Ch 31: Solid Organ Transplant Flashcards
Administration of corticosteroids results in what metabolic consequences?
Hyperglycemia, increased protein catabolism, decreased levels of vit D/phosphorous and increased urinary loss of Ca
Which immunosuppressant medications inhibit pancreatic islet cell function and insulin secretion and cause insulin resistanc?
Cyclosporine and tacrolimus; sirolimus also has these effects, though to a lesser degree
In which type of transplant is PN usually required after surgery?
Small bowel
If EN is required post transplant, what type of formula if appropriate?
Polymeric, high nitrogen formula; can consider fiber containing formula
Which foods inhibit the cytochrome P450 3A4 pathway and can result in elevated concentrations of cyclosporine, tacrolimus, and sirolimus?
Grapefruit, pomegranate, seville oranges, and star fruit
What has become standard management for posttransplant hypercholesterolemia in patients who do not respond to lifestyle modifications?
Statins; lipid alterations are reduced when tacrolimus is used as primary immunosuppressant
What is the most common abnormality metabolism that occurs during early posttransplant period?
Hyperglycemia caused by physiologic stress, infection, and medications
Effect of postop hyperglycemia on outcomes in organ transplant recipients has not been conclusively determined; though ASPEN guidelines for optimal control of blood glucose seems to be appropriate (140-180 mg/dL )
Immunosuppressant medications may result in which electrolyte abnormality?
Hyperkalemia
What are protein needs in the acute posttransplant phase vs the chronic posttransplant phase
1.5-2.0 g/kg of estimated dry weight in acute phase; 1 g/kg/day in chronic phase
Obese transplant recipients tend to have more what than non-obese recipients?
Wound complications and long term graft failure
An underweight transplant patient has increased risk of what?
Long term mortality
Quick weight loss in patients needing to lose weight can exacerbate what and increase transplant risk?
Sarcopenia; goal is for patient to maintain optimal muscle stores during weight loss
Early post op feeding in which type of transplant patients reduces infection rates when compared w/ no post op nutrition support or PN?
Liver transplant; benefit seen in decreased and living donor transplants
Most acute rejections occur within what time frame?
3 months after transplant; for this reason, lab markers and physical signs of rejection are monitored closely
Nutrition support for solid-organ transplant patients receiving cyclosporine may need to be modified due to the presence of what?
Hyperkalemia
