Organ Specific Transplant Indications Flashcards
What is the most frequently sought organ?
The kidney
What are the indications for having a kidney transplant?
- Creatinine clearance less than 15 ml/min
- Patients are listed for transplant based on their ABO and panel reactive antibody level (PRA)
- Preemptive transplant can be done prior to initiation of dialysis, especially if a live donor is available
- Most common cause of ESRD patients: DM, HTN and glomerular diseases
What are some surgical complications that can occur after a kidney transplant?
- Graft thrombosis typically occurs 2-3 days postoperatively. Prognosis is poor, graft is usually lost.
- Urine leak occurs in the same time frame. Ureter can necrose causing a leak, patient has abdominal fullness, pain, creatinine is elevated. An indwelling urinary catheter, nephrostomy or surgical repair is indicated
- Lymphocele: a collection of lymph fluid that surrounds the transplant, can cause obstruction of urine flow. There can be scrotal pain, abdominal pain. Fluid must be aspirated percutaneously
- Bleeding
- Ureteral obstruction – can be due to clot, surgical technique, stricture, rejection or infection. Treated with nephrostomy tube, dilatation of stricture removal of the clot of surgical correction
What are some non-surgical complications that occur after kidney transplant?
Delayed graft function – occurs in 10-50% of kidney transplants
- Causes: ATN, rejection, ischemia-perfusion injury
- Treated with dialysis and modification of immunosuppression and waiting
What can diseases can cause the need for having a liver transplant?
- chronic hepatitis
- alcoholic liver disease
- cholestatic disease
- hepatocellular carcinoma
- Wilson’s Disease
- genetic disorders
What are some surgical complications that can occur with a liver transplant?
- Hepatic artery thrombosis (HAT) and stenosis – can occur any time post transplant. If thrombosis is present, thrombectomy, thrombolytic therapy and surgical regrafting may be done
- Portal vein thrombosis – can cause portal HTN. Care is directed at managing the portal HTN
- Biliary leaks – percutaneous or surgical drainage is done
- Anastomotic bile leaks – surgically repaired
What are some non-surgical complications that can occur after a liver transplant?
- Primary graft dysfunction – the graft does not function within the first week. Prognosis is poor. Treatment is supportive
- Rejection
- Infection
- Biliary cast syndrome – bile duct stricture, biliary sludge formation. Re-transplantation is needed
- Recurrence of original disease
What diseases can cause the need for a lung transplant?
- primary pulmonary hypertension
- cystic fibrosis
- chronic obstructive pulmonary disease
- sarcoidosis
- interstitial lung disease including idiopathic pulmonary fibrosis
What is the indication for having a lung transplant?
Patients are referred for lung transplantation when their life expectancy is 24-36 months.
What are some surgical complications that can occur with a lung transplant?
- Bronchial anastomotic complications – ischemia, necrosis, strictures. Treated with dilation and stenting or re-transplantation
- Bleeding
- Ischemia-reperfusion injury – major cause of mortality. This syndrome is similar to acute respiratory distress syndrome (ARDS). Management is ventilatory support
What are some non-surgical complications that can occur after a lung transplant?
- Infectious complications of the lung including bacterial bronchitis and pneumonia, CMV and mycobacterium
- Sepsis
- Bronchiolitis obliterans syndrome (BOS)
- A manifestation of chronic rejection
- Treatment options are limited and include the addition of high dose corticosteroids and antilymphocytic therapy
- Rejection
What diseases cause the need for a heart transplant?
Most commonly done for patients with cardiomyopathy, cardiac tumor, congenital defect and valvular heart disease
What are the indications for having a heart transplant?
- Patients with end stage heart failure who remain symptomatic despite optimal medical therapy or persistent New York Heart Association (NYHA) functional class IV heart failure symptoms.
- Cardiopulmonary exercise testing is cited as listing criteria for heart transplantation.
What are the complications that can occur after a heart transplant?
- Bleeding – many heart transplant recipients have been on chronic anticoagulation for atrial fibrillation or left ventricular thrombus at the time of transplant. These patients will have their anticoagulation “reversed” prior to surgery. Patients with a left ventricular assist device (LVAD) in place are at a higher risk of bleeding as the timing of reversal of anticoagulation is more stringent
- Rejection
- Cardiac allograft vasculopathy (CAV)
- Leading cause of death in heart recipients
- Is an accelerated form of CAD, incidence is 11% at 1 year post transplant
- Patients presents with heart failure arrhythmias or sudden cardiac death
- Treatment is angioplasty, revascularization and re-transplantation
Denervation
The transplanted heart is denervated and will have an altered response to cardiovascular drugs
Digoxin and atropine have little or no effect on the transplanted heart
Patients typically do not feel chest pain
What are the indications for having a pancrease transplant?
- Only indication is DM type 1
- Goal is to allow insulin independence, improve quality of life and reduce secondary complications of diabetes
