Kidney Transplant (Exam 3) Flashcards
Kidney Recipient Requirements
median time is 678 days
no med issues that increase risk
HIV and Hep B/C ok to have
2-70 yr old, >70 considered on individual basis
histocompatibility studies
Kidney Recipient Contraindications
advanced, uncorrectable cardiac disease
metastatic cancer (less than 2-5 yrs)
chronic infection
psych issues (substance abuse)
long standing pulmonary disease
GI disorders require treatment of long term steroid use
DM and other endocrine disorders are high risk
Live Kidney Donors
paired or chain exchange donation
must have compatible blood type and ABO compatibility
insurance will cover, but it will not cover work time off
living have highest rate of kidney graft survival (90%)
>18 yr old, seldom over 65 although some are over 70
absence of systemic disease or infection
no current active cancer
no HTN or kidney disease
adequate kidney function as determined by diagnostic studies
must express a clear understanding of the surgery and still be willing
some states require a psych evaluation to assess motivation
Deceased Kidney Donors
non heart-beating donors and cadaveric donors
Step 1: Human Leukocyte Antigens (HLA) matching
the immune system uses these markers to identify which cells belong in your body
a close HLA match with another donor makes it more likely that the transplant will work (lowers risk of complications)
matching of 6 HLA is best
Step 2: Panel Reactive Antibody (PRA)
a small amount of the organs recipient serum is mixed with cells from 60 people (separately)
it’s used to determine how many HLAs a person has
the lower it is, less likely to be rejected
Step 3: Crossmatch Test
a small amount of the potential donors white cells is mixed with a small amount of the pts serum
by exposing donors HLA to the recipients serum, we can determine if the recipient has antibodies to any of the donors HLA and crossmatch=immune reaction (rejection is likely, no transplant)
- crossmatch=no reaction, no rejection, ok transplant (good result!)
Recipient Surgical Procedures
failing kidney is not removed unless infection may be present that causes pain (as in PKD)
Donor Surgical Procedures
laparoscopic for live donors
Kidney Recipient Preop
4-5 day hospital stay
preop workup (crossmatch done again right before surgery b/c blood antibodies change over time)
maintain vascular access-may need surgery
dialysis usually 24 hrs before surgery and an infusion of donor blood is usually given
urinary system evaluation
some have not used lower urinary tract for years so ureter and bladder problems may require surgical correction before transplant
Kidney Transplant Donor Preop
2-4 day hospital stay, return to work 4-6 weeks
labs
pain management
wound care
psych support
Urologic Management (Kidney Transplant)
foley is placed to monitor UO and decompress the bladder (CAUTI prevention), removed 3-5 days
Assessment of Hourly Urine Output x 48 hrs for Kidney Transplant
abrupt loss of urine is a sign of rejection, AKI, thrombosis or obstruction
color may be pink/bloody right after surgery, returns to normal over days/weeks
daily urine for UA, glucose, acetone presence, specific gravity and culture if needed
replace 1 ml loss for 1 ml because UO can be as high as 1L per hour prevent dehydration
electrolyte imbalances (high risk) decreased Na and decreased K; 0.9% w/KCL may be needed
daily weights; should not gain weight!!! could indicate kidney isn’t working
Kidney Transplant Complications
rejection-most common (recipients will always usually have at least 1 experience with acute rejection; just increase immunosuppressants to deal with it, make sure pt is calm, they often get scared they could lose their kidney)
susceptibility to infection-most common (inspect the skin; can have flu shots)
thrombosis
renal artery stenosis (may result in HTN, bruit over the artery anastomosis site and decreased kidney function)
wound infection can result in death; prevention is key! strict aseptic technique and handwashing must be enforced!
Kidney Transplant Meds
immunosuppressive drug therapy*
corticosteroids*
Immunosuppressive Drug Therapy (Kidney Transplant)
for life!
inhibitors of T cell proliferation and activity (azathioprine, mycophenolic acid, cyclosporine, and tacrolimus)
mTOR inhibitors (to disrupt stimulatory T-cell signals)
monoclonal antibodies (specifically target the activation sites of T-lymphocytes)
ADE malignancy (cancers), CAD, HTN, infection
Corticosteroids (Kidney Transplants)
corticosteroids (methyl prednisone)
broadly inhibit cytokine production in most leukocytes, resulting in generalized immunosuppression
may be weaned off after a couple of years
ADE HTN, infection, hyperglycemia, osteoporosis, joint pain
Kidney Transplant Complications
risk for CVD (most common death), diabetes, cancer and infections
AA, hispanics, and NA have a greater incidence of graft failure and systemic complications (especially CVD) after transplant
