KIDNEY TRANSPLANT Flashcards
WHAT POPULATION OF PATIENTS WAS GENERALLY REJECTED FOR TRANSPLANT BUT IS NOW BEING CONSIDERED FOR TRANSPLANT?
TYPE 2 DM. (AS LONG AS NO VASCULAR COMPLICATION) ADVANCED CARDIOMYOPATHY MORBID OBESITY VASCULITIS SICKLE CELL DISEASE
WHAT DOES THE PREOP EVALUATION OF RENAL TRANSPLANT PT LOOK LIKE?
USUALLY ASA 3-4. ALWAYS E.
MULTI ORGAN ASSESSMENT. LYTES. HGB. IV ACCESS. METS SCALE. USUALLY LOW HBG SO PREOXYGENATE.
IS THERE A HIGH INCIDENCE OF CAD AND CARDIOMYOPATHY IN DIALYSIS PTS?
YES. THIS IS NOT A CONTRAINDICATION FOR TRANSPLANT BUT THEY SHOULD HAVE ADEQUATE PERFUSION FOR THE NEW KIDNEY SO ANGIOPLASTY/REVASCULARIZATION SHOULD BE DONE PRIOR TO TRANSPLANT IF NECESSARY.
IS UREMIC CARDIOMYOPATHY A REVERSIBLE STATE?
YES. UREMIC CARDIOMYOPATHY IS A CAUSE FOR CHF (ALONG WITH ANEMIA / HYPOALBUMINEMIA)
THIS IS BEST DETECTED ON ECHO.
EF IMPROVES FROM 30 TO 60% POST TRANSPLANT.
SHOULD PROP ANTI HTN BE CONTINUED THE DAY OF SURGERY?
YES. ALL EXCEPT ACE INHIBITORS….THESE ARE STOPPED THE DAY BEFORE.
HTN IS 2ND LEADING CAUSE OF ESRD. DM IS NO. 1.
WHAT IS THE LEADING CAUSE OF DEATH FOR PATIENTS UNDERGOING RENAL TRANSPLANT?
MI. DO SLOW CARDIAC INDUCTION WITH HIGH NARCOTIC. ETOMIDATE. ROC. V SUX.
POSITIVE PRAYER SIGN INDICATES WHAT?
DIFFICULT INTUBATION.
WHAT HCT WOULD YOU CONSIDER BLOOD TRANSFUSION FOR TRANSPLANT CAD PT?
25%.
RENAL PTS PRODUCE LESS ERYTHROPOIETIN. LOW HBG. RIGHT SHIFT ON OXYHGB CURVE.
MAY OPTIMIZE PT WITH HUMAN RECOMBINANT EPO.
WHAT IS UREMIC COAGULOPATHY?
COMPLEX SYNDROME. PLTS DONT WORK. INEFFECTIVE PRODUCTION OF FACTOR 8 AND VON WILLEBRAND FACTOR.
PREVENT: DIALYSIS PRIOR TO SURGERY TO IMPROVE PLT FX.
TREAT: CONJUGATED ESTROGEN AND DESMOPRESSIN. MAY NEED CRYO/FFP DURING SURGERY.
CAN YOU DO REGIONAL ON THESE PTS?
AS LONG AS COAGS ARE OKAY. AND THE OPERATION IS SHORT ENOUGH. SAB MAY NOT LAST LONG ENOUGH SO EPIDURAL IS BETTER. 99% ARE GETA WITH RSI.
ARE REDUCTIONS IN DOSAGE OF PROTEIN BOUND DRUGS NECESSARY FOR RENAL TRANSPLANT PTS?
YES. THEY MAKE LESS PROTEIN SO THEIR WOULD BE MORE FREE DRUG. REDUCE THE DOSE.
WHY DO ESRD PTS WITH DM HAVE ALTERED GI MOTILITY?
WHAT DOES THIS MEAN?
DIABETIC GASTROPARESIS.
RISK FOR ASPIRATION. RSI.
30 ML SODIUM CITRATE (BICITRA). REGLAN 10MG 30 MIN PRE INDUCTION. PEPCID.
HOW OFTEN DO YOU ASSESS AV FISTULA DURING SURGERY?
AT LEAST EVERY 15 MIN.
WHY DO YOU NEED A CVP WITH KIDNEY TRANSPLANT?
TO WATCH GRAFT PERFUSION AND EARLY FUNCTION. THIS LOWERS RISK FOR ACUTE TUBULAR NECROSIS AND TRANSPLANT FAILURE FROM HYPOVOLEMIA. YOU WANT THEM FLUID LOADED TO A CVP 10-15. IF A UDALL IS IN PLACE YOU CAN USE THAT.
CAN YOU USE PROPOFOL SAFELY FOR RENAL TRANSPLANT?
YES BUT USE LESS THAN USUAL 2MG/KG DUE TO VASODILATION.
