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Who is a candidate?
Free of medical problems that would increase risk
- Will NOT take if: advanced/ uncorrected (cardiac) disease, cancer, psych issues, multiple organ involvement |
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Who is a donor?
Healthy, no infection/systemic disease
May donate diseased organs (hepatitis) Living, NHBB, cadavers No significant cancer history No history of kidney disease/adequate kidney function |
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Compatible?
Human Leukocyte Antigen (HLA)
Same blood type, tissue type |
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Tissue typing & blood typing
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Body size
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Geography
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Extensive evaluation process - tissue typing
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Health teaching - ready to take care of themselves?
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Expected clinical findings & potential complications MUST be anticipated by the nurse!
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1. Hyperacute (& Accelerated)
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2. Acute
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3. Chronic
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1st 48 hours - WORST
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Recipient has antibody to donor transplant, not known before
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Risk factors: previous transplant, different blood type
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Clotting cascade vascular damage graft necrosis
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A sure sign of graft failure
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Symptoms: inc. BP & pain at site
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Prevention:
- Matching HLA - Start anti-rejection meds ASAP |
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Within 1 week - 3 months
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Variation of hyperacute
- Body makes lesser amount of antibodies |
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Specific to kidneys
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Symptoms: anuria, inc. BUN & creat., pain
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Within 3 months - MOST COMMON
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Responds best to - immunosuppressive therapy
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Symptoms:
- Dec. urine/anuria - Temp. > 100oF - Inc. BP - Inc. BUN & creat. |
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3 months - 1 year
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Most likely a combination of cell-mediated responses to circulating antibodies
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Symptoms:
- Inc. BUN & creat. - Fatigue - Electrolyte imbalances |
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Treated conservatively
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Infection - AMS, low-grade fevers, opportunistic infections
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Bleeding
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Hematomas/abscesses &
fluid accumulation = wound complications |
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Urinary tract complications
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Combination of...
IMMUNOSUPPRESSANTS & STEROIDS |
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Cyclosporine (Gengraf & Sandimmune): stops the production of IL-2, which prevents activation of lymphocytes involved in transplant rejection
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Anti-proliferatives: inhibit something essential to DNA synthesis, preventing cell division/activating lymphocytes
- Imuran (Azathioprine) - Cellcept (Mycophenolate) - Prograf (Tacrolimus) - Rapamune (Sirolimus) Risk of... leukopenia, thrombocytopenia, opportunistic infection |
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Monoclonal antibodies: target activation sites of T-lymphocytes, increasing their elimination
- Orthoclone (OKT3) - Zenapax (Daclizumab) Risk of... SIRS, developing malignancies |
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Polyclonal antibodies: derived from other animals, bind to and eliminate most T-lymphocytes, stopping rejection
- Atgam (Antithymocyte globulin) |
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