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Clinical 3 > Transplant > Flashcards

Transplant Flashcards

1
Q

is it better to get a transplant or dialysis?

A

Patients who get a kidney transplant before dialysis live an average of 10 to 15 years longer than if they stayed on dialysis.

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2
Q

Renal Transplant

• Advantages and limitations

A

Advantages:
• Increased survival rate
• Preferred method of treatment

Limitations:
• Lengthy waiting list
• Long-term immunosuppressive therapy

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3
Q

Pretransplantation period goal:

A

to optimize nutritional status to decrease:
1- surgical risk
2- post surgical complications
3- length of hospital stay

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4
Q

Concerns with presurgical malnutrition

A

Presurgical malnutrition can involve under or over nutrition and is associated with increased risk of postsurgical complications

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5
Q

effects of overnutrition on renal health

A

Over nutrition - Obese patients have
• Higher mortality rate
• Lower graft function
• Increased incidence of wound complications
• More frequent ICU admissions
• More frequent re-intubations
• Increased incidence of post transplant diabetes

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6
Q

acute post-transplant period foal

A

To manage the increased metabolic demands of surgery

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7
Q

What med is used in Acute post transplant period to increase transplant survival? How? Side effects?

A

• Pharmacologic immunosuppression used to halt body’s response to the kidney enhances graft survival
• Cyclosporin has several unwanted side-effects:
Gingival hyperplasia
GI disturbances
Hyperglycemia
Gynecomastia
Hepatotoxicity, decreased glycogen synthesis
Nephrotoxicity

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8
Q

Use of corticosteroids in renal transplant and side effects

A 
Corticosteroids used to inhibit the production of lymphokines; side-effects include:
Ø Impaired wound healing
Ø Avascular necrosis of long bones 
Ø Upper GI ulceration
Ø Protein catabolism
Ø Hypertension
Ø Steroid induced diabetes
Ø Cataract formation
Ø Stimulation of appetite, weight gain
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9
Q

Posttransplant Patient -Protein and energy needs

A

• Generally increase up to 6-8 weeks post op due to stress and excessive dose of corticosteroids

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10
Q

fat reccs in post-transplant

A

• 25-35% of total Energy. SFA max 7% and remaining are MUFA and PUFA

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11
Q

Sodium reccs

A

• Hypertension common; restrict sodium

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12
Q

Carbohydrate reccs

A
  • Glucose intolerance common (hyperglycemia frequent with corticosteroids, cyclosporine, …)
  • Emphasize on complex carbohydrate, dietary fiber to minimize risk of developing diabetes
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13
Q

what is hyperGL associated with in pot-transplant pts

A

** Hyperglycemia associated with higher risk for infection, rejection, and decreased survival rate

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14
Q

potassium in post-transplant pts

A

• Potassium restriction in acute period if hyperkalemia.
• Hyperkalemia caused by poor graft function, impaired potassium excretion with
cyclosporine and potassium-sparing diuretics.
• No restriction in chronic phase (unless hyperkalemia)

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15
Q

immunosuppressants in post-transplant pts

A
  • Used to prevent acute rejection
  • Used to maintain long-term survival
  • Avoid grapefruit and grapefruit juice if taking tacrolimus and cyclosporine
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16
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: protein

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): 1.3-2.0 g/kg; based on standard or adjusted body weight
Chronic phase (after 8 weeks): 0.8-1.0 g/kg with functionning transplant
17
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: calories

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): 30-35 kcal/kg
Chronic phase (after 8 weeks): 25-35 kcal/kg to maintain desirable weight
18
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: carbs

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): 50-70% non-protein calories; CHO controlled as needed
Chronic phase (after 8 weeks): 45--50% totoal kcal; ++ complex CHO fiber 25g/d (female) to 30g/d (male)
19
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: fats

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): 30-50% non-protein calories
Chronic phase (after 8 weeks): 25-35% ot total kcal with SFA <7% of total kcal
20
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: sodium

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): <4g/d; unrestricted unless HTN or edema
Chronic phase (after 8 weeks): <2.4 g/d
21
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: calcium

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): 1000-1500mg
Chronic phase (after 8 weeks): 2000mg
22
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: phosphorus

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): DRI
Chronic phase (after 8 weeks): DRI
23
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: vitamins, minerals, trace elements

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): DRI
Chronic phase (after 8 weeks): DRO
24
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: fluids

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): Ad libidum; 1 ml/kg dry weight; match output unless diuresis is goal
Chronic phase (after 8 weeks): Ad libidum with functioning transplant
25
Q

Nutrition Guidelines for Adult Kidney Transplant Patients: potassium

A 
Acute phase (up to 8 weeks post transplant and during acute rejection): unrestricted; if hyperkalemia exists <2.4 g/d
Chronic phase (after 8 weeks): no restriction unless hyperkalemia
26
Q

Immunosuppressants and Potential Adverse Effects

A

Common side effects are nausea and vomiting, diarrhea, hyperglycemia, abdominal pain

27
Q

Name common renal transplant complications

A

Obesity
Chronic kidney disease bone mineral disorder (CKD-BMD)
CVD
Rejection

28
Q

CVD in post-transplant patients

A

• Increased risk of CVD; dyslipidemias common (70% of patients) • Lipid-lowering medications may be used

29
Q

Hypomagnesemia in post-transplant patients

A
  • Common after transplant; associated with cyclosporine (immunosuppressant) and tacrolimus (immunosuppressant) use
  • IV replacement may be required
30
Q

Obesity in post-transplant patients

A
  • Weight gain common; may complicate hyperlipidemia and glucose intolerance
  • Emphasize diet, behavior modification, exercise
31
Q

CKD-BMD in post-transplant patients

A

Chronic kidney disease bone mineral disorder (CKD-BMD)
• Mechanisms not completely understood but could be side effects of altered vitamin D metabolism, alteration in PTH, impact of immunosuppressive medications.
• Calcium supplementation, vitamin D, and antiresorptive agents may be needed.
• Hypophosphatemia occurs in 50% patients. Phosphorous supplementation needed early post-transplant.

32
Q

Rejection in post-transplant patients

A

• Corticosteroids increase
• Need for increased protein and energy
requirements

33
Q

Considerations for dietitians with post-transplant patients

A

• Prevent and treat protein-energy malnutrition
• Prevent and treat mineral and electrolyte disorders
• Reducing the impact of other comorbidities (diabetes, obesity, hypertension, lipid metabolism disorders)
-> Improvement in the patient’s quality of life

Clinical 3 (17 decks)

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