Long-term management after liver transplantation: Primary care physician versus hepatologist

Abstract

As long-term survival after liver transplantation increases, metabolic complications are becoming increasingly prevalent. Given concerns about which group of providers should be managing liver recipients and how well metabolic complications are managed, we administered a postal survey to 280 transplant hepatologists to determine attitudes, perceptions, and practice patterns in the management of metabolic complications after transplantation. The response rate was 68.2%. There was great variation in patterns of practice across the United States with respect to the number of posttransplant clinics, clinic format, and number of recipients cared for per week. Hepatologists, primary care physicians (PCPs), and surgeons were primarily responsible for the overall care of liver recipients 1 year or more after liver transplantation according to 66%, 24%, and 8% of respondents, respectively. Hepatologists felt that metabolic complications were common, but few strongly agreed that hypertension (33.3%), chronic renal insufficiency (3.8%), diabetes mellitus (8.8%), dyslipidemia (11.1%), and bone disease (12.8%) were well controlled. The majority of hepatologists indicated that ideally PCPs should be managing recipients' hypertension, diabetes mellitus, dyslipidemia, and bone disease (78.8%, 63.1%, 78.3%, and 72.5%), but they felt that in actuality, PCPs were managing these conditions less frequently (45.4%, 51.4%, 44.6%, and 38%). In conclusion, metabolic complications are perceived to be common but not well controlled post-transplant, and most hepatologists feel that PCPs should take a more active role in the management of these complications. Future studies are needed to identify barriers to care in the treatment of metabolic complications post-transplant with the goal of improving long-term morbidity and mortality. Liver See Editorial on Page 1162Approximately 6000 liver transplants are performed each year in the United States. Since the era of liver transplantation began in 1963, survival after liver transplantation has significantly improved, with overall 1-and 5-year patient survival rates of 86.9% and 73.6%, respectively.1 As long-term survival increases, cardiovascular complications are emerging as major causes of morbidity and mortality. The negative impact of cardiovascular disease on liver transplant recipients has only recently been addressed; recent data indicate that accelerated cardiovascular disease is second only to malignancy as a cause of late mortality in liver transplant patients. 2As more transplant recipients survive into their first and second decades post-transplant, it is likely that more will develop metabolic complications such as hypertension (HTN), chronic renal insufficiency (CRI), diabetes mellitus (DM), dyslipidemia (LIPIDS), obesity,

Uptake of Cancer Screening Tests Among Recipients of Solid Organ Transplantation

“…The rates of being up-to-date for SOTR varied with time since transplantation; however, at no point were the rates in this group as high as that reported in the general population of Ontario during this time period (40). Chan (45,46). patients with obesity and diabetes) (41), the screening uptake in SOTR is lower than that observed in these populations (42)(43)(44).…”

“…Although there is evidence that cancer screening rates are reduced in patients with other chronic diseases (e.g. However, the survey also reported that the majority of hepatologists felt that the involvement of PCP occurred infrequently and only 35.8% were satisfied with the PCPs' level of involvement (45). Chan (45,46).…”

A Survey of Hepatitis C Treatment Clinical Practice Patterns Using the Newly Approved Protease Inhibitors

“…Questions were adapted from earlier validated surveys when available. 10, 12, 13 After initial development, the survey was pretested among seven physicians with hepatology expertise and experience with HCV treatment, with each provider completing a cognitive interview about the survey.…”

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

“…[3][4][5][6] Many centers defer the management of metabolic syndrome and medical complications to primary care physicians. 7 Table 1 summarizes the most common metabolic complications after OLT, and these complications are discussed in greater detail later in this article.…”