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Flashcards in Organ Transplant Deck (30)
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1

List the most common organs to be transplanted

  1. Kidney
  2. Liver
  3. Heart

 

*other → pancreas, lung and intestine

2

what are VCAs?

Vascular composite allografts 

involve the transplantation of multiple structures that may include skin, bone, muscles, blood vessels, nerves and connective tissue

face and hand more common type of VCAs

3

What are the basic criteria for transplantation

  1. presence of end-stage disease in a transplantable organ
  2. failure of conventional therapy to treat the condition successfully
  3. absence of untreatable maligancy or irreversible infection
  4. absence of disease that would attack the transplanted organ or tissue

 

4

In order to get an organ transplant, candidates must:

  1. demonstrate emotional and psychological stability
  2. have an adequate support system
  3. be willing to comply w/lifelong immunosuppressive drug therapy

 

5

where do the organs for transplants come from?

  1. Cadaveric donors
    • ppl involved in trauma, determined to be neurologically dead
    • cardiopulmonary support/mechanical vent required to maintain viability of organ
  2. Living donors 
    • stem cells, kidney transplant, liver, lung and pancreas transplantation
    • can be relative, friend or stranger
    • "best fit" = someone of similar height/weight

 

6

what is the UNOS?

United Network for Organ Sharing

sets standards for transplant centers and teams, tissue typing labs, and organ procurement organizations

7

list some factors in decisions to allocate organs

  1. ABO blood typing
  2. tissue (histocompatibility) typing
  3. size
  4. waiting time
  5. severity of illness/degree of med urgency
  6. geo location (distance between donor and recipient)

 

8

how long are organs viable?

  • Heart → 4-6 hrs
  • Lungs → 4-6 hrs 
  • Pancreas → 24 hrs
  • Liver → 24-30 hrs
  • Kidneys → 48-72 hrs

 

9

list some pre-op pt issues 

  1. weakness
  2. possibly prolonged hospitlization
  3. fatigue
  4. extended confinement to bed or home
  5. poor functional mobility including gait
  6. poor breathing mechanics
  7. poor airway clearance

 

10

describe post-op care for an organ donor

  1. taken off mechanical vent in recovery room and transferred to general surgery or transplant ward
  2. VS and blood counts monitored
  3. keep eye out for post op bleeding
  4. pts usually out of bed and walking by POD1
  5. PT is only invovled in instances of complications

 

11

Describe post-op care for an transplant recipient

  1. post-op care focuses on:
    • allograft function
    • rejection
    • infection
    • AE of immunosuppressive drugs
  2. Complications related to:
    • surgical/medical
    • rejection
    • infection

 

12

what is the leading problem of organ transplants?

transplant rejections

13

list 3 drug approaches to post-transplant management

  1. induction immunosuppression
  2. maintainence immunosuppression
  3. antirejection immunosuppression

 

14

what are some PT considerations for pts on immunosupressive agents following transplantation?

  1. increased risk for infection
  2. all drugs have serious AE:
    • systemic symptoms → N/V, fever, chills
    • liver and kidney toxicity
    • mental status changes

 

15

List the types of graft rejections

  1. Hyperacute rejection
  2. Acute rejection
  3. Chronic rejection

 

16

Describe hyperacute rejections

  1. occurs 48 hrs of transplant surgery
    • graft becomes nonfunctional within hrs/days
    • usually due to ABO blood groups or HLA
  2. Usually unresponsive to trx
    • can sometimes be reversed w/vigorous pharm therapy
  3. removal of transplant and subsequent retransplantation

 

 

17

Describe acute rejections

  1. adapative response involving T cells mediated by CD8 T cells, CD4 T cells, or both 
    • may occur within 3 months to one yr post op
    • treatable but requires early intervention
    • antirejection drugs
  2. verifying ABO compatibility and "crossmatching" between donor and recipient decreases likelihood
  3. HLA matching sig improves success rate

 

18

Describe chronic rejections

  1. most likely antibody mediated process involving T and B lymphocytes:
    • usually occurs within a few months post-op
    • gradual and progressive deterioration of graft
    • evental transplantation required
  2. manifests differently in each organ
    • lungs → bronchiolitis obliterans
    • heart → cardiac transplant vasculopathy
    • kidney → transplant nephropathys/transplant glomerulopathy
    • liver → ductopenic rejection/vanishing bile duct syndrome

 

19

what is Acute GVHD?

Acute Graft versus Host Disease

  1. causes tissue destruction via immune response
  2. contributes to post-transplant mortality in 15-40% of pts
  3. symptoms:
    • hepatitis
    • dermatitis
    • GI issues
  4. Cytokine storm

 

20

what is Chronic GVHD?

Chronic Graft vs Host Disease

  1. multiple organ toxicity
  2. develops in 15-50% of pts who survive 3 months post-transplant
  3. involves:
    • integumentary
    • Ocular
    • GI
    • range of other organ dysfunction

 

21

T/F: infections are the leading cause of critical illness, hospitilzations, morbidity and mortality following organ transplant

TRUE

22

List the general S/S of infection

  1. temp > 100.5 F or 38C
  2. Fatigue
  3. shaking, chills, body aches
  4. sweating
  5. diarrhea lasting longer than 2 days
  6. dyspnea
  7. cough or sore throat

 

23

What is the typical LOS for an organ transplant pt?

3-16 days depending on type of transplant and complications

24

What should be included in the basic PT eval?

  1. VS
  2. ROM/strength
  3. integumentary assessment
  4. posture assessment
  5. pulmonary assessment
  6. endurance/activity tolerance
  7. functional mobility
  8. preparing for D/C

 

25

what are the S/S of GVHD?

  1. abdominal pain 
  2. N/V/D
  3. often accompanied by skin rash
  4. specific to organ

 

26

what are S/S of organ rejection?

  1. flu-like symptoms
  2. fever > 101
  3. pain over transplant
  4. fatigue
  5. specific to organ symptoms

 

27

MAP should be at what in post-op transplant pts?

>60-70 mmHg to ensure adequate perfusion to organs

28

PT interventions should focus on what with transplant pts?

  1. focus on impaired gas exchange
  2. airway clearance
  3. positioning
  4. Therex
  5. Transfer training
  6. Gait training

 

29

List some general PT guidelines for post-op transplant pts

  1. coordinate best time to treat pt
  2. monitor MAP
  3. infection control
  4. early mobilization is key
  5. modify activity as appropriate
  6. monitor VS
  7. organ rejection and exercise (can continue if mild-moderate)
  8. effects of immunosuppressive agents
  9. appropriate outcome measures
  10. activity progression

 

30

how long should strenuous exercise that places stress on the incision site be avoided?

~2 months post-op

contact sports should also be avoided for life after transplant