Long-term care of liver transplant recipients and who should be responsible?

Abstract

Currently, liver transplantation is the treatment of choice of for end stage liver dis­ease, some metabolic disorders, fulminant hepatic failure, and selected primary and secondary liver tumours. This treatment is broadly available for patients in need in the Czech Republic with overall excellent long-term survival based on specific indication and the recipient’s age. The high-quality life-long fol­low-up necessary for achieving good results is currently provided mostly by transplant centres. With the rising number of liver transplant recipients and, their aging and rising polymorbidity, this praxis is unsustainable. Therefore, close cooperation between transplant centres and primary care physicians, and redefinition of responsibilities during the fol­low-up is needed. Patients with community dis­eases, frequent metabolic complications of immunosuppression (arterial hypertension, metabolic syndrome, coronary heart dis­ease, dyslipidaemia, bone dis­ease, etc.) as well as many acute disorders should be served locally. Preventive measures should be cared of by the primary care physician (family physician or internist) with guidance from transplant professionals. Meanwhile, specific complications related to transplant procedure, immunological complications of liver transplantation, and dis­ease recurrence should remain in the hands of transplant clinicians, but local practitioners should have some insight into the most frequent complications of transplantation treatment. Improvement in communication between transplant centres and local professionals as well as systematic education of patients and primary care clinicians will assist to further improvement and sustainability of post-transplantation care of liver transplant recipients.