Posttransplantation

Posttransplantation refers to the period following organ transplantation, with goals including restoration of organ function, prevention of rejection, and minimization of complications. The process begins with the immediate postoperative hospital stay and continues with long-term outpatient care and surveillance.

Immunosuppression is a central feature of posttransplant care. Induction therapy may be given at the time of transplant to reduce early rejection risk. Maintenance regimens typically combine a calcineurin inhibitor (such as tacrolimus or cyclosporine), an antiproliferative agent (such as mycophenolate mofetil), and sometimes corticosteroids. Some regimens use mTOR inhibitors or other agents. Doses are adjusted based on drug levels, organ function, and adverse effects, with the goal of preventing rejection while limiting toxicity.

Monitoring and follow-up rely on regular laboratory testing, imaging when indicated, and, for many organs, periodic biopsies to assess for rejection. Graft function tests are organ-specific (for example, creatinine for kidney, bilirubin and enzymes for liver, echocardiography for heart, and pulmonary function for lung). Infection prophylaxis is common in the early period and may continue long-term, given ongoing immunosuppression. Vaccinations appropriate for immunocompromised patients are considered, and live vaccines are typically avoided.

Common posttransplant complications include acute or chronic rejection, infections, drug toxicity (notably nephrotoxicity from calcineurin inhibitors), and an increased risk of malignancies such as posttransplant lymphoproliferative disorder. Long-term care emphasizes adherence to medication, management of cardiovascular and metabolic risk factors, cancer screening, and psychosocial support.

Outcomes after transplantation have improved substantially, but success depends on close multidisciplinary care, adherence, and timely management of complications.