Follow-up of liver transplant recipients

Abstract

The number of surviving liver allograft recipients is increasing almost exponentially. The quality and length of life is increasing but most recipients have reduced survival and quality of life compared with healthy matched individuals. Causes of premature death include cardio and cerebrovascular disease, renal failure, graft failure, de novo malignancy and recurrent disease. Follow-up is needed lifelong to ensure graft and patient health and ensure that complications are recognised and treated early. Immunosuppression is kept to the appropriate minimum and prophylactic interventions are given early, such as use of statins and tight control of blood pressure and blood sugar. Recipients will require life-long follow-up, and this is placing an increasing burden on transplant units. Follow-up is best done by close collaboration between the Liver Transplant Unit, the local hospital and primary care team. Involvement of other health care practitioners, such as recipient coordinators, pharmacists, dermatologists and addiction specialists may improve outcomes. Key to successful follow-up are agreed protocols and good communication between the recipients and all relevant health care providers. Use of IT allows for better communication and will support use of video and telephone consultations in selected instances. The most appropriate follow-up will depend on many factors, including logistic and geographic issues, local experience. The provision of well-funded and supported registries at local, national and international levels will allow for improvements in management.

Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression

“…As the number of liver transplant recipient increases, follow‐up is becoming an increasing burden. Given that chronic follow‐up being typically concentrated at expert centers at a distance from many recipients, the logistic and socio‐economic burden on recipients may be considerable 4 …”

“…1,2 The aims of chronic follow-up are (1) monitoring of at expert centers at a distance from many recipients, the logistic and socio-economic burden on recipients may be considerable. 4 Over the past decade, the increasing availability and utilization of computers and smartphones have drastically changed delivery and communication in health care. 5,6 With its ability to eliminate geographic barriers, telemedicine is a rapidly expanding area of health care delivery.…”

“…Given that chronic follow‐up being typically concentrated at expert centers at a distance from many recipients, the logistic and socio‐economic burden on recipients may be considerable. 4 …”

Patients’ Experiences of Life Challenges After Liver Transplantation: A Qualitative Study

“…This should be done in close collaboration between the liver transplant unit, the primary care team, and the hospital. Involvement of other health care practitioners, such as recipient coordinators, social workers, dermatologists, pharmacists, and addiction specialists, may enhance results (19).Yet, there is limited information about post-LT challenges. The present study was conducted to address this gap.…”

Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review

“…The average cost after the first year was USD 154 thousand per recipient. The cost of re-transplantation was USD 388 thousand per-patient, and the costs in the second year post-LT were USD 28 thousand [1,2]. In a study by Serper and colleagues, nearly one-fifth of the recipients made tradeoffs for the medications post-LT that led to decreased compliance and increased hospital admissions.…”