Kidney Transplant Flashcards
Kidney transplant success
Very successful
One year graft survival rate
-cadaver transplant: 90%
-Live donor: 95%
Recipient selection
Candidacy determined by variety of medical and psychosocial factors that vary among transplant centers
Preemptive transplantation is possible if the recipient has a living donor
Preemptive transplantation
Before dialysis is required
Contraindications to transplantation
Disseminated malignancies Untreated cardiac disease Chronic respiratory failure Extensive vascular disease Chronic infection Unresolved psychosocial disorders
Kidney transplantation histocompatability studies
Purpose of testing is to identify the HLA antigens for both donors and potential recipients
Donor sources
Deceased donors with compatible blood type Blood relatives Emotionally related living donors Altruistic living donors Paired organ donation
Live donor
Extensive multidisciplinary evaluation Psychosocial and financial evaluations Crossmatches Advantages -Better patient and graft survival rates -Immediate organ availability -Minimal cold time
Live donor diagnostic studies
ECG, chest x-ray, ulrasound, arteriograph
Lab studies:
-24 hour urine (creatinine clearance, total protein)
-CBC
-Chemistry and electrolyte profiles
-Hep B and C, HIV, CMV testing
Deceased donor
Cadaver kidney donors are relatively healthy individuals
Have suffered an irreversible brain injury and are declared brain dead
Surgical procedure for live donor
Nephrectomy performed by urologist or transplant surgeon
Begins 1-2 hours before recipient’s surgery is started
Surgical procedure for kidney transplant recipient
Organ usually placed in the iliac fossa
Right iliac fossa is preferred
Preoperative care
Emotional and physical preparation Immunosuppressive drugs ECG Chest x-ray Lab studies
Post operative care for live donor
Care is similar to that for open or laparoscopic nephrectomy
Close monitoring of renal funciton and hct
Post operative care for recipient
Maintenance of fluid and electrolyte balance is first priority
Large volumes of urine soon after transplanted kidney placed as a result of
-New kidney’s ability to filter BUN
-Abundance of fluids during operation
-Initial renal tubular dysfunction
Urine output replaced with fluids milliliter by milliliter hourly
-urine output closely monitored
Acute tubular necrosis can occur
-may necessitate dialysis
Maintain catheter patency
Rejection types
Hyperacute rejection
Acute rejection
Chronic rejection
