Canterbury DHB

Context

Discharge and Follow Up

In This Section

Discharge to Other Centres

Autologous Patients

Allogeneic Patients

Shared Protocols and Documentation

Post-Transplant Follow-Up

Re-referral Criteria

Contact Us

Discharge to Other Centres

This refers to the transfer of care to a referring centre and not discharge from the BMTU. Patients may remain under the care of the Transplant Programme while an out-patient prior to discharge.

Discharge criteria will vary according to the local expertise at the referring centre:

  1. Centres with a specialist haematology service and 24/7 cover, including a dedicated in-patient unit and haematologists with experience in post-transplant follow up, e.g. Dunedin Hospital.
  2. Centres providing a part-time haematology service capable of specialist out-patient follow-up, but without a dedicated in-patient unit, e.g Nelson Hospital.
  3. Centres providing a general medical service without any specialist haematology service, e.g. Invercargill, Timaru, Ashburton, Blenheim. Note: These patients may have general physicians with considerable experience and some training in the care of transplant patients.
  4. Centres with family doctor cover and remote from a general hospital, e.g. some rural centres on West Coast and Central Otago.

Exceptions:

These policies may not apply to patients who are being treated with palliative intent or when social circumstances dictate that patient's overall best interests are served by returning to their home/whanau.

Autologous Patients

General considerations for autologous patients before discharge:

Allogeneic Patients

As above for autologous transplant patients, with the additional requirements;

Shared Protocols and Documentation

The receiving centre is to receive a copy of the patient’s transplant protocol and discharge summary.

GVHD follow up must be recorded at approximately 100 days, 6 months and yearly post-transplant. Use the transplant programme forms and fax or email a copy back to the BMT Coordinator; fax (03) 364 1486. Use the Red Book as a source of information and contact patient’s primary haematologist for advice.

Fortnightly transplant committee meetings are an opportunity to discuss follow up care.

Post-Transplant Follow-Up

After discharge from Christchurch Hospital, patients should be followed up initially at weekly intervals for one month (autologous) or until immunosuppressive therapy is stable (allogeneic). The interval can be extended to fortnightly for two months (autologous) or until immunosuppressive therapy is withdrawn (allogeneic).

Vital obs (pulse, BP, oxygen sats, RR, temp) and weight should be measured weekly initially and then at each visit.

Allogeneic transplant patients should be monitored for development of GVHD. Helpful tips can be obtained from the Red Book and Be The Match website.

In the first month after discharge, the patient should have the following laboratory tests measured at least weekly:

Once stable, immunosuppressive drugs (e.g. cyclosporin, tacrolimus) should be measured 2-weekly and more frequently if toxicity is suspected (e.g. cytopenias, abnormal renal function, anaemia, abnormal liver function, peripheral tremor).

CMV and EBV monitoring should be performed as recommended in the Transplant Protocol.

Chimerism testing should be performed as recommended in the Transplant Protocol.

Infection prophylaxis for encapsulated bacteriae, PCP, HSV, VZV, toxoplasma, EBV and CMV should be performed as in the Transplant Protocol. See the Gynaecological Allogeneic Transplant flowchart.

Refer to the Post-Discharge Toolkit (Be The Match) for guidelines on testing requirements at follow-up appointments.

Complete the Transplant Programme forms during the 100 days post transplant assessment, 6 months post-transplant assessment and annually post-transplant. Fax or email a copy of the completed form to the BMT Coordinator; fax (03) 364 1486.

See also Reporting Data to International Registries

Re-referral Criteria

We request that you contact us to notify us of any significant event including the following:

Contact Us

Advice is available to any physician caring for a patient transplanted at Christchurch Hospital. Written advice can be obtained by e-mailing the primary specialist (named on the Transplant Protocol; email address is firstname.surname@cdhb.health.nz) or faxing a referral to 03 364 1067.

For urgent questions in normal working hours, call the hospital switchboard and ask for the primary specialist. Out of hours, the on-call haematologist can be contacted via the hospital switchboard on 03 364 0640.

About this Canterbury DHB document (92275):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 92275