Transplants Flashcards
what are the goals of transplant?
- decrease disabling symptoms
- improve functional capacity
- improve health related quality of life
- increase life expectancy?
what is the balance for transplant recovery
infection vs rejection
too much immunosuppression can lead to infection and too little immunosuppression can lead to rejection of the new organ
how long are rejection and infection risks for?
lifelong
what is failure of immunosuppression medications to prevent activation of immune effector cells
rejection
what are common post operative issues with transplants?
- psychological issues
-unfullfilled expectations
understanding of disease process
complex medical regimen
unacustomed life stype - medical
-anemia
-hypertension
-electrolyte abnormalities
-weight gain
what is the median survival after heart transplants
10 years
what are some of the general indications for heart transplant?
-chronic, irreversible disease
-usually patients will only have a single organ dysfunction
what is the NYHA classification system
severity of heart failure
Class 1: no symptoms
Class 2: mild symptoms with normal physical activity
Class 3: moderate symptoms with less than normal physical activity comfortable at rest
Class 4: severe symptoms at rest
what is considered low risk/ medium/ high risk for heart transplant scoring?
low risk: score >8.1
medium risk: score >7.2 less than 8.1
low risk: less than 7.2
presense of CAD
HRrest
LV Ejection fracture
MAP
VO2max
Explain the denervated heart
electrical activity cannot cross suture line
-recipient atrial activity is present but not conducted—can see occasional 2 pwaves
-Donor atrium denervated but source of electrophysiologic response
no autonomic nervous system from the donor heart but their HR can still increase because of endocrine systme
With transplant there is a loss of _____ and ____ innervation to donor heart
SNS and PNS
vagal stimulation has no effect on sinus and AV nodes
no reflex tachycardia in response to hypovolemia, hypotension
how does HR increase in a transplant patient
rely on increases in SV via Frank-starling mechanism and circulating catecholamines to increase CO with activity
What are signs/symptoms of rejection?
fever
dsyrhythmias
reduced contractility
increased dyspnea
decreased exercise tolerance
when initiated early after cardiac transplant exercise training _____ the capacity for physical work
increases
Who are candidates for lung transplant?
-advanced lung disease
-50% mortality 24-37 months
-progressive dyspnea
-decreasing function
-high lung allocation score
-good match
what are contraindications for lung transplant?
smoking
extreme weight
profound debility
symptomatic osteoporosis leading to disability
other chronic medical conditions poorly controlled or end-organ damage
what condition has the highest rate for single lung transplants
COPD
what two conditions have the highest rate for double lung transplant
copd
CF- due to the high risk of infection in patients with CF
New lung transplant guidelines are based on lung allocation scores
higher score better or worse?
higher score= higher priority
What are some post lung transplant considerations
-loss of pulmonary lymphatics
-denervated lung- impaired cough reflex
-pulmonary edema
-secretions- increased extravascular fluid
what outcomes change with exercise after lung transplant?
improved exercise capacity
VO2 increases but remains sub-normal
improves myopathy
improved bone health
Increased BMD
improved quality of life
The greatest obstacle to transplantation is _____
lack of donor organs
heightened vulnerability to stressors in the presence of low physiological reserve
frailty
frailty increases with age but is NOT synonymous with age T or F
true
