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Solid Organ Transplantation

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Care of Adults with Chronic Childhood Conditions

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Abstract

As patients live longer with functioning allografts, the prevalence of solid organ transplant recipients will continue to increase, thus making it likely that many primary care providers will treat patients with an organ transplant. As the population of living transplant recipients grows, primary care providers will increasingly play a key role in the long-term management of transplant recipients. The introductory case presentation and discussion aim to educate the primary care provider about common medical problems experienced by transplant recipients, to provide some fundamental knowledge of immunosuppressive medications and their drug interactions, and to highlight key issues when comanagement with the transplant sub-subspecialist is indicated. Though the chapter focuses on kidney transplantation, the issues can be related to liver and cardiac transplant recipients with some caveats.

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Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of South Carolina School of Medicine - Palmetto Richland Children’s Hospital, 9 Medical Park, Suite 270, Columbia, SC, 29203, USA

    Heather Stewart

  2. Departments of Internal Medicine and Pediatrics, Mount Sinai Medical Center, 17 East 102 St, Seventh Floor, New York, NY, 10029, USA

    Eva Waite

  3. 17 East 102 Street, Box 1087, New York, NY, 10029, USA

    Heather Stewart

Authors
  1. Heather Stewart
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  2. Eva Waite
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Corresponding author

Correspondence to Heather Stewart .

Editor information

Editors and Affiliations

  1. School of Medicine, Hofstra North Shore-LIJ School of Medicine, LAKE SUCCESS, New York, USA

    Mariecel Pilapil

  2. Mount Sinai School of Medicine , NEW YORK, New York, USA

    David E. DeLaet

  3. University of California Los Angeles , SANTA MONICA, California, USA

    Alice A. Kuo

  4. Baylor Clinic , HOUSTON, Texas, USA

    Cynthia Peacock

  5. Brigham and Women's Hospital , BOSTON, Massachusetts, USA

    Niraj Sharma

Appendix

Appendix

Solid organ transplant fact sheet

Definition

The replacement of a nonfunctioning solid organ such as kidney, liver, or heart with an organ obtained by donation from another individual. It can be either cadaveric or living donor. The individual must remain on immunosuppressant regimen in order to avoid rejecting the organ

Epidemiology

The number of pediatric patients living with a kidney transplant has more than doubled since 1988 with 5485 children transplanted in 2012. The first-year deceased- and living-donor transplant outcomes have steadily improved over the last 20 years

Pathophysiology

The type of solid organ, and whether it is a first or second transplant, often predicates the intensity of the immunosuppressant regimen used

The immunosuppressants are from several classes:

∙ Calcineurin inhibitors (tacrolimus, cyclosporine)

∙ Mtor inhibitors (sirolimus, everolimus)

∙ Steroids (prednisone)

∙ Anti-metabolite (mycophenlic acid, mycophenolate and azathioprine)

∙ Costimualtory blocker (Belatacept)—kidney transplantation only

Sequelae of original disease

Poor growth

Metabolic bone disease

Association with syndromes affecting other organ systems:

∙ Alagille syndrome

∙ Alport syndrome

May have some degree of developmental delay associated with underlying disease or complicated treatment course

Recurrence of original disease (systemic lupus erythematosus)

Sequelae of immunosuppressant regimen

Infection

Increase risk of metabolic disorders:

∙ Diabetes

∙ Hyperlipidemia

∙ Gout

∙ Osteoporosis

Hypertension

Increased risk for cardiovascular disease

Increased risk for kidney dysfunction

Increased risk for cytopenias

Increased for malignancies:

∙ Dermatologic

∙ Aerodigestive

∙ Vulvar

∙ Post-transplant lymphoproliferative disorder

Medication interaction

Must always adjust for decreased function of the transplanted organ

Always evaluate interaction with immunosuppressant regimen

Challenges in transition

Some centers have reported increased risk of graft rejection and loss when transitioning from pediatric to adult providers

Adult providers are less familiar with some of the underlying pediatric syndromes

Helpful Resources

CDC contraception 2010 application (app) download for smartphones

  1. CDC Centers for Disease Control

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Stewart, H., Waite, E. (2016). Solid Organ Transplantation. In: Pilapil, M., DeLaet, D., Kuo, A., Peacock, C., Sharma, N. (eds) Care of Adults with Chronic Childhood Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-43827-6_17

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  • DOI: https://doi.org/10.1007/978-3-319-43827-6_17

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  • Online ISBN: 978-3-319-43827-6

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