role in this – repeat prescription under shared care, be cautious with drug interactions, never change immunosupressive therapy without specialist input

Infection Risk and Prevention

Viral – CMV, EBV

Opportunistic – PJP

Fungal – candida, Aspergillus

GP – same day referral for patient with fever, specialist led prophylaxis

Vaccinations

Avoid live vaccines (MMR, Varicella, Yellow Fever, intra-nasal flu)

Annual influenza

COVID-19

Pneumococcal

Specialist advice regarding travel vaccines

Long term complications

Cardiovascular

Renal

Metabolic

Malignancy

Post-transplant lymphoproliferative disease

Bone disease

Graft dysfunction

Kidney – rising creatinine, reduced urine output

Liver – abnormal LFTs, jaundice

Heart transplant – breathlessness, arrythmias

Shared care & communication

Specialist – adjust immunotherapy, manage rejection, specialist monitoring

GP – prescription, routine blood monitoring, manage comorbidities

Urgent referral – fever or suspected infection, severe diarrhoea,  drug toxicity