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
clinical signs of renal transpant rejection
- temp >100F (37.7C)
- pain or tenderness over grafted kidney
- 2-3lb weight gain in 24hrs
- edema
- hypertension
- malaise
- increased BUN & serum creatinine levels
- decreased creatinine clearance
- increased WBC
- rejection indicated by ultrasound or biopsy
ethics of organ transplantation
- history of organ transplantation
- national organ procurement & transplantation network
- disparity of supply and demand
- organ/tissue donation uniform anatomical gift act
national organ transplant act
- prohibited buying/selling organs
- to address the nations critical donation shortage and improve organ matching and placement process, the US congress passed the national organ transplant act in 1984
- the act established the organ procurement and transplantation network to maintain a national registry for organ matching
- the act also called for the network to be operated by a private, non-profit organization under federal contract
- established scientific registry of transplant recipients
post kidney biopsy care
The patient must lie on his or her back for 8 to 24 hours. Some nephrologists advocate a 24-hour recovery in the hospital, where the patient can be observed for complications.
The kidney contains many blood vessels and bleeds as a result of the biopsy. Bright red (arterial) blood in the urine (hematuria) may be seen for the first 24 hours. If blood is seen in the urine after 24 hours, further care may be required to stop the bleeding. Many people experience muscle aches and general soreness during recovery.
