Week 12: Organ Recipient Flashcards Preview

NUR4630 > Week 12: Organ Recipient > Flashcards

Flashcards in Week 12: Organ Recipient Deck (13):
1

Histocompatability

  • The ability of the cells and tissues to live withut the interference from the immune system.
  • Histocompatability complexes (MHC)
    • Special molecules that allow the body to identify foreign bodies
    • Human leukocytes antigens (HLA)- appears in pairs on cells and are genetically determined.
  • Two groups of MHCs
    • MHC I (Class I) Antigens: those that are found in the surface of potentially all nucleated cells
    • MHC II (Class II ) Antigens: found on b-lymphocytes

 

2

donor recipient compatability testing

Tissue Typing: actual identification of the HLA antigens and looks at both the donor and recipient to see if there is a degree of compatability between those two
Crossmatching: looking for antidonor antibodies (had presensitization to antigens coming from recipient tissue).
ABO Typing: Identifies blood group of donor and recipient

 

 

3

technical post transplant complications

  • Vascular Thrombosis: the actual tissue organ being grafted has clot formation within the vasculature itself (arteries).  
  • Bleeding: In liver transplant recipients, it's often difficult to differentiate if bleeding is secondary to coagulopathy from liver or surgical problem.  More difficult to manage.  Allow bleeding to continue until coagulopathy has resolved and there is normal liver function.  Treat symptoms but not try to correct was causes it.  Coagulopathy will self correct. 
  • Anastomosis Leakage: At site where graft was placed.  Occurs 1-3 weeks after.

 

*Have to do with the actual performing of the transplant

4

Graft Rejection

 

*activation of immune response against transplanted tissue.  Triggers auto-immune response.  Seen as a result of T and B lymphocyte activites.  Rejection is based on time and speed

Hyperacute: type 3 hypersensitivity response occuring within minutes to hours.

Acute Rejection: Sudden onset within days or months, typically beginning as hypersensitivy response.  HLA antigens are recognized as being foreign, triggering immune response


Chronic Rejections: Slow.  Begins any time following transplant, up to years.  Over time the organ becomes ischemic and dies

 


 

5

immunosuppressant-related problems

  • Infection: Leading cause of death in post-transplant pts.  Common sources include pneumonia, absecces, and point of access from a catheter or wound, CMV, CDiff, fungi
  • Organ dysfunction:toxicity from medications 
  • Malignancy: At increased risk for this.  Non-hodkins, lymphoma, caposes carcoma etc.
  • Steroid-Induced Problems: Long term use results in hyperglycemia, weight gain, bone diseases, increased risk for infections

 

 

 

6

Cylosporine

  • Concentration controlled drug: regular blood draws are obtained to evaluate serum levels
  • CyA or CsA (abbreviations).  Prevention of allograft rejections. 
  • Formulations
    • Sandimmune
    • Neoral
    • Gengraf
  • Targets helper T cells
  • Hepatotoxicity, nephrotoxicity, neuronal toxicity, hyperglycemia, facial hair growth, hyperplasia of gingivae

 

7

Corticosteroids

  • Have both anti-inflammatory and immunosuppressant qualities
  • Interfere with the production and secretion of interleukin-2 (T lymphocyte)
  • High doses impact immunoglobulin G (IgG) (B lymphocytes)
  • Suppression of the macrophages
  • Used as a rescue therapy for those experiencing rejection

8

Antimetabolites

Cytotoxic agents.  Used in pts to target t and b cells


Azathioprine (AZA)

  • Inhibits DNA and RNA synthesis
  • Target T cells but has effect on B cells
  • Imuran: significant effects on pts blood cell production (anemias and thrombocytopenias, leukopenia)

Mycophenolate Mofetil (MMF): Newer agent, less likely to cause anemias, thrombocytopenias, and leukopenias, LESS TOXIC

  • Less toxic than AZA
  • Produced from PCN mold
  • Inhibits DNA and RNA synthesis
  • Targets T and B cells
  • Cellcept

9

Antibodies 

Antilymphocyte antibodies

Two catagories:

  • Monoclonal Antibodies (mAB): increase attack targeted to the lymphocytes to prevent immune rejection.
    • Cytokine-release syndrome (CRS): reaction associated with initiation of this therapy.  See it with very first dose.  Severe flu-like symptoms.
  • OKT3
    • Polyclonal antibodies

 

 

10

Macrolide Antibotics

  • Tacrolimus (Prograf):  attacks helper T lymphocytes.  Been associated with onset of DM.  Reversible with cessation of Prograf.
  • Sirolimus (Rapamune):  Blocks both T and B cells (cytokine proliferation).  Similar to Prograf, but has less toxicity.

Used to cause cellular death

11

Kidney transplantation preparation of recipient and post op

Preparation

  • Prophylactic antibiotics
  • Crossmatching
  • Immunosuppressant tx

Post op

  • IV fluids to keep UO  greater than 100cc/hr
  • Diuretic therapy
  • Daily weights
  • CVP and vital signs
  • Prophylactic antibiotics
  • Monitor: serum creatinine and electrolytes, H&H, glucose, BUN, ABG’s, WBCs
  • Hourly I&O
  •  

12

heart, heart-lung, and lung transplant prep and post-op

Preparation for transplant

  • Most require aggressive treatment to bridge to transplant

Post-operative management

  • similar to that of any open heart surgery.
  • However, increase risk of pulmonary dysfunction.

 

 

13

liver transplant

Preparation of the recipient

  • similar to any other organ transplant

Post-operative management

  • Monitor bile drainage
  • PT/PTT
  • ALT
  • AST
  • Bilirubin (total and direct)
  • Ammonia levels
  • Glucose
  • Neuro status

*Rejection often is noted with increase in ALT/AST, Bilirubin, WBC, and s/s malaise, fever, confusion, hepatomegaly, and RUQ pain.