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Medical management of the renal transplant patient: clinic guide and immunosuppression guidelines

Frequent out patient review is required. Patients are usually seen twice a week for the first two months, then weekly for two months then once a fortnight forthe next two months. Handback of clinical supervision to the referring unit takes place by mutual agreement as soon as practically possible.

Supporting information guidelines for prescribing (previously called ‘shared care guidelines’) have been in operation for a number of years. The guidelines are generated by both primary and secondary care health professionals and they are locally agreed between Plymouth Hospitals NHS Trust and the local PCTs.

These guidelines are to support the prescribing of a variety of different medicines both by GPs and hospital doctors in areas of specialist knowledge e.g. transplant immunosuppression / anti-rejection therapy (kidney and liver).

The prescribing documents for tacrolimus (Prograf®) and ciclosporin (Neoral®) have now been updated and approved with brand new guidelines for generated for sirolimus (Rapamune®) and mycophenolate mofetil (CellCept®)(Jan 07). Please note the documents are specific for the indications included within the text (predominantly transplantation). The latter does not include Myfortic which has been approved as a hospital only drug.

In practice, for a number of months until stabilised, a patient will receive prescriptions for these medicines from their hospital specialist (although they are often prescribed on prescriptions that may be taken to the patients local pharmacy / dispensing doctor), however after that period, providing the GP agrees, the patient may then obtain their prescription from their GP surgery.

All transplant supporting information guidelines can be found in the Plymouth Area Joint Formulary website in Chapter 8 – Malignant Disease & Immunosuppression or the link as follows:-

The geographical area 'covered' by the documents are Plymouth PCT, South Hams &West Devon PCT and East Cornwall PCT.

All General Practitioners will be given general guidelines, any other problems please contact the Transplant Nurse Practitioner.

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