renal transplantation Flashcards
renal transplantation stats
- best treatment for pts with ESRD
- less expensive than dialysis after first year
renal stransplantation
- human kidney from compatible donor is implanted into a recipient
- kidney transplantation is performed for irreversible kidney failure
- the recipient must take immunosuppressive meds for life
living related donors
- most desirable
- screened for: ABO blood group, tissue-specific antigen, human leukocyte antigen suitability, mixed lymphocyte culture index, communicable diseases
- complete medical evalutaion
- nephrology consult
- must be in excellent condition with 2 functioning kidneys
- emotional well-being is assessed
- complete understanding of the whole process
cadaver donors
- must meet institutions criteria for brain death
- need to be younger than 70
- must have normal renal function
- no malignant disease outside of CNS
- no generalized infection or communicable diseases
- no renal trauma
- potential donor must be (-) for communicable diseases at time of donation
transplant process
- organ becomes available
- donor info is put into computer (united network for organ sharing (UNOS) maintians a central computer network containing the names of all pts waiting for donation
organ matching criteria
- medical emergency
- tissue match
- blood type
- wait time
- organ size
- immune status, geographic location
transplant process cont.
- perfect HLA (Human Leukocyte antigen) and blood type match gets kidney
- if no perfect match-local people first
- once cerebral death has been established, management of the donor is determined by organ bank personnel
cold ischemic time
time elapsed between cessation of blood flow to the kidney and time required for anastomosis of the kidney in the recipient
-less than 24 hrs for kidney
preoperative interventions
- verify histocompatibiity tests of donor
- administer immunosuppressive drugs to recipient
- maintain strict aseptic technique
- verify that hemodialysis of the recipient was completed 24hrs prior to transplant
- ensure recipient is free from any infections
- assess renal function studies
- encourage discussion of feelings
- provide psychological support
post op interventions
monitor: urine output hourly
- VS,CVP, pulse ox
- IV fluids closely
- DW
- Daily lab results
- foley catheter patency
- 3-way bladder irrigation
- for infection
- bowel sounds
post op cont
- promote live donor and recipient relationship
- assist recipient with body image disturbance
- advise of available support groups
client instructions following kideny transplant
- avoid long periods of sitting (PE,clot)
- monitor I&Os
- recognize the s/s of infection and rejection
- use meds as prescribed & maintain immunosuppressive therapy for life
- avoid contact sports (kidney is in front with no protection)
- avoid people with infections
- know s/s that require MD contact
- ensure follow up care
graft rejection: hyperacute
- occurs at time of anatomosis of the organ
- interventions: remove kindey
graft rejection : acute
most common type
- most frequently occurs within 6 weeks post op but can occur any time
- interventions: -potentially reversible with increased immunosuppression and if treated early
- administer high doses of corticosteroids
- monoclonal antibodies if corticosteroids dont work
graft rejection: chronic
occurs slowly months to years after transplant
- mimics CRF
- interventions: immunosuppressive medication
- retransplantation if necesarry
