Long-Term Medical Management for Patients with Kidney Transplants

idney transplantation improves the quality of life in nearly all patients who undergo the procedure, freeing them from the constraints of maintenance renal replacement therapy. The surgery liberalizes patients’ fluid intake, allows them to consume a normal diet, and often reestablishes sexual function in both sexes. Moreover, it can restore fertility in women. In elderly patients and those with diabetes mellitus, recent evidence suggests that not only is quality of life improved after kidney transplantation, but length of life is also prolonged. 1 With modern immunosuppression techniques, most patients can anticipate many years without a need for dialysis once they receive a kidney transplant as treatment for their renal disease. The care of patients who have undergone kidney transplantation generally comprises 2 distinct time periods. During the immediate posttransplantation period, the patient is often seen multiple times every week and may have blood drawn even more frequently. It is a period of very intensive care that requires a fulltime staff of dedicated nurses and physicians trained in transplantation medicine. Depending on the number of posttransplantation complications, this period usually lasts from 6 months to 1 year. This article will largely deal with the second time period, or the time from when acute posttransplantation issues are resolved onward. During this period, the general internist has an active role, in conjunction with the transplantation nephrologist, in the comanagement of patients with kidney transplants.