Cohen D, Galbraith C
Columbia Presbyterian Hospital, New York, NY 10032, USA.
Am J Kidney Dis. 2001 Dec;38(6 Suppl 6):S10-24. doi: 10.1053/ajkd.2001.28922.
The steady improvement in short-term success rates in renal transplant patients has translated into better long-term success rates and a large number of patients with long-functioning renal transplants. The necessity for the lifelong administration of immunosuppressive medications to prevent rejection, coupled with the presence in many patients of a variety of other medical problems dating from the period of renal insufficiency prior to the time of renal transplantation, has created a large group of patients with a unique and complex set of long-term medical care needs. Due to the constraints of managed care, considerations of geography, or patient preference, the long-term care of an increasing number of renal transplant recipients has shifted away from the transplant center to the community-based nephrologist or internist. For optimal care to be delivered, it is important that the physicians managing these patients be cognizant of the complex and interacting medical issues involved in their care. Appropriate management can significantly prolong the life of the allograft as well as that of the patient. Guidelines for understanding and managing some of the more important and common general medical problems facing the long-term renal transplant recipient (eg, infectious complications, cardiovascular disease, hypertension, diabetes, hyperlipidemia, malignancy, pregnancy, bone disease, dental care, preventive care) are addressed in this section.
肾移植患者短期成功率的稳步提高已转化为更好的长期成功率，并有大量患者拥有长期功能良好的肾移植。为防止排斥反应而终身服用免疫抑制药物的必要性，再加上许多患者在肾移植前肾功能不全时期就存在各种其他医疗问题，造就了一大群有着独特而复杂的长期医疗护理需求的患者。由于管理式医疗的限制、地理位置因素或患者偏好，越来越多肾移植受者的长期护理已从移植中心转移至社区肾病科医生或内科医生手中。为了提供最佳护理，管理这些患者的医生必须了解其护理中涉及的复杂且相互作用的医疗问题，这一点很重要。适当的管理可显著延长同种异体移植物以及患者的寿命。本节阐述了理解和管理长期肾移植受者面临的一些更重要且常见的一般医疗问题（如感染并发症、心血管疾病、高血压、糖尿病、高脂血症、恶性肿瘤、妊娠、骨病、牙科护理、预防保健）的指南。
