[Long-term management of renal transplant recipients]

Transplantation has been demonstrated to improve the quality of life and long-term survival of patients with end-stage renal disease (ESRD) when compared with dialysis. This has resulted in a progressive increase in patients living with a functioning kidney graft as a percentage of the total ESRD population. Renal transplant recipients require complex long-term medical care, which is straining the limited resources of transplant centers. Moreover, due to considerations of geography or individual preference, a large number of patients, once their condition has stabilized, move away from the transplant center to the local nephrology unit. To facilitate and enhance the specialized care of these patients, it is crucial that nephrology units understand and manage the medical problems affecting long-term transplant recipients (e.g., chronic graft dysfunction, toxicity of immunosuppressive therapy, cardiovascular, infectious and neoplastic complications, hematological issues, bone disease, pregnancy and nonadherence to prescriptions). Regular interactive communication between the nephrology unit and the transplant center optimizes the continuity of care. Practice guidelines and the available literature on the subject are revised and critically analyzed in this paper.