Challenges in the Management of the Post-Transplant Period in Modern Transplantology

Abstract

The post-transplant period is a defining moment in the evolution of contemporary transplantology and is largely responsible for long-term clinical outcomes and patient survival. While great progress in surgical techniques and perioperative management has been made and has led to better early post-transplant success, the success of transplantation is increasingly dependent on comprehensive and sustained management after surgery. The post-transplant period is marked by constant physiological adaptation, long-term immunosuppression, and the requirement for meticulous clinical surveillance, which is a complex and highly individualised period. This narrative review is an attempt to address the major problems that come with managing the post-transplant period in contemporary transplantology without a focus on a specific transplanted organ. The review synthesises the current state of the art that addresses some of the key aspects of post-transplant care, including the optimisation of immunosuppressive regimen, prevention and early identification of infectious complications, management of metabolic and systemic changes, patient adherence and the importance of multidisciplinary follow-up. The dynamic nature of post-transplant care and inherent limitations of the uniform management protocols are emphasised. The literature analysed points to the effect of long-term outcomes being strongly affected by individualised and patient-centred management approaches as opposed to standardised practices only. Immunosuppressive regimens require constant adjustment in order to maintain the balance of immunity yet minimise adverse effects. Infectious complications often have atypical clinical manifestations, underlining the necessity for active monitoring instead of treatment based on symptoms. In addition, metabolic disturbances and psychosocial factors become important contributors to morbidity and decreased quality of life among transplant recipients.