Kidney Transplant Flashcards
most common transplant
- kidney
- in US, Europe, and Asia
Kidney transplant vs HD
- kidney transplant more cost effective
- 40-60% decrease in death rate vs remaining on HD
graft survival rate after 3 years
- cadaveric - 88%
- living donor - 93%
paired donor
- have a living donor that is not the same blood type as you, they can donate to another person and then another person will donate to you
- kind of like a trade
average waiting time for kidney
4-5 years
ESRD etiology
- diabetes (30-40%)
- glomerulonephritis
- polycystic kidney disease
- hypertensive kidney disease
- chronic pyelonephritis
- obstructive uropathy
- SLE
- alport’s syndrome
alport’s syndrome
- disease that damages the tiny blood vessels in your kidneys
- lead to kidney damage and kidney failure
pathophysiology of ESRD
- reduction of GFR and UOP
- decreased GFR < 30 mL/min
- build up of nitrogenous waste
- retain fluid and lytes
- UOP < 400 mL/day
- multi-system dysfunction
- CV disease major cause of death
multisystem effects of ESRD
- CHF
- pleural effusion
- anemic
- vitamin D absorption and calcium absorption decreased so fragile bones
- CV disease
organ matching and allocation
- ABO compatibility –> all organ transplants
- HLA profile
- patient specific crossmatch
preop evaluation prior to transplant
- EKG (100P)
- also stress echo and/or cardiac cath
- preop beta block (helpful for cardiac protection)
- autonomic neuropathy (gastric reflux, considered full stomach)
- CBC, lytes, coags (plts do not function properly)
dialysis
- how much removed
- are thy dry?
- know dry and pre-dialysis weight
- volume and lyte correction may be necessary
other preop prep
- may need immunosuppression prior
- antibiotic protocol
anesthetic management for kidney
- standard monitors
- art/CVP based on patient comorbidities
- need good, large bore IVs
- GETA –> RSI
- balanced technique –> narcotic/volatiles + TIVA
fluids for kidney tx
- plasma lyte preferred or NS
- CVP goal 10-15 mmHg
- SBP >90 mmHg; mean >60 mmHg
volatile inhalation agents kidney tx
any are fine
sevo = compound A but generally fine
muscle relaxant kidney tx
- succ or roc for intubation
- if using succ, then check a potassium
- cisatricurium for maintenance
where is kidney implanted
R iliac fossa, anatomically better
clamp time kidney tx
no longer than 15-30 minutes
monitoring with reperfusion
- anitcipate hypotension
- build up of metabolites
- fluids, turn gas down, pressors
- pressors to use –> dobutamine, dopa, ephedrine
- pressors to NOT use –> def not neo
monitor UOP
- obstruction/irrigation
- US diagnosis - thrombosis in anastomosis
- pharmacologic therapy
- 1st 100 cc of UOP might be flushing kidneys talk to surgeon
- no urine - may be obstructed like ureter or blood clot; rejection can also cause no UOP
- promote UOP with fluids, lasix, mannitol
lasix and mannitol use in kidney tx
- promote diuresis
- mannitol scavenges ROS
rejection in kidney tx
-hyperacute biopsy for dx
how long does heparin need to circulate
3 minutes
post op renal transplant management
- analgesia - narcs, PCA
- combination of blocks (intercostal, TAP block)
