Candidates
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Who is a candidate? Free of medical problems that would increase risk
- Will NOT take if: advanced/ uncorrected (cardiac) disease, cancer, psych issues, multiple organ involvement
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Who is a donor? Healthy, no infection/systemic disease
May donate diseased organs (hepatitis)
Living, NHBB, cadavers
No significant cancer history
No history of kidney disease/adequate kidney function
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Compatible? Human Leukocyte Antigen (HLA)
Same blood type, tissue type
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Kidney: ages 2-70
Heart: <65yo, <1 yr to live, stages 3 & 4 HF
Factors to Consider
Tissue typing & blood typing |
Body size |
Geography |
Pre-Op
Extensive evaluation process - tissue typing |
Health teaching - ready to take care of themselves? |
Kidney transplant: dialysis after, may receive blood transfusion before
Post-Op
Expected clinical findings & potential complications MUST be anticipated by the nurse! |
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Stages of Rejection
1. Hyperacute (& Accelerated) |
2. Acute |
3. Chronic |
Hyperacute Rejection
1st 48 hours - WORST |
Recipient has antibody to donor transplant, not known before |
Risk factors: previous transplant, different blood type |
Clotting cascade vascular damage graft necrosis |
A sure sign of graft failure |
Symptoms: inc. BP & pain at site |
Prevention:
- Matching HLA
- Start anti-rejection meds ASAP |
Accelerated Rejection
Within 1 week - 3 months |
Variation of hyperacute
- Body makes lesser amount of antibodies |
Specific to kidneys |
Symptoms: anuria, inc. BUN & creat., pain |
Acute Rejection
Within 3 months - MOST COMMON |
Responds best to - immunosuppressive therapy |
Symptoms:
- Dec. urine/anuria
- Temp. > 100oF
- Inc. BP
- Inc. BUN & creat. |
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Chronic Rejection
3 months - 1 year |
Most likely a combination of cell-mediated responses to circulating antibodies |
Symptoms:
- Inc. BUN & creat.
- Fatigue
- Electrolyte imbalances |
Treated conservatively |
Other Complications
Infection - AMS, low-grade fevers, opportunistic infections |
Bleeding |
Hematomas/abscesses &
fluid accumulation = wound complications |
Urinary tract complications |
Maintenance Drug Therapy
Combination of...
IMMUNOSUPPRESSANTS & STEROIDS |
Cyclosporine (Gengraf & Sandimmune): stops the production of IL-2, which prevents activation of lymphocytes involved in transplant rejection |
Anti-proliferatives: inhibit something essential to DNA synthesis, preventing cell division/activating lymphocytes
- Imuran (Azathioprine)
- Cellcept (Mycophenolate)
- Prograf (Tacrolimus)
- Rapamune (Sirolimus)
Risk of... leukopenia, thrombocytopenia, opportunistic infection |
Monoclonal antibodies: target activation sites of T-lymphocytes, increasing their elimination
- Orthoclone (OKT3)
- Zenapax (Daclizumab)
Risk of... SIRS, developing malignancies |
Polyclonal antibodies: derived from other animals, bind to and eliminate most T-lymphocytes, stopping rejection
- Atgam (Antithymocyte globulin) |
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