MEDICAL CARE OF SOLID ORGAN TRANSPLANT RECIPIENTS AND THE TIME COURSE OF TRANSPLANT-RELATED COMPLICATIONS

Clinical practice in solid organ transplantation has reached its current level of success primarily through the development of goal-oriented surgical and medical protocols. Patients typically progress through the stages of evaluation for transplant candidature, preparation for transplantation, management as a new graft recipient, and maintenance of mid- and long-term post-transplant care under the supervision of a highly specialized team of physicians and surgeons. In order to successfully steer solid organ transplant recipients through each of these processes, the primary management team characteristically prioritizes specific goals and focuses on detection and treatment of the most immediately threatening complications. Table 7.1 provides a generalized summary of important stages in this process and of the major complication risks for each. Although the details of individual management protocols vary significantly depending on both the organ transplanted and the transplant center, the central paradigms that have emerged from five decades of experience are quite similar.

The approach of prioritized management, investigation, and decision-making by a specialized team has served to consolidate clinical experience in transplantation and to create benchmarks for success as a basis for achieving ongoing improvements. To some degree, however, it may also have inhibited the ability of other primary care and subspecialist practitioners to participate actively in the care of transplant recipients and to collaborate in clinical research protocols involving these patients.