Long-term management of the renal transplant recipient: optimizing the relationship between the transplant center and the community nephrologist.

Rapid growth in the number of kidney transplant recipients along with improved viability of transplanted organs and increased patient survival have all led to the need for effective long-term management of these patients. The increasing numbers of transplants and the duration of posttransplant medical care can overwhelm the resources of a transplant center. These factors highlight the need for optimizing the relationship between the transplant center and the community nephrologist. There are several factors that affect the timing for transitioning patients from the transplant center to the community nephrologist and no standard timing has yet been established. Continued management of pretransplant comorbid conditions is important as are monitoring for adverse effects of failure of immunosuppressive therapy and the development of posttransplant complications. An array of testing that can be useful in monitoring these patients as well as the suggested frequency for their use are reviewed. Guidelines for the optimal interaction between the transplant center and the community nephrologist are provided to include circumstances concerning adjustment or conversion of immunosuppressive medications, evidence of allograft dysfunction, and the development of malignancy.