Solid Organ Transplant

Question 1

what is the most common organ transplant
why?

Answer 1

kidney

living donors

Question 2

Indication: Decompensated end-stage organ failure
e.g., ESLD, ESRD, CHF, respiratory failure due to COPD or CF

Contraindications:
active ____________, multisystem ________, active ___________, advanced ______, ________, severe _________, poor prognosis

Answer 2

infection or sepsis
organ failure
substance abuse
age
frailty
obesity

Question 3

Pre-Transplant Phase
Goals of MNT:

Optimize ______ status as much as possible prior to transplant
Many patients awaiting transplant are ______
Malnourished patients have higher rates of ______
Alleviate complications caused by organ failure

Answer 3

nutritional
malnourished
post-transplant morbidity & mortality

Question 4

Acute/Immediate Post-Transplant Phase
1st _______ post-transplant
Medical concerns: _________

Nutrition concerns - Provide adequate nutrition to:
heal ______
fight______
replete stores
Food-drug interactions of ___________

Answer 4

2 months
Rejection; Infections

surgical wounds
infection
immunosuppressive regimen

Question 5

Immunosuppressive Medications

Answer 5

Cyclosporine
Tacrolimus (Prograf)
Azathioprine (Imuran)
Corticosteroids (e.g., prednisone)

Question 6

Cyclosporine food drug interactions

avoid ______

SE of drug ___________

Answer 6

grapefruit

hypomagnesemia
hyperkalemia
hyperglycemia
HTN
hyperlipidemia
toxic to kidney

Question 7

Tacrolimus (Prograf) food drug interactions

avoid _________

SE of drug ________

Answer 7

grapefruit (decrease metabolism of drug=toxic levels)

hypomagnesemia
hyperkalemia
hyperglycemia
HTN
N/V
toxic to kidney

Question 8

Azathioprine (Imuran) side effects ____

Answer 8

macrocytic anemia
N/V
mouth sores
acute pancreatitis

Question 9

Corticosteroids (e.g., prednisone) side effects

Answer 9

hyperglycemia
hyperphagia; weight gain
sodium retention
HTN
muscle wasting & weakness
impaired wound healing
osteoporosis

Question 10

Acute/Immediate Post-Transplant Nutritional Needs

Energy needs: _____ kcal/kg
Protein needs: ____ g/kg
Fluid needs=> Individualize based on fluid status, organ function, fluid losses
Calcium: _____ mg/d

Answer 10

30-35
1.5-2.0
1200

Question 11

Acute/Immediate Post-Transplant MNT

Advance as tolerated to a Regular diet
MNT for ____________
If fluid retention=> ______diet, possible fluid restriction
Hyperglycemia=> _______ diet

MVIM
ONS if needed

Answer 11

comorbidities
2 gm Na
CHO-controlled

Question 12

If intubated or poor appetite=> ________
- High _________ formula
- If fluid overload=> ________formula

Monitor:
Nutritional intake
Weight
Labs: serum glucose, serum electrolytes
Fluid status
Wound healing

Answer 12

enteral nutrition
nitrogen
concentrated

Question 13

Chronic Post-Transplant Phase

Nutrition concerns
Weight gain and obesity
Hyperglycemia=>drug-induced DM
Hyperlipidemia
HTN
Electrolyte imbalances
Micronutrient deficiencies
Osteoporosis

Goal of MNT?
_____________
_____________

Answer 13

ensure adequate weight
prevent and treat complications

Question 14

Chronic Post-Transplant MNT

Calories to promote healthy BW
Protein needs: ____ g/kg
MVIM
Calcium intake: ________ mg/d
May need supplementation if inadequate intake
Monitor: wt, dietary intake, labs
Diet education:
Heart healthy diet; additional diet recommendations as needed
food saftey

Answer 14

1
1200 – 1500