transplant patient Flashcards
criteria
end stage disease
conventional rx failed
no untreatable malignancy/infection
no disease process leading to attack of transplanted organ/itssue
demonstrates emotional and psych stability
good support system
good compliance w/ medical regimen
cadaveric donors
transplant source
suffered severe nero trauma w/ resulting brain death
organs remain viable w/ meds and mechanical means
no sepsis, malignancy, communicable disease
living donors
kidney, liver, lung, pancreas, bone marrow
more time to be evaluated by transplant team
newborn –> 65yo
no hx of drug/ETOH abuse, chronic disease, malignancy, communicable diseases
compatibility issues
ABO blood type
histocompatibility typing
size
histocompatibility typing
HLA (human leukocyte antigens)
white cell crossmatch
due to short organ ischemic times, may bot have time to perform typing
UNOS
united network for organ sharing
responsible for procurement and distribution of organs
sets standards for MD, transplant facilities, labs, organ procurement organizations
UNOS distributes organs based on
illness severity, blood type, weight match, recipient eating time
transplant rejection
normal immune repsonse
immunosuppressive drugs
immunosuppressive drugs
usually double or triple drug regimen
prevent total rejection
decrease body response to fighting infection
balance is key
hyper acute graft rejection
occurs w/in first 48 hrs of transplant usually due to ABO incompatibility or cytotoxic antibodies in recipient presents w/ high fever and malaise unresponsive to tx only option is to remove transplant
acute graft rejection
occurs during first year
small vessel damage due to T lymphocyte repsonse
if not detected, whole organ becomes ischemic
treatable and reversible
acute graft rejection presents w/
sudden weight gain peripheral edema malaise dyspnea decreased urine output electrolyte imbalance elevated BP swelling/tenderness at graft site
chronic graft rejection
occurs after first year of transplant
due to immunoglobulin M complexes and compliment formed in organ vessels
deterioration is gradual and progressive
drugs may slow process down, but will not stop it
eventual need of re-transplant
presentation depends on organ involved
infection
immunosuppressants increase chance
if present, decrease drugs and start Antibiotics
proper hand washing before and after pt care
highest risk of infection is
within 3 months of transplant
signs of infection
temp > 100.5 fatigue chills sweating diarrhea > 2 days dyspnea cough c/o sore throat
transplant types
kidney liver pancreas heart lung bone marrow double transplants
cadaveric kidney may be viable for 72 hours
72 hours
last organ usually harvested
30-40% chance of acute tubular necrosis
type of donor preferred for renal transplant
increase graft and recipient survival
more time for match eval
decrease chance of damage during procurement
decreased risk of ATN
recipient kindly remains unless
infected or uncontrolled HTN
donor kidney placed in
iliac fossa
extraperitoneal
low ab incision
advantages
renal artery/vein of donor connected to iliac artery/vein or recipient
ureter sutured to bladder
renal post op
dialysis may be needed first few weeks
strict I and O
signs of rejection
decreased urine output increased BUN and serum creatinine increased BP wt gain (>1kg/24 hr) ankle edema
BP w/ renal treatment
systolic maintained > 110 mm Hg
ensure adequate rental perfusion
increase is higher than normal w/ acitivity
orthotopic cadaveric (liver)
disease liver removed
new liver placed in anatomical position
incision-midline sternotomy and continuous laparotomy
living adult donor (liver)
single lobe transplanted
liver regulates to normal size in donor and recipient w/in several months
split liver
adult cadaveric liver is divided into two in situ
usually left lobe given to child due to small size
right lobe given to adult
domino (liver)
pt w/ FAP
involves 3 people
pt w/ FAP recieves donor liver
FAP liver goes to another recipeient
symptoms from FAP manifest
40-60 years
liver post op
three JP suction drains
biliary T tube
liver rejection
prolonged PT/PTT, abnormal liver panel, oliguria, metabolic acidosis, hyperkalemia, kypoglecemia, coma
tx for liver rejection
immediate retransplant
liver therapy - post op ascites
increased abdominal girth
LE edema
increased lumbar lordosis
COG shifts leading to possible balance
pancreas transplant
not live saving procedure
pt w/ metabolic implant, Type I DM, severe brittle diabetes
may prohibit neuropathy progression
performed before severe diabetic complications occur
pancreas transplant procedure
lower oblique abdominal incision
bladder drainage technique
BW monitored
some pts insulin indep 5 yrs
pancreas - bladder drainage technique
donor duodenum attached to urinary bladder
loss of fluids needs to be monitored
pancreas transplant post op
strict bed rest for a few days
loss of fluids monitored
pancreas transplant post op - signs of rejection
ab pain fever tenderness at graft site hematuria hyperglycemia
pancreas transplant therapy
remind pt to stay hydrated esp w/ avitivieis
record I and O on record sheet
pancreas and kidney transplants in diabetic pts
MDs may prefer to perform simultaneously due to potent immunosuppressive drugs
orthotopic heart transplant
most common
median sternotomy incision
medial sternotomy incision
heart is removed except for post right atrium w/ SA node, left atrium, aorta, pulmonary artery
new heart is placed in anatomical position
EKG shows two P waves, but only new heart has ventricular contraction
hetertopic heart transplant
rare
diseased heart is left in place
donor heart placed to right side of existing
donor L vent supports systemic circulation
native R ven supports pulm circulation
EKG shows 2 rhythms/rates
