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Flashcards in transplant patient Deck (42):
1

criteria

end stage disease
conventional rx failed
no untreatable malignancy/infection
no disease process leading to attack of transplanted organ/itssue
demonstrates emotional and psych stability
good support system
good compliance w/ medical regimen

2

cadaveric donors

transplant source
suffered severe nero trauma w/ resulting brain death
organs remain viable w/ meds and mechanical means
no sepsis, malignancy, communicable disease

3

living donors

kidney, liver, lung, pancreas, bone marrow
more time to be evaluated by transplant team
newborn --> 65yo
no hx of drug/ETOH abuse, chronic disease, malignancy, communicable diseases

4

compatibility issues

ABO blood type
histocompatibility typing
size

5

histocompatibility typing

HLA (human leukocyte antigens)
white cell crossmatch
due to short organ ischemic times, may bot have time to perform typing

6

UNOS

united network for organ sharing

responsible for procurement and distribution of organs
sets standards for MD, transplant facilities, labs, organ procurement organizations

7

UNOS distributes organs based on

illness severity, blood type, weight match, recipient eating time

8

transplant rejection

normal immune repsonse
immunosuppressive drugs

9

immunosuppressive drugs

usually double or triple drug regimen
prevent total rejection
decrease body response to fighting infection
balance is key

10

hyper acute graft rejection

occurs w/in first 48 hrs of transplant
usually due to ABO incompatibility or cytotoxic antibodies in recipient
presents w/ high fever and malaise
unresponsive to tx
only option is to remove transplant

11

acute graft rejection

occurs during first year
small vessel damage due to T lymphocyte repsonse
if not detected, whole organ becomes ischemic
treatable and reversible

12

acute graft rejection presents w/

sudden weight gain
peripheral edema
malaise
dyspnea
decreased urine output
electrolyte imbalance
elevated BP
swelling/tenderness at graft site

13

chronic graft rejection

occurs after first year of transplant
due to immunoglobulin M complexes and compliment formed in organ vessels
deterioration is gradual and progressive
drugs may slow process down, but will not stop it
eventual need of re-transplant
presentation depends on organ involved

14

infection

immunosuppressants increase chance
if present, decrease drugs and start Antibiotics
proper hand washing before and after pt care

15

highest risk of infection is

within 3 months of transplant

16

signs of infection

temp > 100.5
fatigue
chills
sweating
diarrhea > 2 days
dyspnea
cough
c/o sore throat

17

transplant types

kidney
liver
pancreas
heart
lung
bone marrow
double transplants

18

cadaveric kidney may be viable for 72 hours

72 hours

last organ usually harvested
30-40% chance of acute tubular necrosis

19

type of donor preferred for renal transplant

increase graft and recipient survival
more time for match eval
decrease chance of damage during procurement
decreased risk of ATN

20

recipient kindly remains unless

infected or uncontrolled HTN

21

donor kidney placed in

iliac fossa

extraperitoneal
low ab incision
advantages

renal artery/vein of donor connected to iliac artery/vein or recipient

ureter sutured to bladder

22

renal post op

dialysis may be needed first few weeks
strict I and O

23

signs of rejection

decreased urine output
increased BUN and serum creatinine
increased BP
wt gain (>1kg/24 hr)
ankle edema

24

BP w/ renal treatment

systolic maintained > 110 mm Hg
ensure adequate rental perfusion

increase is higher than normal w/ acitivity

25

orthotopic cadaveric (liver)

disease liver removed
new liver placed in anatomical position
incision-midline sternotomy and continuous laparotomy

26

living adult donor (liver)

single lobe transplanted
liver regulates to normal size in donor and recipient w/in several months

27

split liver

adult cadaveric liver is divided into two in situ
usually left lobe given to child due to small size
right lobe given to adult

28

domino (liver)

pt w/ FAP
involves 3 people
pt w/ FAP recieves donor liver
FAP liver goes to another recipeient

29

symptoms from FAP manifest

40-60 years

30

liver post op

three JP suction drains
biliary T tube

31

liver rejection

prolonged PT/PTT, abnormal liver panel, oliguria, metabolic acidosis, hyperkalemia, kypoglecemia, coma

32

tx for liver rejection

immediate retransplant

33

liver therapy - post op ascites

increased abdominal girth
LE edema
increased lumbar lordosis
COG shifts leading to possible balance

34

pancreas transplant

not live saving procedure
pt w/ metabolic implant, Type I DM, severe brittle diabetes
may prohibit neuropathy progression
performed before severe diabetic complications occur

35

pancreas transplant procedure

lower oblique abdominal incision
bladder drainage technique
BW monitored
some pts insulin indep 5 yrs

36

pancreas - bladder drainage technique

donor duodenum attached to urinary bladder
loss of fluids needs to be monitored

37

pancreas transplant post op

strict bed rest for a few days
loss of fluids monitored

38

pancreas transplant post op - signs of rejection

ab pain
fever
tenderness at graft site
hematuria
hyperglycemia

39

pancreas transplant therapy

remind pt to stay hydrated esp w/ avitivieis
record I and O on record sheet

40

pancreas and kidney transplants in diabetic pts

MDs may prefer to perform simultaneously due to potent immunosuppressive drugs

41

orthotopic heart transplant

most common
median sternotomy incision
medial sternotomy incision
heart is removed except for post right atrium w/ SA node, left atrium, aorta, pulmonary artery
new heart is placed in anatomical position
EKG shows two P waves, but only new heart has ventricular contraction

42

hetertopic heart transplant

rare
diseased heart is left in place
donor heart placed to right side of existing
donor L vent supports systemic circulation
native R ven supports pulm circulation
EKG shows 2 rhythms/rates