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Considerations for a Primary Care Physician Assistant in Treating Kidney Transplant Recipients

Joseph Horzempa

The escalating amount of kidney transplant recipients
(KTRs) represents a significant dilemma for primary care
providers. As the number of physician assistants (PAs) has been
steadily increasing in primary care in the United States, the
utilization of these healthcare professionals presents a solution
for the care of post-kidney transplant recipients. A physician
assistant (PA) is a state licensed healthcare professional who
practices medicine under physician supervision and can
alleviate some of the increasing demands for primary patient
care. Here we provide an outline of the crucial components and
considerations for PAs caring for kidney transplant recipients.
These include renal function and routine screenings, drug
monitoring (both immunosuppressive and therapeutic), preexisting
and co-existing conditions, immunizations, nutrition,
physical activity, infection, cancer, and the patient’s emotional
well-being. PAs should routinely monitor renal function and
blood chemistry of KTRs. Drug monitoring of KTRs is a crucial
responsibility of the PA because of the possible side-effects
and potential drug-drug interactions. Therefore, PAs should
obtain a careful and detailed patient history from KTRs. PAs
should be aware of pre- and co-existing conditions of KTRs
as this impacts treatment decisions. Regarding immunization,
PAs should avoid administering vaccines containing live or
attenuated viruses to KTRs. Because obesity following kidney
transplantation is associated with decreased allograft survival,
PAs should encourage KTRs to maintain a balanced diet with
limited sugar. In addition, KTRs should be urged to gradually
increase their levels of physical activity over subsequent years
following surgery. PAs should be aware that immunosuppressive
medications diminish immune defenses and make KTRs more
susceptible to bacterial, viral, and fungal infections. Moreover,
KTRs should be screened routinely for cancer due to the higher
risk of development from immunosuppressive therapy. PAs
must remain cognizant of the emotional well-being of the KTR,
as many transplant patients struggle with fear, frustration, and
acceptance.