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• W2094255616 abstract "Approximately 5000 to 6000 liver transplantation (LT) procedures are performed each year in the United States. Outcomes of LT have dramatically improved over the past 2 decades because of advances in surgical techniques and immunosuppression, appropriate donor and recipient selection, and improved therapies that prevent and treat early postoperative complications. This improvement in post-LT outcomes has led to the emergence of complications associated with patients' longevity, including cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, obesity, and bone disease.1 Cardiovascular disease and de novo malignancies (rather than graft loss) are currently the leading causes of post-LT death.2, 3 The absence of any specific guidelines to address these long-term complications post-LT has created a special role for primary care physicians (PCPs) in the overall long-term care of patients post-LT. LT, liver transplantation; PCP, primary care physician. In this issue of Liver Transplantation, Forman et al.4 present the results of a pilot validated survey that was submitted to transplant hepatologists to determine attitudes, perceptions, and practice patterns in the long-term management of metabolic complications post-LT. The postal survey was sent to 280 transplant hepatologists nationwide with a 68.2% response rate. Respondents to the survey stated that primary responsibility for the overall care of patients beyond 1 year after transplantation predominantly belonged to PCPs (66% of respondents), whereas hepatologists and surgeons were providing this care for only 24% and 8.4% of patients, respectively. Most hepatologists agreed that metabolic complications were common, but less than one-third thought that these complications were adequately controlled. Although the majority of respondents (approximately 75%) felt that those metabolic complications should be managed by PCPs, they felt that PCPs were adequately managing these issues in only 38% to 51% of LT recipients. The authors acknowledge several shortcomings in the present study: the results were based on the perceptions of hepatologists (no hard data were collected) regarding the prevalence of metabolic complications. There was interinstitutional variability in the responses of hepatologists, and the survey lacked any representation of PCPs. This most likely led to a significant bias toward hepatologists. Nevertheless, the data derived from the survey regarding the prevalence of these metabolic complications post-LT do correlate with most of the data published so far. This study brings to light a few important issues faced by most if not all transplant centers nationwide. There is an increasing prevalence of metabolic complications among LT recipients as well as inadequate communication between PCPs and hepatologists, which most likely is affecting how well these complications are controlled. Poorly controlled metabolic complications have significant effects on both graft and patient survival.2, 5, 6 Addressing these issues cannot be achieved by transplant hepatologists alone. During an era of increased clinical demands on transplant hepatologists, increasing numbers of patients awaiting LT, and a national shortage of transplant hepatologists, assuming the overall care of LT recipients will be overwhelming and unlikely the solution to the problem.7 Based on experience in the long-term care of patients with chronic medical diseases, a few lessons can be learned to help improve the long-term care of LT recipients.8 First, transplant hepatologists should spearhead the effort to not only evaluate graft-related complications but also establish guidelines for identification, long-term prevention, and treatment of metabolic complications post-LT. Those guidelines should be established and adopted with the help of general internists and PCPs. This effort should be combined with improved coordination with PCPs. This coordination will be best achieved if hepatologists embrace the efforts of PCPs and timely and continuous communications with PCPs. Within this model, transplant hepatologists will continue to manage immunosuppression medications, allograft dysfunction and rejection, and biliary complications, whereas PCPs will be expected to follow the newly published guidelines to help them manage the long-term metabolic complications (cardiovascular diseases, diabetes mellitus, bone disease, and renal disease) in LT recipients. Even though this study was based on perceptions rather than hard data, it will most likely serve as a basis for future studies that address the real prevalence of metabolic complications post-LT, the adequacy of treatment, and the identification of the barriers to care for the treatment of these metabolic complications." @default.
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• W2094255616 date "2009-09-29" @default.
• W2094255616 modified "2023-09-24" @default.
• W2094255616 title "Should transplant hepatologists serve as primary care physicians?" @default.
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• W2094255616 doi "https://doi.org/10.1002/lt.21837" @default.
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