What are the common complications following kidney transplantation that I should be aware of in primary care?

Following kidney transplantation, primary care clinicians should be vigilant for several common complications that can impact patient outcomes and require timely recognition and management. Infections are a major concern due to immunosuppression, with patients at increased risk of opportunistic infections and reactivation of latent infections. Acute and chronic rejection of the transplanted kidney can occur, often presenting with deteriorating renal function, which necessitates prompt specialist referral. Cardiovascular disease remains a leading cause of morbidity and mortality post-transplant, driven by traditional risk factors and transplant-specific factors such as immunosuppressive therapy. Metabolic complications including hypertension, diabetes mellitus (new-onset or pre-existing), and dyslipidaemia are common and require active management in primary care. MalignanciesMedication-related adverse effects such as nephrotoxicity from calcineurin inhibitors, bone disease, and gastrointestinal symptoms should be monitored. Additionally, psychological issues including anxiety, depression, and adherence challenges are important considerations for holistic care. Primary care should also support lifestyle modifications and coordinate with transplant teams for ongoing monitoring and management adjustments.

Overall, primary care plays a crucial role in early detection of complications, managing comorbidities, supporting medication adherence, and providing psychosocial support to kidney transplant recipients to optimise long-term outcomes NICE NG107 Voora & Adey 2019 Jethwani 2023.