Transplant Quiz 4

Question 1

What is the criteria for an organ transplant?

Answer 1

End-stage disease in transplantable organ
Failure of conventional therapy
Absence of untreatable malignancy or irreversible infection
Absence of disease that would attack new organ

Question 2

What other qualities must a transplant candidate demonstrate in order to receive an organ?

Answer 2

Emotional and psychological stability
Adequate support system
Willing to comply with lifelong immunosuppressive therapy
Age limits and drug and alcohol abuse are specific to transplant facility

Question 3

Who all is on the team of health care professionals to evaluate candidates?

Answer 3

Transplant surgeon
Transplant nurse coordinator
Infectious disease physician
Psychiatrists
Social Worker
Nutritionists
Sometimes a PT

Question 4

What are the types of donors?

Answer 4

Cadaveric - (dead by neurological criteria, death must happen at a place where cardiopulm support is available)
Living- Get to have greater evaluation of organs)

Question 5

What is the average length of stay in the hospital after donating an organ?

Answer 5

1-2 days for kidneys

8 days for simultaneous pancrease-kidney (SPK)

Question 6

How soon are patients ambulating after surgery?

Answer 6

Postop day 1

Question 7

What are some complications after a transplant?

Answer 7

Surgical - vascular (thrombosis, stenosis, leakage at anastomotic sites, and bleeding)
Medical - Fluid overload or dehydration, electrolyte imbalance, hypo/hypertension
Rejection
Infection

Question 8

What are the most common side effects of immunosupressants?

Answer 8

Hypertension
Bone marrow suppression
Electrolyte disturbances
Decrease bone density
Renal dysfunction
Hepatotoxicity

Question 9

What are the 3 approaches to posttransplant immnosupression?

Answer 9

Induction immunosuppression (high dose to prevent acute rejection)
Maintenance (long term)
Antirejection (managing any specific acute rejection at any point)

Question 10

What are the types of rejection?

Answer 10

Hyperacute - within 48 hours, ischemia and necrosis of the graft (general malaise and high fever). Unresponsive to treatment
Acute - within first 3 months to year. Treatable
Chronic - After first few months and is gradual and progressive deterioration of the graft

Question 11

What types of infection are most common with transplants?

Answer 11

Bacterial, Viral, Fungal

Question 12

What is the most common cause of hospitalization, morbidity/mortality after transplant?

Answer 12

Infection

Question 13

What are some general SxS of infection?

Answer 13

Temperature greater than 100.5
Fatigue
Shaking, chills, body aches
Sweating
Diarrhea lasting longer than 2 days
Dyspnea
Cough or sore throat

Question 14

Where is a kidney transplant placed?

Answer 14

Extraperitoneally in the iliac fossa through an obliue lower abdominal incision

Question 15

What is considered excellent renal function?

Answer 15

Urine output of 800-1000 ml per hour
Declining levels of BUN and serum creatinine
(Dialysis may be needed directly after transplant until levels normalize)

Question 16

What are the most common signs of rejection with a kidney transplant?

Answer 16

Increase BUN and serum creatinine levels
Decrease urine output
Increase BP
Weight gain greater than 1 kg in 24 hours
Ankle edema

Question 17

What parameters do you want to monitor with kidney transplant patients?

Answer 17

Intake/output
Daily weights
Inspection of neck veins, 
Skin tugor
Mucous membranes for dehydration
Extremities for edema
Auscultation (crackles can be sign of excess volume)

Question 18

What are some therapy considerations for kidney transplant patients?

Answer 18

Assist in adhering to fluid recommendations (2-3 liters)
BP needs to be maintained to ensure adequate perfusion (systolic needs to be above 110 mmHg)
Consistent BP needs to be monitored over the lifespan because many patients develop hypertension overtime.

Question 19

What’s the goal for preoperative physical therapy for liver transplants?

Answer 19

Aerobic conditioning
Strength training
Posteral education
Maximize functional mobility with focus on education regarding postop follow-up
Fall prevention
Home exercise program
Lifestyle modification

Question 20

What are the types of Liver transplant?

Answer 20

Orthotopic Cadaveric - (removal of diseased liver and new one put in place)
Cadaveric Split - (Divide adult cadaveric liver in situ into 2 functional allografts)
Living Adult Donor

Question 21

What are some indications of liver function after transplant?

Answer 21

Bile production (thick dark-green bile drainage)
Coagulation factors (PT, PTT, INR)
Hypokalemia
Normal to sightly elevated blood glucose levels

Question 22

How long are the tubes left in after liver transplant?

Answer 22

JP suction drains - 1 week

T Tube in bile duct - 12 weeks

Question 23

What is the typical length of stay in the hospital after liver transplant?

Answer 23

1-3 weeks

Question 24

What are some PT considerations after liver transplant?

Answer 24

Deep breathing exercises (prone to atelectasis and pneumonia)
Increased lower extremity edema and abdominal girth can throw off balance and can cause low back pain

Question 25

What are some contraindications for pancreas transplant?

Answer 25

Age greater than 50
Morbid obesity
Active smoking
Severe CVD

Question 26

How fast can a transplanted pancrease start producing insulin?

Answer 26

24 hours

Question 27

What are the types of cardiac transplant?

Answer 27

Orthotopic - removal of previous heart

Heterotpic - “piggy back” retain diseased heart (used for pulmonary HTN)

Question 28

Where do you want the head of the bed after heart transplant?

Answer 28

30-degrees to promote mediastinal drainage

Question 29

When are chest tubes and pacing wires removed after heart transplant?

Answer 29

Chest tubes - 2 days (once drainage is less than 25 ml per hour)
Pacing wires 7 days

Question 30

What are some complications related to pre-op state with heart transplants?

Answer 30

Chronic CHF –> Liver congestion
Anticoagulation reversal inadequate
Renal insufficiency d/t decreased cardiac output, CHF, and diuretics

Question 31

What are some PT considerations after a heart transplant?

Answer 31

Phase 1 cardiac rehab begins 2-3 days post-op

1. ) Ischemia (reduce myocardial contractility)
2. ) Denervation (heart is unaffected by recipients sympathetic and parasympathetic nervous system)
3. ) Diastolic dysfunction (impaired filling)
4. ) Skeletal muscles and biochemical abnormalities

Question 32

What are some physiologic changes after cardiac transplant?

Answer 32

Resting
-Higher HR
-Higher BP
-Normal to slightly less CO
Exercise
-Delayed increase HR
-higher systolic, diastolic may fall
-Delayed increase in CO

Question 33

What are some considerations for PTs and exercise with cardiac transplant?

Answer 33

Sternal precautions
Extended warm-up and cool-down
Use RPE scale
May not experience typical anginal symptoms
Might have 2 P-waves
30-40% lower exercise capacity

Question 34

What are the types of lung transplants?

Answer 34

Single - single anterolateral or posterolateral thoracotomy

Double - Bilateral anterior thoracotomy in 4th or 5th intercostal space (or clamshell incision, Transverse sternotomy)

Question 35

What are some pre-op PT considerations for lung transplants?

Answer 35

Resistive training focus on proximal muscles of upper and lower extremities, core, and respiratory muscles
Use caution with upper-extremity exercise (may lead to dyssynchronous thoracoabdominal breathing and dyspnea

Question 36

What are some post-op complications with lung transplant?

Answer 36

Present with impaired cough reflex, incisional pain, altered chest wall musculoskeletal function and diminished mucociliary clearance
Higher rate of infections (graft is exposed to environment)

Question 37

What are some post-op PT considerations with a lung transplant?

Answer 37

Reeducation in coughing techniques
Education in breathing techniques (diaphragmatic breathing)
Suctioning
Vibration and gentle percussion
Incentive spirometry (maximize lung expansion)
Chest and upper extremity mobilization
Postural drainage and positioning