KIDNEY TRANSPLANT Flashcards
Kidney recipient selection includes
- No medical issues that increase risk
- HIV & Hep B or C okay to have.
- 2-70 yo, >70 considered on individual basis
- Histocompatibility Studies
Kidney donor selection includes
- Paired or Chain exchange donation
- Must have compatible blood type & ABO compatibility
- Insurance will cover, but it will not cover work time off
- Living have highest rate of kidney graft survival (90%)
- > 18yo, seldom over 65, although some are over 70
- Absence of systemic disease and infection
- No current active cancer
- No hypertension or kidney disease
- Adequate kidney function as determined by diagnostic studies
- Must express a clear understanding of the surgery and still be willing
- Some states require a psych eval to assess motivation
Contraindications for recipient
- Advanced, uncorrectable cardiac disease
- Metastatic cancer (less than 2-5 years)
- Chronic infection
- Psych issues (substance abuse)
- Long standing pulmonary disease
- GI disorders require treatment because of long term
steroid use. - DM and other endocrine disorders are high risk
Labs
Step 1 – Human Leukocyte Antigens (HLA) Matching
Matching of 6 HLA is best
Step 2 – Panel Reactive Antibody (PRA)
Lower %age is better
Step 3 – Cross match Test
Negative is good result
Preop care for recipient
- 4-5-day hospital stay
- Preop workup – crossmatch done again right before
surgery b/c blood antibodies change over time* - Maintain vascular access – may need after surgery
- Dialysis usually 24 hours before surgery & an infusion
of donor blood is usually given - Urinary system evaluation
- Some have not used lower urinary tract for years so
ureter and bladder problems may require surgical
correction before transplant
Preop care for donor
- 2-4-day hospital stay, return to work 4-6 weeks
- Labs
- Pain management
- Wound care
- Psych support
Foley is placed to monitor UO and decompress the bladder (CAUTI prevention), removed 3-5 days.
Assessment of hourly urine output × 48 hours
o Abrupt loss of urine is a sign of rejection, AKI, thrombosis, or obstruction
o Color may be pink/bloody right after surgery, returns to normal over days/weeks
o Daily urine for UA, glucose, acetone presence, specific gravity, & culture (if needed)
o Replace 1ml loss for 1ml because UO can be as high as 1L per hour **Prevent dehydration
o Electrolyte imbalances – High risk – decreased Na and decreased K – 0.9% w/KCL may be needed
o Daily weights – should not gain weight!!!! Could indicate kidney not working
Complications
Rejection
Susceptibility to infection
Thrombosis
Renal artery stenosis
Wound infection
Post Kidney transplant rejection signs
Hyperacute
onset within 24 hrs
Malaise, high fever, ^BP
Pain at transplant site
Organ must be removed
Post Kidney transplant rejection signs
Acute
occurs within 6 months
oliguria, anuria
^temp over 100F
^BP
Flank tenderness
Lethargy
^BUN, K, Creatinine
Fluid retention
Not uncommon to have at least one rejection episode
Post Kidney transplant rejection signs
Chronic
Gradual over months to years
Gradual ^ BUN, Creatinine
Imbalances in proteinuria electrolytes
Fatigue
Irreversible
Immunosuppressive drug therapy must be adhered to.
Immunosuppressants for life! & Corticosteroids (may wean off after a couple years
A/E of immunosuppressants
Malignancy (cancers), CAD, HTN, Infection
A/E of corticosteroids
Hyperglycemia, Infection, HTN, Hyperlipidemia, Osteoporosis, Joint pain
Kidney transplant recipients are at risk for
cardiovascular disease (the most common cause of death
among kidney transplant recipients), diabetes, cancer,
and infections
