CandidatesWho 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 | 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 | Compatible? Human Leukocyte Antigen (HLA)
Same blood type, tissue type |
Kidney: ages 2-70
Heart: <65yo, <1 yr to live, stages 3 & 4 HF Factors to ConsiderTissue typing & blood typing | Body size | Geography |
Pre-OpExtensive evaluation process - tissue typing | Health teaching - ready to take care of themselves? |
Kidney transplant: dialysis after, may receive blood transfusion before Post-OpExpected clinical findings & potential complications MUST be anticipated by the nurse! |
| | Stages of Rejection1. Hyperacute (& Accelerated) | 2. Acute | 3. Chronic |
Hyperacute Rejection1st 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 RejectionWithin 1 week - 3 months | Variation of hyperacute
- Body makes lesser amount of antibodies | Specific to kidneys | Symptoms: anuria, inc. BUN & creat., pain |
Acute RejectionWithin 3 months - MOST COMMON | Responds best to - immunosuppressive therapy | Symptoms:
- Dec. urine/anuria
- Temp. > 100oF
- Inc. BP
- Inc. BUN & creat. |
| | Chronic Rejection3 months - 1 year | Most likely a combination of cell-mediated responses to circulating antibodies | Symptoms:
- Inc. BUN & creat.
- Fatigue
- Electrolyte imbalances | Treated conservatively |
Other ComplicationsInfection - AMS, low-grade fevers, opportunistic infections | Bleeding | Hematomas/abscesses &
fluid accumulation = wound complications | Urinary tract complications |
Maintenance Drug TherapyCombination 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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