Kidney transplantation Flashcards
what are contraindications to transplantation?
disseminated malignancies, refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders( nonadherence to medical regimens, alcoholism, drug addiction) . Hep B or C is not a contraindication
Live donor evaluation
complete history and physical, determine if emotionally stable, need to teach that costs of the evaluation is covered by the recipients insurance, no compensation is available for lost wages furring post hospitalization recovery period.( 6 weeks or longer)
What is another option when there is ABO incomatblity?
paired donor exchange is a viable alternative
Plasmapheresis is also another option which is to remove antibodies from the recipient
Deceased donors
relatively healthy individuals who have suffered an irreversible brain injury and are declared brain dead.
Kidney transplant cold time
time outside of the body when being transported from the decrease donor to the recipient. prolonged cold time increases the like hood that the kidney will not function immediately and acute tubular necrosis may develop.
Two exceptions to the transplantation rule that move the client to the top of the list
if emergency transplant needed( no vascular access sites left and can no longer dialyze), and zero mismatches
what is done after kidney is removed
It is flushed with a chilled sterile electrolyte solution and prepared for immediate transplant into the recipient.
during kidney implantation in the recipient
urinary catheter is place in the bladder, antibiotic solution is instilled to distend the balder and decrease the risk of infection
Criteria for transplantation
presence of end stage disease, absence of untreatable malignancy and irreversible infection, ability to survive the surgical procedure
Brain death criteria
no gag reflex, oculocepahic reflex ( doll’s eye), oculovestiular reflex( cold calorics exam) for ear, pupil non reactive to light, no movement in response to external stimuli
Donor maintenance
adequate CO and BP, MAP> or equal to 60mmHg, UOP > 30ml or 1ml/kg/hr., EF> or equal to 45%, vasoactive drug support( dopamine, dobutamine)
which organ have the longest preservation time?
Kidneys
