Transplant

Question 1

What is frailty?

Answer 1

Biologic syndrome of decreased reserve and resistance to stressors resulting from cumulative declines across multiple physiologic systems causing vulnerability to outcomes.
Includes age-associated declines in lean body mass, strength, endurance, balance, walking performance, and low activity.
Associated with greater risk of mortality post-transplant, increased risk of delayed graft function, longer length of hospitalization, and early readmission

Question 2

What are the goals of immunosuppressive therapy posttransplant?

Answer 2

Prevent acute and chronic organ rejection.
Minimize toxicities of agents
Lessen rates of infection and malignancy
Achieve highest possible rates of patient and graft survival
Two types: induction and antirejection

Question 3

What is induction therapy posttransplant?

Answer 3

Uses antilymphocyte antibody medications administered for short duration immediately posttransplant
Minimizes risks of early rejection episodes
Adverse effects are minimal and no major nutritional concerns.

Question 4

When is antirejection therapy started posttransplant?

Answer 4

Used immediately posttransplant and continued indefinitely

Question 5

What are the protein recommendations posttransplant?

Answer 5

Acute period: 1.2-2.0 g/kg
Chronic period: 0.6-0.8 g/kg without DM, 0.8-0.9 g/kg with DM (adjust. with chronic graft dysfunction)

Question 6

What are the kcal recommendations posttransplant?

Answer 6

Acute period: 30-35 kcal/kg or BEE x 1.3-1.5, may increase with post-op complications
Chronic period: 23-35 kcal/kg, adjust to maintain desirable BW

Question 7

What are the CHO recommendations posttransplant?

Answer 7

Acute period: limit simple CHO with high BG and unwanted wt. gain
Chronic period: emphasize complex CHO intake and distribution

Question 8

What are the fat recommendations posttransplant?

Answer 8

Acute period: 30% total kcal, emphasize PUFA and MUFA sources
Chronic period: less than 30% total kcal, emphasize PUFA and MUFA sources

Question 9

What are the sodium recommendations posttransplant?

Answer 9

Acute period: restrict if BP/fluid status dictates, aim for 2-4 g with delayed graft function
Chronic period: 2300 mg/day, individualize with HTN or edema

Question 10

What are the potassium recommendations posttransplant?

Answer 10

Acute period: 2000-4000 mg if hyperkalemic
Chronic period: individualize to maintain serum levels WNL

Question 11

What are the phosphorus recommendations posttransplant?

Answer 11

Acute period: individualize to maintain serum levels WNL
Chronic period: individualize to maintain serum levels WNL

Question 12

What are the fluid recommendations posttransplant?

Answer 12

Acute period: limited only by graft function, generally unrestricted and encouraged.
Chronic period: limited only by graft function, generally unrestricted.

Question 13

What are the recommendations regarding herbs and botanicals posttransplant?

Answer 13

Contraindicated until adequate research is available.

Question 14

What is cytomegalovirus?

Answer 14

Viral infection that is common in immunocompromised patients
May affect any portion of GI tract and may lead to ischemic colitis and toxic megacolon.
Symptoms: dysphagia, odynophagia, nausea, vomiting, abd. pain, diarrhea, GI bleed, gut perforation
Early diagnosis is imperative–can spread to other organs

Question 15

What are common infections posttransplant?

Answer 15

Herpes simplex (oral cavity and esophagus)
Candida esophagitis with or without thrush
C.diff colitis
H. Pylori (70%)
Gastritis (65%)
Lactose intolerance