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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