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17 Gender-Afrming Care oftheAdult Solid Organ Transplant Recipient
483© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2025
C. J. Wong (ed.), Primary Care of the Solid Organ Transplant Recipient,
https://doi.org/10.1007/978-3-031-98076-3
A
Abortion care for solid organ transplant
recipients, 389, 390
Abscesses, 241–243
Absolute incidence of cancers, 299
Academy of Consultation Liaison Psychiatry
(ACLP), 360, 420
Acamprosate, 373
Actinic keratosis (AK), 282
Active/uncontrolled infections, 15
Acute cellular rejection (ACR), 117, 144
Acute diarrhea, 280
Acute rejection, 73, 100
Adjustment-related symptoms, 458
Adolescent and young adult (AYA) SOT
recipients, 440
Adult liver transplant recipient,
primary care of
anatomy, 112, 113
caval reconstruction, variations in, 114
clinical diagnosis, liver transplants by, 112
early post-transplant period–rst 12
months, 114
allograft rejection, 117, 118
biliary complications, 117
graft dysfunction, 115, 116
infection, 115
typical immunosuppressive course, 115
vascular complications, 116
late post-transplant period–after 12 months
chronic liver disease, recurrence of,
120, 121
chronic rejection, 120
late surgical complications, 122
liver test abnormalities, evaluation of,
119, 120
survival and cause of death, 118
typical immunosuppressive course, 118
preventive care for, 122–124
cancer screening, 124, 125
fertility, pregnancy, and breast-feeding,
125, 126
immunizations, 124
immunosuppression management,
122, 124
systemic disease and overall health
chronic kidney disease, 128
Covid-19 and, 129
diabetes mellitus, 126, 127
dyslipidemia, 127, 128
infectious disease, 128
mental health, 128
obesity and nutrition, 126
pain management, 129
systemic hypertension, 127
Adult solid organ transplant recipient
anti-rejection medication therapy in, 29
anti-rejection medications, classes
of, 31–35
COVID-19 drug-related
concerns, 38, 50
drug interactions, 38–49
drug-related complications, 37
immunosuppressant course, 30
monitoring, 36, 37
pregnancy and breast-feeding, 50, 51
Index
484
Adult solid organ transplant recipient (cont.)
primary care provider, pearls for, 51
preventive health in
adherence to cancer screening,
403, 404
anal cancer screening, 402
behavioral health, 420, 421
cancer screening, 397, 398, 401, 403
cardiovascular disease and diabetes,
risk of, 404, 405
cervical cancer screening, 399, 400
checklist for, 423
colorectal cancer screening, 403
disease prevention, strategies for, 417
immunizations, 411, 413–415
liver cancer screening, 402
metabolic bone disease, 406–411
PTLD screening, 403
safe living practices, 416–420
skin cancer screening, 398, 399
substance use, 421, 422
vaccine recommendations for, 412–413
Advance care planning (ACP), 449
advance directive, 449, 450
challenges, 452
conversations, 453
goals of care, 451
pre-transplant illness, 450
primary care assessment, 452
resources for, 453, 454
Advance directive (AD), 449, 450
Adverse effects, 470, 471, 473–476
Airway complications, 180, 181
Airway dehiscence, 180
Alcohol, 18
Alcohol-related liver disease, 121
Alcohol Use Disorders Identication Test
(AUDIT), 421
Alcohol use trajectories, 362
Allograft dysfunction, kidney transplant
recipients, 71, 72
acute rejection, 73, 74
chronic allograft nephropathy, 74
surgical complications, 72
Allograft injury, 178
Allograft rejection, 117, 118
Allopurinol, 346
Alopecia, 476
American Association for the Study of Liver
Disease (AASLD), 402
Amlodipine,
333
Anakinra, 345
Anal cancer screening, 402
Anal intraepithelial neoplasia (AIN), 315
Anastomoses, 58, 137–138
Anemia, 268
Angiotensin receptor blockers
(ARBs), 80, 333
Angiotensin-converting enzyme-inhibitors
(ACE-i), 80, 333, 342
Anterior myocardial infarction, 164
Antibiotics, 292
Antibody-mediated rejection, 144
Anti-hypertensive therapy, 333
Antimetabolite agents, 140, 303
Anti-rejection medication therapy
adult solid organ transplant recipient, 29
anti-rejection medications, classes
of, 31–35
COVID-19 drug-related
concerns, 38, 50
drug interactions, 38–49
drug-related complications, 37
immunosuppressant course, 30
monitoring, 36, 37
pregnancy and breast-feeding, 50, 51
primary care provider, pearls for, 51
management of psychiatric side
effects, 370
Antiresorptive therapy, 348
Anxiety, 268, 458
Anxiety, pharmacologic management of, 372
Arrhythmias, 153, 154
Aspergillus, 238
Aspergillus fumigatus, 261
Aspirin, 90, 157, 334
Assisted reproductive technology (ART), 392
Astrovirus, 223–224
Asymptomatic bacteriuria (ASB), 230
Atrial bradyarrhythmias, 154
Atrial brillation, 153
Autoimmune liver disease, 121
Avascular necrosis (AVN), 291
Azathioprine, 33, 37, 140, 303, 346, 384, 392
Azithromycin, 184
B
Bacterial infections of the CNS, 237
Bacterial pneumonia, 212, 213
Barrier methods, 388
Behavioral health, 420, 421
Belatacept, 65
Benzodiazepines, 456
Beta blockers, 80, 333
Beta-hemolytic streptococci, 241
Bicaval method, 137–138
Biliary complications, 117
Index
485
Biomarkers, graft function surveillance, 149
Bisphosphonate therapy, 407
Bisphosphonates, 349
BK nephropathy, 74, 75
Bone disease, 87
Bone mineral density (BMD), 10–11, 87, 188
Breast cancer, 318, 319
Breastfeeding, 50–51, 126
Bridge-to-transplantation (BTT), 134
Bronchial arteries, 174
Bronchoalveolar lavage (BAL), 179
Budd-Chiari syndrome, 387
Bupropion, 372
C
Calcineurin inhibitor-induced pain syndrome
(CIPS), 291
Calcineurin inhibitors (CNIs), 64, 118, 140,
303, 331, 338, 341, 343, 344,
370, 384
nephrotoxicity, 65
tacrolimus, 176
therapy, 334
Calcitriol, 349
Calcium, 85
Calcium channel blockers, 333
Cancer, 158, 262, 290
types of, 301
incidence, 299, 300
mortality, 300, 301
Cancer and Organ Transplant Clinic
(COTC), 321
Carbapenem-resistant Klebsiella pneumoniae
(CRKP), 231
Cardiac allograft vasculopathy (CAV),
150–152, 330, 331
Cardiac imaging, 146, 149
Cardiac implantable electronic devices
(CIED), 156
Cardiopulmonary screening, 10
Cardiovascular disease (CVD), 78, 79, 157,
404, 405, 478
epidemiology, 330, 331
pathophysiology, 330, 331
prevention and treatment, 332–335
screening, 332
Caval reconstruction, 114
Cellular rejection, 145–146
Cellulitis, 241–243
Center for Disease Control (CDC), 400
Cervical cancer screening, 399, 400
Cervical intraepithelial neoplasia (CIN),
315, 399
Chest imaging, 200
Chronic allograft nephropathy, 74
Chronic (ductopenic) rejection, 120
Chronic kidney disease (CKD), 157, 164
adult liver transplant recipient, primary
care, 128
causes, 340
epidemiology, 340
pathophysiology, 340, 341
prevention and treatment, 342
screening, 341
Chronic Kidney Disease-Metabolic Bone
Disease (CKD-MBD), 85–88
Chronic liver disease, 111, 120, 121
Chronic lung allograft dysfunction (CLAD),
174, 183, 184
Chronic obstructive pulmonary disease
(COPD), 173
Chronic or recurrent infections, 15
Cirrhosis, 111
Clinical transplant dieticians, 438
Clostridioides difcile, 217
diagnosis, 219, 220
epidemiology, 218, 219
treatment, 220, 221
Clostridioides difcile infection (CDI), 275
Colchicine, 345
Colon cancer, 189
Colonization, 15
Colorectal cancer, 317, 318
Colorectal cancer screening, 403
Combined hormonal contraceptive (CHC)
methods, 387
Congenital anomalies of the kidney and
urinary system (CAKUT), 93
Constipation, 456, 457
Continuity care provider, 432, 433
Contraception, 386–389
Coronary angiograms, 149
Coronary artery disease, 135
Corticosteroids, 370, 385, 392
Corynebacterium urealyticum, 76
Cosmesis, solid organ transplantation,
dermatologic issues in, 288
Co-stimulation blockage, 65
Cough,
456
clinical stability, 258
differential diagnosis, 260–262
examination, 260
history, 258–260
non-infectious, 262, 263
testing and treatment, 263–265
Covid-19, 90, 91, 129, 413, 414, 434
Cryptococcus, 238
Index
486
Cryptosporidium, 416
Cyclosporine, 32, 37, 64, 344, 370, 392
Cylex Immuknow™ assay, 143
Cystitis, 230, 233
Cytomegalovirus (CMV), 161, 221, 276,
306, 436
diagnosis, 222
infection prevention, 385, 386
risk factors, 222
treatment, 223
Cytopenias, 162
D
Denervation, 138
De novo coronary atherosclerosis, 153
Dental evaluation, 11
Depot medroxyprogesterone (DMPA), 387
Depression, 128, 371, 458
Developmental outcomes, 439
Diabetes, 81, 82, 159, 404, 405
Diabetes mellitus (DM)
adult liver transplant recipient, primary
care, 126, 127
diagnostic criteria, 337
epidemiology, 335
natural history, 335, 337
pathophysiology, 337, 338
prevention and treatment, 338, 339
screening, 338
type II, 164
Diagnostic and Statistical Manual of Mental
Disorders-5 (DSM-5), 466
Dialysis, 55
Diarrhea, 273, 456, 457
clinical stability, 273
differential diagnosis, 275–279
examination, 275
history, 274, 275
testing and treatment, 280, 281
Diet, heart transplant recipient, 160
Dihydropyridine calcium channel blockers
(CCBs), 333
Dipeptidyl peptidase 4 (DPP4) inhibitors, 339
Diuretics, 333
Donor derived cell-free DNA
(dd-cf- DNA), 146
Donor left atrium, 137
Donor specic antibodies (DSA), 62
Donor transmitted cancer, 306
Donor-derived cell-free DNA
(dd-cfDNA), 70, 178
Donor-derived infections, 234
Donor-derived SARS-CoV-2 infections, 91
Donor-specic antibodies (DSAs), 69, 147
Dosing and therapeutic monitoring,
467, 472–475
Drug interactions, 468, 470, 472–475
Drug-induced diarrhea, 278
Dual-energy X-ray absorptiometry
(DXA), 87, 407
Durable Power of Attorney for Healthcare
(DPOA-HC), 449
Dyslipidemia, 127, 128, 334
Dyspnea, 265, 456
clinical stability, 265
differential diagnosis, 267, 268
examination, 266
history, 266
testing and treatment, 269
E
Early post-transplant diabetes mellitus, 335
Echocardiograms, 149
Edema, 457
Edmonton symptom assessment system
(ESAS), 454
Electrolyte abnormalities, 88, 89
Electronic health records (EHRs), 452
En-bloc pediatric kidneys, 59, 60
En-bloc transplantation, 60
End stage kidney disease (ESKD), 55, 232
Endomyocardial biopsy, 145
Endoscopic retrograde
cholangiopancreatography
(ERCP), 117
End-stage organ failure, 431, 438, 439
End-stage renal disease (ESRD), 455
Enteric pathogen panel PCR (EPP), 217
Epstein-Barr virus (EBV), 306, 403, 436, 437
Erik Erikson’s Stages of psychosocial
development, 365
Escitalopram, 372
Esophagitis, 225–227
Estimated glomerular ltration rate
(eGFR), 478
Estimated post-transplant survival (EPTS), 58
Estradiol therapy, 470
Estrogen, 467
adverse effects and monitoring, 470, 471
dosing and therapeutic monitoring, 467
drug interactions, 468, 470
timing, 471, 472
Everolimus, 35, 331
Excess absolute risk (EAR), 300
Index
487
Exercise, heart transplant recipient, 160
Extended-spectrum beta-lactamase producing
Klebsiella pneumoniae
(ESBL-KP), 231
Ezetimibe, 79
F
Famciclovir, 244
Familial cardiomyopathy, 163
Familiarity, 63
Febuxostat, 346
Fecal microbiota transplant (FMT), 221
Fertility, 125, 126
Finasteride, 472, 473
Fluvastatin, 334
Fracture, 290
Functional status, 10–11
Fungal infections, 196
Fungal pneumonia, 214, 215
G
Gabapentin, 372
Gastroesophageal reux disease (GERD), 182,
183, 263
Gastrointestinal infections, SOT, 216–228
Clostridioides difcile, 217, 219–221
cytomegalovirus, 221–223
diagnostic considerations, 217, 218
esophagitis, 225
non-infectious causes, 224
norovirus, sapovirus and astrovirus,
223, 224
oral lesions, 225, 228
parasites, 224
Gender afrming care
denition, 466
hormonal and surgical treatments, 467
hormone regimens, 468
medications used in, 467
estrogen, 467, 468, 470–472
GnRH agonists, 474–475
progestins, 473
spironolactone and nasteride, 472, 473
testosterone, 475, 476
mental health, 478, 479
risk tools, 477, 478
sex/gender-specic laboratory reference
intervals, 477, 478
surgery, 476, 477
Gender dysphoria, 466
Gender incongruence, 466
Gene expression prole (GEP), 70, 145
General anxiety disorder-7 (GAD-7), 361, 458
Genomics,
70
GLP1 agonists (GLP1a), 82
Gonadotropin-releasing hormone (GnRH)
agonists, 474–475
Gout, 290
clinical presentation and diagnosis,
344, 345
epidemiology, 343
pathophysiology, 344
prevention, 346, 347
screening/surveillance, 344
treatment, 345
Graduating, 2
Graft dysfunction, 115, 116
Graft function, 22
Graft function surveillance, 148
cardiac imaging and biomarkers, 149
kidney transplant recipients, 67
biopsies, 71
clinical evaluation, 69
frequency of monitoring, 68
immune surveillance and allograft
injury biomarkers, 69, 70
timing and donor factors, 148, 149
Graft-versus-host disease (GVHD), 278, 287
Growth failure, 438
Gynecologic cancers, 393
H
Head and neck cancer, 315, 316
Healthcare providers, 467
Health-related quality of life (HRQOL), 438
Heart disease, 268
Heart failure (HF), 133
Heart-kidney transplant recipient, 471
Heart retransplantation, 460
Heart transplant recipient, 407, 460
Heart transplant recipient, primary care of,
133, 134
anatomy, 137
anastomoses, 137, 138
denervation, 138
pericardium, 138, 139
complications
activity and exercise, 160
arrhythmias, 153, 154
cancer, 158
cardiac allograft vasculopathy, 150–152
cardiovascular disease, 157
chronic kidney disease, 157
Index
488
Heart transplant recipient, primary care
of (cont.)
clinical pearls, 155, 156
de novo coronary atherosclerosis, 153
diabetes, 159
diet, 160
hypertension, 158
infectious endocarditis
prophylaxis, 159
pregnancy, 159
prevention and treatment of
infections, 156
valvular disease, 154
graft function surveillance, 148
cardiac imaging and biomarkers, 149
timing and donor factors, 148, 149
patient management, 161–163
pre-transplant course, 135
indications, 135, 136
pre-transplant workup and
treatment, 136
rejection
clinical presentation, 144
evaluation, 144
pathophysiology, 143
rejection surveillance
antibody-mediated rejection, 144,
146, 147
cellular rejection, 145, 146
surgical technique, 134
typical anti-rejection course, 139
induction, 139, 140
long-term dose adjustments, 143
maintenance, 140, 142, 143
vascular anastomosis, development of,
134, 135
Heart transplantation, 134
Hematologic abnormalities, 89, 90
Hepatitis A, 418
Hepatitis B (HBV), 306, 414, 418
Hepatitis C, 306
Hepatobiliary cancer, 316, 317
Hepatocellular carcinoma (HCC), 121
Herpes viruses, 211, 212
High-resolution anoscopy (HRA), 402
HMG CoA reductase inhibitors, 157
Hospital Anxiety and Depression Scale
(HADS), 361
HPV-associated cancer, 314, 315
H2 receptor antagonists (H2RA), 183
Human papillomavirus (HPV), 305, 415
Hyperacute rejection, 73
Hypercholesterolemia, 188
Hyperglycemia, 335
Hyperkalemia,
88
Hyperlipidemia, 79
Hypernatremia, 89
Hypertension (HTN), 79–81, 127, 158, 164,
188, 330, 332
Hyperuricemia, 343
Hypokalemia, 88
Hyponatremia, 89
Hypophosphatemia, 86
I
Idiopathic pulmonary brosis (IPF), 173
Immune checkpoint inhibitors (ICIs), 321
Immunizations, 124, 411, 413–415, 418
Immunosuppression, 50, 125, 301, 303,
434, 437
azathioprine and mycophenolate/
mycophenolic acid, 303
calcineurin inhibitors, 303
induction immune suppression, 304
kidney transplant recipients, 61
alternative immunosuppressive
strategies, 65, 66
assessment of, 67
induction, 61–63
maintenance therapy, components
of, 63–65
mTOR inhibitors, 304
Immunosuppressive medications, 29, 331
Impact of Events Scale-Revised (IES-R), 361
In vitro fertilization (IVF), 392
Inactivated inuenza vaccine (IIV), 434
Induction, 139, 140, 175
Infection, 14–15, 115
lung transplant recipient, 181, 182
solid organ transplantation, dermatologic
issues in, 286
Infections of central nervous system, 235–239
bacterial infections, 237
diagnostic considerations, 236, 237
fungal infections, 236, 238
viral infections, 237, 238
Infectious disease, 128
Infectious endocarditis prophylaxis, 159
Infectious nodular, 244–245
Infectious vesicular eruptions, 243–244
Inammatory arthritis, 291
Inammatory bowel disease (IBD), 279
Inuenza, 264, 413
clinical presentation, 208
diagnosis, 208
Index
489
prevention, 210, 211
treatment, 209, 210
vaccine, 414
Interleukin 1 inhibitors, 345
Interleukin-2 receptor (IL-2R) antagonist, 175
International Society for Heart and Lung
Transplantation (ISHLT), 407
Interstitial brosis and tubular atrophy
(IFTA), 74
Interstitial lung disease, 263, 268
Intra-articular glucocorticoids, 345
Intrauterine device (IUD), 12, 387
Invasive cervical cancer, 315
Invasive monitoring, 151
Ischemic cardiomyopathy, 161, 164
J
Japanese encephalitis (JE), 418
Joint pain
clinical stability, 288
differential diagnosis, 290, 291
history, 289
physical examination, 290
testing, 291
K
Kaposi’s sarcoma, 285, 306, 318
Kidney cancers, 313, 314
Kidney Disease Improving Global Outcomes
(KDIGO) guidelines, 55, 332,
341, 410
Kidney transplant anastomoses, 59
Kidney transplant recipients, 55, 56, 410, 459
allograft dysfunction, 71, 72
acute rejection, 73, 74
chronic allograft nephropathy, 74
surgical complications, 72
anatomy, 58–60
BK nephropathy, 74, 75
cardiovascular disease, 78, 79
CKD-MBD, 85–88
COVID-19, 90, 91
diabetes, 81, 82
electrolyte abnormalities, 88, 89
graft function surveillance, 67
biopsies, 71
clinical evaluation, 69
frequency of monitoring, 68
immune surveillance and allograft
injury biomarkers, 69, 70
hematologic abnormalities, 89, 90
hyperlipidemia, 79
hypertension, 79–81
immunosuppression regimen, 61
alternative immunosuppressive
strategies, 65, 66
assessment of, 67
induction, 61–63
maintenance therapy, components
of, 63–65
pancreas transplant recipients, 94, 95
acute rejection, 100
anatomy, 97
benets of, 96
eligibility criteria and pre-transplant
considerations for, 96, 97
immunosuppression, 97, 99
pancreas allograft dysfunction, clinical
presentation and differential
diagnosis of, 99
pancreas allograft dysfunction,
monitoring and detection of, 99
suspected acute rejection, workup
for, 100
pediatric kidney transplant
recipients, 92, 93
peri-operative management of, 91, 92
post-transplant malignancies, 83–85
pregnancy and sexual health, 93, 94
pre-transplant course, 56
allocation, 58
indication for, 56, 57
treatment, 57
waiting list, 57
primary care, outpatient visits in, 92
urinary tract infection, 76–78
weight gain, 82, 83
L
Latent infection, 15
Late post-transplant diabetes mellitus, 335
Leukopenia, 90
Life expectancy, 451
Life-threatening organ failure, 450
Linezolid, 242
Liver cancer screening, 402
Liver transplant activity, 111
Liver transplant recipients, 407, 460
Lucocorticoids, 345
Lumbar puncture (LP), 236
Lung cancer, 312, 313
Index
490
Lung transplant recipient, primary care of,
173, 174
anatomy, 174, 175
complications, surveillance and monitoring
for, 177, 178
immunosuppression, 175, 176
issues, 184, 185, 187
malignancy, 186, 188–190
post-lung transplant pulmonary
complications
acute rejection, 180
airway complications, 180, 181
CLAD, 183, 184
gastroesophageal reux disease,
182, 183
infections, 181, 182
issues, 178, 179
prevention, 188
renal, cardiovascular, and metabolic
complications post-lung transplant,
187, 188
Lymphatics, 175
Lymphoceles, 72
Lymphomas, 437
M
Malignancy, 158, 268, 279
lung transplant recipient, primary care,
186, 188–190
solid organ transplantation, dermatologic
issues in, 282
Mammalian target of rapamycin inhibitors
(mTORi), 66, 165, 304, 331, 338,
341, 370, 385
Marijuana, 18
Mechanical circulatory support (MCS), 134
Melanoma, 284, 308
Meningococcal vaccine, 414
Menopausal hormone therapy (MHT),
392, 393
Mental health, 478, 479
adult liver transplant recipient, primary
care, 128
anti-rejection medications, management of
psychiatric side effects, 370
anxiety, pharmacologic
management of, 372
coordination and referral, 374, 375
depression, pharmacologic
management of, 371
disorders post-transplant, 359
approach to behavioral management,
368
, 369
impact of affective disorders, 360
psychological approach to behavioral
health assessment, 364–367
prevalence of affective disorders, 359
screening of affective disorders,
360, 361
substance use disorders, prevalence and
impact of, 361–363
management of post-transplant
non- adherence, 369
pre-transplant mental health
pharmacology considerations, 358
prevalence of affective disorders, 356
primary care, 358
psychosocial and mental health
screening, 356, 357
substance use disorders, prevalence and
screening, 357, 358
psychiatric issues in delayed graft function
and in graft rejection, 371
substance use disorders, behavioral and
pharmacologic management of,
373, 374
Merkel cell carcinoma, 286, 306
Metabolic bone disease, 406
history, 406, 407
screening tests and preventive
therapy, 407–411
Metabolic dysfunction-associated
steatohepatitis (MASH), 120
Metabolic dysfunction-associated steatotic
liver disease (MASLD), 330,
342, 343
Methylprednisolone, 34
Microscopic colitis, 279
Mifepristone, 390
Mineralocorticoid antagonists, 80
Mirtazapine, 372
Misoprostol, 390
Molnupiravir, 207
Monitoring, 470, 471, 473–476
Mortality, 301, 304
Mpox, 245, 415
Multidisciplinary cancer centers, 321, 322
Musculoskeletal symptoms, 288
joint pain
clinical stability, 288
differential diagnosis, 290, 291
history, 289
physical examination, 290
Index