PEDIATRIC SURGERY FOR THE PRIMARY CARE PEDIATRICIAN, PART zyxwvu II 0031-3955/98 $8.00 zy + .OO CARE OF THE PEDIATRIC SOLID ORGAN TRANSPLANT RECIPIENT The Primary Care Perspective Beverly Kosmach, MSN, CRNP, Steven zyx A. Webber, MD, and Jorge Reyes, MD Organ transplantation is an effective and often necessary treatment for children with end-stage liver, kidney, or cardiac disease. Nearly 14,000 pediatric patients have received either a heart, kidney, or liver transplant since 1988 (Table l), with 1-year patient survival rates of 76%, ‘97y0, and 81% (Table zyx 2) and 1-year graft survival of 75%, 85%, and 68%, respectively (Table 3).” Consequently, primary care physicians or pediatricians will likely care for one or more trans- plant recipients in their community practice. Transplant recipients may be followed exclusively by the transplant center for up to 3 months postoperatively. These children and their families reside in the transplant center area for clinic visits to monitor graft function, immunosup- pressive therapy, and any evidence of infection. Beyond the acute stage of transplantation, it is imperative that consistent pediatric care be established for the best outcome. The primary care physician must be able to provide routine pediatric care within the context of transplantation and to assess for potential transplant-related complications. This is accomplished under continued and cooperative supervision by the transplant team for transplant-related issues. This article discusses the fundamentals of medical management in pediatric solid organ transplantation and how supervision by primary care physicians can significantly impact children’s survival. From the Department of Transplant Surgery (BK), Pediatric Heart and Heart-Lung Trans- plantation Division of Cardiology (SAW), Children’s Hospital of Pittsburgh; and Pediatric Transplant Surgery, Thomas E. Starzl Transplantation Institute (BK, JR), Pittsburgh, Pennsylvania PEDIATRIC CLINICS OF NORTH AMERICA VOLUME 45 * NUMBER 6 * DECEMBER 1998 1395