Organ transplant recipient in primary health care – Related resources

Cochrane reviews

Antiviral therapy for recurrent liver graft infection with hepatitis C virus might possibly be of no clinical benefit, but there is insufficient evidence from adequate trials .
• Pre-emptive treatment with antiviral agents for solid organ transplant recipients reduces the risk of cytomegalovirus disease when compared to placebo or standard care. The outcomes are similar to routine prophylactic antiviral therapy. There is insufficient evidence of the efficacy of pre-emptive therapy compared with prophylaxis to prevent CMV disease .
• Prophylaxis with immunoglobulin G (IgG), anti CMV vaccine or interferon appear not to significantly reduce CMV disease and CMV-associated mortality in solid organ transplant recipients .
• Fish oil appears not to improve clinical outcomes in kidney transplant recipients . Tacrolimus is superior to cyclosporin in improving graft survival and preventing acute rejection after kidney transplantation, but increases post-transplant diabetes and neurological and gastrointestinal side effects . "?>
• Interleukin 2 receptor antagonists for prophylaxis against acute rejection in kidney transplant recipients are as effective as other antibody therapies and with significantly fewer side effects, but there is no definite improvement in graft or patient survival .
• Calcium channel blockers given in the peri-operative period appear to reduce the incidence of acute tubular necrosis in kidney transplant recipients .
• Treatment with a bisphosphonate, vitamin D sterol or calcitonin after kidney transplantation may protect against immunosuppression-induced reductions in bone mineral density and prevent fracture .

Other evidence summaries

• Transplantation may result in improvement of the quality of life in the majority of patients . Simultaneous pancreas-kidney transplantation may improve survival in patients with type-1 diabetes and end-stage renal failure .
• Steroid withdrawal in renal transplant patients on triple therapy with a calcineurin inhibitor and mycophenolate mofetil results a low but significant risk of acute rejection, but may not increase the risk of early graft failure .