1 / 11

The renal transplant patient

The renal transplant patient. Tintinalli’s Chapter 99. Majority of solid organ transplants 60% are cadaveric donors (the ones we donate to LifeBanc) Graft prognosis is directly related to source of donor kidney Cadaveric kidneys have more episodes of rejection and lower graft survival rates

maxima
Download Presentation

The renal transplant patient

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The renal transplant patient Tintinalli’s Chapter 99

  2. Majority of solid organ transplants • 60% are cadaveric donors (the ones we donate to LifeBanc) • Graft prognosis is directly related to source of donor kidney • Cadaveric kidneys have more episodes of rejection and lower graft survival rates • Major causes of morbidity = hypertension, hyperlipidemia, cardiovascular dz, DM, osteoporosis, & malignant neoplasm • Graft prognosis from live donors is better • Causes of death = CAD, sepsis, neoplasm, stroke

  3. ARF (20% rise in baseline serum creatinine) • Complications of surgery • Rejection syndromes • Anti-rejection meds (immunosuppressive agents) • Recurrent renal dz • Renal vascular stenosis & thrombosis • Second post-op month to after 1 yr Causes of graft failure

  4. Transplant rejection • Hyperacute (mins to hrs of transplant) • Acute (days to decades after transplant; most commonly in the first 3 mos.) • Hypertension, low urine output, fever, pain over graft site, leukocytosis; ck creatinine • Chronic • Anytime there is a gradual inc. in creatinine with low grade proteinuria and progressive hypertension Causes of graft failure

  5. Table 99-2 • Corticosteroids • Cyclosporine • Tacrolimus • Sirolimus • Azathioprine • Mycophenolate mofetil • Monoclonal antibodies Immunosuppressive agents

  6. Most common cause of mortality & morbidity in the 1st year • Most common types: • Mucocutaneous • UTI • Respiratory tract (pneumonia accounts for about ½ of deaths from infection) • Most common orgs: • Bacteria • Viral (most common: CMV, HSV, VZV) • Fungal • Protozoan • Table 99-4 Infectious complications

  7. Cardiovascular dz • Inc. in post-transplant pts. (3-5-fold) • Hypertension • CCB’s to tx • Chronic liver dz • Viral hepatitis (CMV, Hep C & B) • Side effects of antirejection drugs • Malignancy • Colon, larynx, lung & bladder; prostate & testis • Lip, skin, kidney, endocrine glands & non-Hodgkin’s lymphoma; cervix & vulva-vagina Other complications…….

  8. Immunosuppressed pts need CMV seronegative blood for transfusion • Most common reason presenting to ED: fever (may be masked secondary to immunosuppressive agents) • Work up for infxn, hypersensitivity rxn, rejection, or malignancy • Esp. if b/w 1st-6th postoperative months

  9. Physical exam (table 99-6) • Edema (may be misleading in vol. depleted pt) • Pain over graft site • Orthostatics to determine hypovolemia • Vital signs, pt wt, skin turgor • Look for common sites of infxn. • Over graft • Surgical incision • Pulmonary tract • GU tract • Abdomen • Head & neck • Rectum

  10. Tests • Serum creatinine • U/A • Cyclosporine/tacrolimus blood levels • CBC w/ diff • LFT’s • Urine Legionella Ag • Bacterial & fungal blood & urine cxs • Renal US

  11. Disposition • GET THEM BACK TO THEIR TRANSPLANT CENTER!!! • Call transplant coordinator ASAP

More Related