Kidney Transplant

Question 1

Preoperative Care

Answer 1

1. Immunologic studies
   > Is the donor suitable so the recipient doesn’t reject what is seen as “foreign tissue?”
   > Tissue and blood typing – must be same blood type
2. Procedure education for client, family and donor (if living)
   > After care education
3. Patient assessments, including
   > Diagnostic tests
   > Treatment plans
4. Dialysis 24 hours before procedure
5. Blood transfusion
   > Typically blood from donor to increase graft survival rate

Question 2

Operative Procedure

Answer 2

1. Procedure varies depending on the donor
   > Open procedure for non-heart beating or cadaver donors
   > Laparoscopic procedure for living donors
2. Several hours in length
3. Donor Kidney Placement
   > Placed in the right or left anterior iliac fossa instead of normal kidney position
   > Allows for an easier connection of the ureter and renal artery and vein; easier palpation
   > Failed kidneys not removed unless infected or d/t pain

Question 3

Postoperative Care

Answer 3

1. Ongoing assessments
   > Kidney function
   > Monitoring specifically for complications – rejection and infection
   > Electrolytes
2. Drug Therapy
   > Anti-rejections meds reduce client’s immunity, impairs healing, and increases risk for infection
3. Urologic management involves catheter care
   > Urine output – I&O important, can indicate complications (rejection, AKI, thrombosis, obstruction)
   > Decompression of bladder – prevent stretching of sutures

Question 4

Transplant Complications

Answer 4

1. Rejection - #1 cause of graft loss
   > Hyperacute
   > Acute
   > Chronic
2. Thrombosis of the major renal blood vessels
   > During the first 2-3 days after transplant
   > Results in sudden decrease in urine output
   > Ultrasound may show decreased or absent blood supply; emergency surgery is required to prevent ischemic damage or loss of graft
3. Renal artery stenosis
   > Resulting in HTN
   > Bruit over artery anastomosis site will develop, resulting in decreased kidney function
   > Artery will have to be repaired, either surgically or by balloon angioplasty
4. Other complications
   > Surgical wound
   > Abscesses, hematomas, lymphoceles (cysts containing lymph fluid)
   > All increase risk for infection and put unnecessary pressure on new kidney
   > Urinary tract
   > Ureteral leakage, fistula, obstruction, stone formation, bladder neck contracture, rupture of graft
   > All require surgical intervention

Question 5

Hyperacute Rejection

Answer 5

1. Onset: Within 48 hrs after surgery
2. Signs and Symptoms:
   > Increased temperature
   > Increased blood pressure
   > Pain at transplant site
3. Treatment: Immediate removal of the transplanted kidney

Question 6

Acute Rejection

Answer 6

1. Onset: 1 week to anytime after surgery: occurs over days to week
2. Signs and Symptoms:
   > Oliguria or anuria
   > Temp over 100
   > Increased BP
   > Enlarged, tender kidney
   > Lethargy
   > Elevated BUN, creatinine, potassium levels
3. Treatment: Increased doses of immunosuppressive drugs

Question 7

Chronic Rejection

Answer 7

1. Onset: Occurs gradually during a period of months to years
2. Signs and Symptoms
   > Gradual increase in BUN and creatinine levels
   > Fluid retention
   > Changes in electrolytes
   > Fatigue
3. Treatment: Conservative management until dialysis required

Question 8

Immunosuppressive Drug Therapy

Answer 8

1. Must be given so that the new kidney is not seen as foreign and rejected
2. Changes client’s immune response
3. HUGE RISKS r/t Taking Immunosuppressive drugs:
   > Clients at increased risk for death from infection
   > Clients that do not follow therapy regimen are at high risk of losing transplanted kidney
4. Other risks r/t taking immunosuppressive drugs:
   > Cardiovascular disease (most common cause of death among kidney transplant recipients)
   > Diabetes
   > Cancer
   > Other types of infection