1.5 Liver/Kidney Transplant and Immunosuppression

Question 1

Risks of Solid Organ Transplant

Answer 1

• Acute/Chronic Rejection
• Development of malignancies secondary to immunosuppression
• Life threatening infections
• Recurrent organ failure
• Death

STANDARD FOR ENDSTAGE DISEASE IS ORGAN TRANSPLANT

Question 2

Immunosuppression and Allogenic Graft Transplantation

Answer 2

Allogenic Graft Transplant - Transplant from someone else (related or unrelated who is not an identical twin)
Autologous - Stem cells come from one’s own body

• Main goal is to prevent the body from rejection the foreign invader orgran
• Best way to do this is to look for the best match of human leukocyte antigens (HLA)
• Identical donors are usually the best match
• THE MOST IMPORTANT FACTOR THAT PREDICTS DEGREE OF HOST IMMUNE RESPONSE IS HOW SIMILAR THE 2 PEOPLE ARE GENETICALLY (GENETIC DISPARITY)

Question 3

Nursing Care

Answer 3

• Educating patient on their medication and need to remain compliant
• Infection, medication side effect, complications (organ toxicity) management. (Common side effect is bone marrow suppression)
• GOAL of medication is to provide minimal effective dose to reduce risk of organ toxicity and other complications.

IMMUNOSUPPRESSANT RISKS
- Effects all major organ systems (renal, hepatic, cardiovascular, hematologic, metabolic, neurologic) so patients are at increased risk of developing new or dysfunction or exacerbations of old dysfunctions.

Question 4

Complications of Immunosuppressive Therapy

Answer 4

• MOST COMMON COMPLICATION IS INCREASED RISK OF INFECTION AND NEW MALIGNANCIES
• Both caused by weakened immune system
• Best way to deal with infection is prevention, early diagnosis, and AGGRESSIVE management.
  (Most infections caused by immunosuppressive medications are opportunistic infections)
• Malignancies is a major complication of transplantation
• Immunosuppression causes malignancies due to direct oncogenic effects (tumor creating).
• Dosage of medications directly influences rate of oncogenesis

Question 5

Solid Organ Transplant Graft vs Host Disease (SOT-GVHD)

Answer 5

Antibody Mediated

• Most common type.
• Donor with blood type O attack recipients blood with A,B,AB blood
• Leads to mild transient hemolytic anemia

Cellular

• More severe (less common)
• Rare complication following an organ transplant
• Diagnosed via Biopsy

Question 6

SOT-GVHD

Answer 6

Prognosis is poor for patients with SOT-GVHD
- Death caused by infection from marrow suppression and multiorgan failure

• Liver transplants mortality (75%)
• Kidney transplant mortality (30%)

TREATMENT

• High dose corticosteroids
• Antibiotics, antifungals, antivirals prophylactically for potential sepsis
• TREATMENT MUST BE QUICK AND AGGRESSIVE

Question 7

SOT-GVHD Manifestations

Answer 7

• Fever
• Diarrhea
• Rash
• Pancytopenia (deficiency of all blood cell types)
• Multilineage Cytopenia (deficiency of a few cell types)
• S/S are usually subtle and are often confused with early infection.