Immune (Transplants) Flashcards
What is a Autologous transplant:
from themselves (stem cells transplants)
4 types of transplants
Autograft: take from one part of body and put it on another (skin, hair, bone)
Allograft: Between members of same species (most common, human-human, kidney, heart, lung, liver)
Isograft: Between identical twins
Xenograft: monkey, pig, cow transplant
What two organs can be partially transplanted
Liver
Lung lobes
Highest demand for _______, ________, _________.
kidneys, hearts, livers
When can a deceased donor donate organs
Usually from brain death. Must have sufficient CV function to perfuse organs
NURSE’S ROLE IN DETERMINING ELIGIBILITY FOR DONATION
follow institution policy to determine if a candidate
contact the local organ donation organization (LifeNet Health)
WE DO NOT TALK TO THE FAMILY ABOUT TOPIC OF ORGAN DONATION
WHAT TESTS ARE DONE TO DETERMINE ELIGIBILITY TO RECEIVE AN ORGAN
HLA: human leukocyte antigen (Helps the immune system distinguish between the body’s own cells and foreign substances)
Antibody panels
ABO compatibility
Assessment for comorbidities
What happens after someone receives a transplant organ
critical care immediately post-op
Must have immunosuppressive drug levels checked to ensure that immunosuppression is therapeutic
Possible organ biopsies after hospitalization (to ensure immune system isn’t breaking it down)
Immunosuppressants start on high dosages that are reduced over time
T/F: You need to be put on immunosuppressants if you receive a autograft
False. Immunosuppression not needed if receiving an autograft
What is the immunosuppressant drug regiment people are put on for solid organs
Triple therapy
Name a Calcineurin Inhibitor commonly used in Triple therapy
Tacrolimus : Inhibit communication with the Tcells to other parts of the immune system
Name a Cytotoxic drug commonly used in Triple therapy
Mycophenolate mofetil: Keeps your T and B cells from replicating
What are the three drugs used in Triple therapy
Calcineurin Inhibitors
Corticosteroids
Cytotoxic drugs
What drug do you expect a transplant patient to be on the rest of their lives?
Corticosteroids
What Sx should you report for a transplant pt
Signs of infection: fever, malaise, flu-like symptoms
Check inflammation: ESR, CRP
Manifestations of rejection: Pain at the site, flu-like symptoms
T/F: A patient on immunosuppressants will have a high or low WBC count?
low WBC
What is hyperacute rejection
Occurs within 24 hours of transplantation
Individual had pre-existing antibodies against the organ
Transplanted organ must be removed
What is acute rejection
Occurs within first 6 months
Can normally be curbed with increase in immunosuppression
Common to have at least 1 bout with rejection
What is chronic rejection
Occurs over months or years with repeated acute rejection episodes
Irreversible
Supportive therapy: may or may not receive another organ
What is GVHD
ORGAN TRANSPLANT COMPLICATION-GRAFT VERSUS HOST DISEASE
occurs within a month of transplantation
T cells from the donated organ or tissue infiltrate the system of the recipient and start to attack the host’s body
Can lead to SKIN OR LIVER disease which can become fatal
Most effectively treated with IMMUNOSUPRESSION
What is the Bruce Tucker case
First ever successful heart transplant. Took heart from black man and never spoke to family about it.
What is the Uniform Anatomical Gift Act-1968
Allowed individuals to gift their organs
What is Uniform Determination of Death Act-1980
Provided a definition of brain death
What is National Organ Transplant Act-1984
Created more regulation and the organ procurement networks (tried to make more equitable)
What is the Cole Hartman Case
Child drowned in washing machine, anesthesiologist tried to make child brain dead so they could donate their organs.
T/F: The ability to pay for transplant and needed services can affect eligibility
True. Socioeconomic status is considered when deciding who gets an organ
What do you need to do to a kidney recipient before they can receive a kidney transplant
If recipient is on dialysis, will be dialyzed very close to procedure to correct electrolyte and fluid balance
Nursing considerations for kidney transplant patients
Should see diuresis in the first few hours
Frequent labs
Monitor for clots in the catheter
start triple therapy
I/O recording
The nurse should report the following sx to the provider for a kidney transplant patient
Pain at transplant site (back below ribcage), decreased urine output, flu-like sx, UTI sx
T/F: You only donate one lung at a time to a recipient because you only need one lung
False. You can donate a part of a lung, and entire lung, or two lungs depending on what the recipient needs
Nursing considerations for lung transplant patients
Will be on the ventilator post-op (frequent ABGs done)
on triple therapy
High risk for lung infections due to presence of endotracheal tube (ETT) and immunosuppression
The nurse should report the following sx to the provider for a lung transplant patient
Dyspnea
Cough
O2 desaturation
flu-like sx
Three Major Types of STEM CELL TRANSPLANTs:
Allogenic
Syngeneic
Autologous
Allogenic
stem cells Get from another individual
Autologous
stem cells Get from themselves
Syngeneic
What are the most common diseases in which you would extract stem cells?
Used primarily for those with blood-borne cancers such as leukemia, multiple myeloma
What drug is given to increase number of hematopoietic stem cells
G-CSF
What is apheresis
Stem cell harvesting via spinning blood and picking out stem cells, and freezing them. Need certain amount of stem cells, may take longer from some than others.
Why use high-dose chemotherapy for blood cancer?
Kill all bone marrow creating cancerous blood, then transplant stem cells back in
only works for 3-5, sometimes 10 years. Will likely need another transplant.
What should you monitor for a patient currently undergoing high dose chemotherapy for leukemia?
Become pancytopenic
CBC: low blood count, low iron, low platelets
become anemic, high risk for infection, high risk for bleeding
As soon as pt has a fever, you infuse antibiotics
Chemistry panel
Get blood products as needed.
What should you monitor for a patient who received a donor stem cell transplant
GRAFT VERSUS HOST DISEASE (GVHD): More likely with stem cell transplant because the stem cells can create T and B cells that will attack the individual
There is a ___ hour window for heart transplantation to take place after it has been removed from the donor
4
s/s of heart transplant rejection
JVD, SOB, Edema, cardiac dysrhythmias, flu-like sx
T/F: Many deceased donor livers are split in two and given to two different recipients
true
What labs do you monitor LIVER TRANSPLANT POST-OP
Monitor LFTs (elevated can mean rejection)
bleeding times (PTT, INR)
CBC (anemia)
Sx: jaundice, ascites, indc of liver failure
Triple therapy
If have Hepatitis they’ll be treated with antiviral post-op
