Heller J Christie, Prochazka Allan V, Everson Gregory T, Forman Lisa M
Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, CO, USA.
Liver Transpl. 2009 Oct;15(10):1330-5. doi: 10.1002/lt.21786.
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.
随着肝移植术后长期生存率的提高，代谢并发症日益普遍。鉴于对应由哪类医疗服务提供者管理肝移植受者以及代谢并发症的管理效果的担忧，我们对280名移植肝病专家进行了邮寄调查，以确定移植后代谢并发症管理中的态度、认知和实践模式。回复率为68.2%。在美国，移植后诊所数量、诊所形式以及每周护理的受者数量方面，实践模式存在很大差异。分别有66%、24%和8%的受访者表示，肝病专家、初级保健医生（PCP）和外科医生主要负责肝移植术后1年及以上肝移植受者的整体护理。肝病专家认为代谢并发症很常见，但很少有人强烈认同高血压（33.3%）、慢性肾功能不全（3.8%）、糖尿病（8.8%）、血脂异常（11.1%）和骨病（12.8%）得到了良好控制。大多数肝病专家表示，理想情况下PCP应管理受者的高血压、糖尿病、血脂异常和骨病（分别为78.8%、63.1%、78.3%和72.5%），但他们认为实际上PCP对这些疾病的管理频率较低（分别为45.4%、51.4%、44.6%和38%）。总之，代谢并发症被认为很常见，但移植后控制不佳，大多数肝病专家认为PCP应在这些并发症的管理中发挥更积极的作用。需要进一步研究确定移植后代谢并发症治疗中的护理障碍，以改善长期发病率和死亡率。
