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KIDNEY
TRANSPLANTATION
PRESENTER: MODERATOR:
DAINY THOMAS MADAM RACHELANDREWS
MSc NURSING IST YEAR STUDENT, LECTURER,
AIIMS. AIIMS.
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INTRODUCTIONINTRODUCTION
Organ transplant of a kidney into a
patient with end- stage renal disease.
Typically classified as deceased-
donor (formerly known as cadaveric)
or living-donor transplantation
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INTRODUCTIONINTRODUCTION
It is the most cost
effective
treatment methodfor ESRD.
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KIDNEY TRANSPLANTATIONKIDNEY TRANSPLANTATION
Living-donor renal transplants:
Genetically related (living-related)
Non-related (living-unrelated)
transplants, depending on whether a
biological relationship exists between the
donor and recipient.
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Donor kidneyDonor kidney--placed inferior of the normalplaced inferior of the normal
anatomical location.anatomical location.
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y First human to human transplant done in
1936, from a B+ cadaver to O+ recipient.
y First cadaveric kidney transplantation in
the United States 1950- polycystic
kidney disease, at Illinois.
y The first kidney transplants between
living patients -1954 (Boston and Paris).
HISTORYHISTORY
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HISTORY (CONTD)HISTORY (CONTD)
y The procedure was done between identical
twins to eliminate any problems of an
immune reaction.
y Dr. Murray received - Nobel Prize for
Medicine(1990).
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ADVANTAGESADVANTAGES
The kidney - easiest organ to transplant:
Tissue typing - simple.
Organ - relatively easy to remove and
implant.Live donors could be used without
difficulty.
In the event of failure, dialysis wasavailable from the 1940s.
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INDICATIONS FOR KTPINDICATIONS FOR KTP
y End-Stage Renal Disease (ESRD),
regardless of the primary cause.
y ESRD is defined as a drop in
the glomerular filtratration rate (GFR)
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CONTRAINDICATIONSCONTRAINDICATIONS
y MALIGNANCY
y RECURRENT DISEASES
y INFECTION
y HIGH PROBABILITY OF POST OPERATIVE
MORBIDITY& MORTALITY
y NONCOMPLIANCE
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Contraindications for KTPContraindications for KTP
Cardiac and pulmonary insufficiency,
Hepatic disease
Incurable terminal infectious diseases
Morbid obesity
Psychiatric illness and/or significant on-
going substance abuse issues.
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SOURCES OF KIDNEY
Depending on the source of the recipient
organ.
y Living-donor transplantation
Genetically related (living-related)
Non-related (living-unrelated)
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SOURCES(Contd)
y Deceased-donor (formerly known as
cadaveric).
Brain-dead (BD) donors or ("heart-
beating): Donor's heart continues to
pump and maintain the circulation.
Donation after Cardiac
Death (DCD):
Have elected via a living will or through
family to withdraw support.
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PAIRED KIDNEY DONATIONPAIRED KIDNEY DONATION
y It is an option for
patients in need of a
kidney transplant who
have a living donor
whose blood or tissue
type is not compatible.
y
Known as KIDN
EYSWAPING
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Recipient evaluation processRecipient evaluation process
y Early referral : as soon as CKD is diagnosed.
y Patient education
y Age
yPolycystic kidneys
y Urinary tract
y Cardiac disease evaluation
y GIT evaluation
y Respiratory disease evaluationy Obesity
y Oral hygiene
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Benefits of a renalBenefits of a renal
transplantationtransplantationy Improved quality of life
y Freedom from dialysis
y Normal healthy diet
y Freedom from liquid restriction
y
Travel freelyy Employment
y Improved fertility
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PRE TRANSPLANTATIONPRE TRANSPLANTATIONPREPARATIONPREPARATION
STAGE 1:STAGE 1: Information and discussionInformation and discussion
Desire to receive a transplantDesire to receive a transplant
Benefits of a renal transplantBenefits of a renal transplant
Risks/ disadvantages of a renal transplantRisks/ disadvantages of a renal transplant
STAGE 2 :STAGE 2 : Clinical assessmentClinical assessment
Clinical historyClinical history
Renal disease & disease progression; dialysisRenal disease & disease progression; dialysis
statusstatus
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Pre transplantation prep.Pre transplantation prep.
STA
GE 2:
Previous medical history: BT, pregnancy,
surgery
Current clinical status
Social history& family status
Personal history: smoking , alcohol, drug abuse
Current medication, allergies, blood group
System wise assessment
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Pre transplantation prepPre transplantation prep
y Information: discussion
x Risks
x Further investigation
x Living donor or cadaveric list
x Immuno suppression regimen
x Decision
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y Stage 3 : Routine Investigations
Blood group
Tissue typing
Biochemistry
Haematology
Liver function tests
Lipid level
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Pre transplantation prepPre transplantation prep
Virology:Hep B &C, HIV, CMV
Chest X- ray, ECG
Mid stream urine
Specific investigation required
y STAGE 4 :
Orientation, Final cross match
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DONOR AND RECIPIENTDONOR AND RECIPIENT
MATCHINGMATCHING
y ABO Blood group
y Major histocompatibility complex (human leukocyte
antigen): Two major types: class 1& class 2
Class 1: HLAA, HLAB,HLAC
Class 2: HLADP, HLADQ, HLADR
A,B,C & DR - 4 Main series important for
transplantation
y Pre transplant cross matching
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Pre transplant cross- match
y Blood sample of recipient +
lymphocytes from the donor.
y If donors cell die, its a +ve cross match
y i.e. recipient is adversely reacting to
donors antigens, so the transplantationwould be rejected.
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SensitizationSensitization
y It is defined as being immunized, or able to
mount an immune response, against an
antigen by previous exposure to that antigen.
Desensitization
y IVIG (2g/kg)
y IVIG + Plasmapheresis
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Research input
yA comparison of the results of renal transplantation fromnon-heart-beating, conventional cadaveric, and living
donors.
y Nicholson ML et al
y Kidney Int. 2000 Dec;58(6):2585-91
y The initial function rates forNHBD, HBD, and LD
transplants were 6.5, 76.3, 93% respectively .Despite being
associated with poor initial graft function, the long-term
allograft survival ofNHBD kidneys does not differ
significantly from the results ofHBD and LD transplants.
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KIDNEY HARVESTINGKIDNEY HARVESTING
From a living donor: Steps
1.Assessment & preparation for donation:
Donor & recipient matching.
Informed consent
Physical and clinical examination
2.Investigations
3.Assessment of surgical risk: Is donation safe for the
recipient & donor ?
4.Preoperative assessment
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ASSESSMENT ANDASSESSMENT AND
PREPARATION OF DONORSPREPARATION OF DONORS
THREE STAGES
y STAGE 1:Assessment
1.Age2.Informed consent
3.Preliminary medical history
4.Renal disease5.Smoking, Drug or alcohol abuse
6.Obesity
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Stage 2: Donor blood clinicalStage 2: Donor blood clinical
teststestsy Blood group
y Tissue typing: T cell &B cell cross match
y Urea ,electrolytes & creatinine
y LFT, fasting glucose
y Hemoglobin & clotting screen
y Viral screen
y Urine tests
y B. P, pulse, weight ,height
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Investigations : 2nd stageInvestigations : 2nd stage
y Done prior to medical assessmenty Blood tests: repeat tissue typing, LFT,
hematology
y
Clinical tests: chest X-ray, ECG, USG of renalsystem
y Urine tests:
Midstream urine,
Urinalysis: proteinuria, hematuria
Assess GFR: 24hr urine for creatinine
clearance, clearance scan.
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Stage 3: Medical AssessmentStage 3: Medical Assessment
y Is donation safe for recipient?
yIs donor fit for a nephrectomy?
yCan donor afford the gift?
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Preoperative Assessment Of bothPreoperative Assessment Of both
donor and recipientdonor and recipient
y Final cross matching & tissue typing
y Methicillin-resistant swabs for Staph.
aureus( throat, nose, axilla, groin)
y Mid stream urine, urinalysis
y Biochemistry,LFT, Hematology,clotting
system
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CONTD
yECG, BP, Pulse, Temperature,Chest
X ray
yOrientation to the unit.
y Final cross- match.
y Pre post op. care.
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CADAVERIC DONATIONCADAVERIC DONATION
Cadaveric donors are patients who sufferedirreversible brain stem damage.
Criteria for multiple organ donationCriteria for multiple organ donation
Patient:Patient:yy Is aged between 18monthsIs aged between 18months--80 years80 years
yy Has suffered irreversible brain damageHas suffered irreversible brain damage
yy Is maintained on a ventilatorIs maintained on a ventilatoryy Has no major untreated sepsisHas no major untreated sepsis
yy Is HIV,Is HIV, HepHep B&C negativeB&C negative
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LIVING DONORSLIVING DONORS
EXCLUSION CRITERIA
y Cognitive deficit
y Active drug or alcohol abuse
y Evidence of renal disease ( low GFR,
proteinuria, abnormal renal anatomy)
y Diabetes , hypertension, CAD
y Active infection, chronic viral
infection(Hep B, Hep C)
y Current/history of neoplasm, family
history of any renal cell cancer
y Current pregnancy
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Surgical technique for livingSurgical technique for living
donor nephrectomydonor nephrectomy
Two approaches:
flank incision with
y Rib resectingy Supra costal approach
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Surgical techniques forSurgical techniques for
nephrectomynephrectomy
yTrans abdominal
yLaparoscopic
y Single port access surgery
yNatural orifice Transluminalendoscopic surgery
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Kidney harvestingKidney harvesting
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Transplantation OperationTransplantation Operation
y In most cases the barely functioning existing
kidneys are not removed.
yThe new kidney is placed in the iliac fossa.
Right side regardless of the side origin
from donor.
Contralateral side to the side of donor.
Ipsilateral side to the donor kidney.
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ContCont
y Its blood vessels connected to arteries and
veins in the recipient's body i.e.,
Renal artery of the kidney, is often
connected to the external iliac artery inthe recipient.
Renal vein of the new kidney, is often
connected to the external iliac vein in therecipient.
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ContCont
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Kidney preservationKidney preservation
1.Cold storage method:
y Suitable upto 30hrs of preservation.
2.Machine perfusion
y Suitable upto 48 hrs.
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Solutions used forSolutions used for
preservationpreservation
y Collins solution.
y University of Wisconsin
solution
y HTK- Custodial
solution
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HTK SolutionHTK Solution
y HTK(Histidine-
Tryptophan-
Ketoglutarate)
Solution.y HTK is perfused as a
cold solution, so that
its hypothermic
effect contributes to adecreased metabolic
rate.
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ContdContd
y Surgery lasts five hours on average.
y Living donor kidneys normally require
35 days to reach normal functioning
levels.
y Cadaveric donations stretch that interval
to 715 days.
y Hospital stay is typically for 47 days.
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Indications forIndications for pretransplantationpretransplantation
native nephrectomynative nephrectomy
Chronic renalChronic renal parenchymalparenchymal infections.infections.
Infected stonesInfected stones
HeavyHeavy ProteinuriaProteinuria
Intractable hypertensionIntractable hypertension
Polycystic kidney diseasePolycystic kidney disease
Acquired renal cystic diseaseAcquired renal cystic disease
Infected refluxInfected reflux
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Postoperative management:Postoperative management:
living donorliving donor
y Hydration: fluid & electrolyte balance
IV hydration for first 24- 48 hrs
monitoring of fluid & electrolyte balance
intake output monitoring
y Wound management- Regular inspection -
bleeding and infection
y Emotional support
y Discharge
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PostPost--opop MxMx of donorsof donors
y Check vital signs.
y Input/ output charting
y Get a Chest -X-ray to exclude any
pneumothorax
y Early ambulation
y Administer analgesics as prescribed
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y Can eat 24-48 hrs post-op.
y Wound management
y Complete recovery takes about 6-8 wks.
y Educate the donor for some lifestyle
changes for risk modification.
PostPost--opop MxMx of donorsof donors
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PostPost-- Op Nursing CareOp Nursing Care
Vital signs every 1hr for 24 hrs, then every
4hrs.
I/O every hr for 24 hrs.
Intravenous fluids as prescribed
Daily weight
Turn, cough, deep breathing, intensive
spirometry.
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Dressing changes, palpate fistula every 4 hr.
No BP or venipuncture in extremity with
fistula.
Catheter care and irrigation
Notify if urine output
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COMMONLY GIVENFLUIDSCOMMONLY GIVENFLUIDS
y Types of fluids
y 5% dextrose RingerLactate NS
y Amount of fluid to be given
Output less than 50ml/hr : inform
Output 50- 200ml/hr: output+150ml
Output 200-400ml/hr: output amount
Output 400-500ml/hr:400ml of fluid
Post operativePost operative
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y For a delayed functioning graft
y Intravenous fluids- maintain CVP 10-15
cm water & frusemide to induce diuresis
y Serum electrolytes: any disturbances
warrant immediate attention
Post operativePost operative
management..management..
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Post op management ofPost op management of
recipientrecipienty Immunosuppressant drugs are must for
good outcome.
y Most common medication are
Calcineurin inhibitors: Tacrolimus or
cyclosporine
Mycophenolate mofetil andAzathioprine
Corticosteroids: prednisolone IVIG
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Uses ofUses of immunoglobulinsimmunoglobulins
y To reduce high levels of preformed anti-
HLA antibodies in sensitized patients.
y To facilitate living donor transplants in
case of +ve cross-match orABO
incompatibility.
y To treat acute rejection.
y To treat certain post transplant viralinfection.
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Post operative management..Post operative management..
Tubes and drains
catheter removal: in the first week
Closed suction drain removal: when output
decreases to
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1.Renal transplant rejection1.Renal transplant rejection
Three types:
yHyper acute rejection
yAcute rejection
yChronic rejection
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HYPER ACUTE REJECTION
Occurs immediately in the operating room, when thegraft becomes mottled and cyanotic.
Causes:previous exposure to the donor antigens.
As in:
Previous rejected kidney transplant.
Multiparous women.
Previous blood transfusion.
Prognosis: kidney removal
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HYPER ACUTE REJECTION
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ACUTE REJECTION
Appears within the first 3 post transplant
months.
Affects 30% of cadaveric transplants and 27%
of transplants from living donors.
20% of patients with transplants experience
recurrent rejection episodes.
S
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SIGNS AND SYMPTOMS
Decreasing urine output
Hypertension, rising creatinine
Mild leukocytosis
Fever
Graft swelling
Pain
Tenderness may be observed
Final diagnosis depends upon a graft biopsy
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y Investigations
Radio isotope renography
Ultra sound
Urine culture and sensitivity
Needle biopsy
yTreatment: high dose pulses ofglucocorticoids
ACUTE REJECTIONACUTE REJECTION
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ManagementManagement
1.High dose corticosteroids
.
2.Repeated.
3.Triple therapy.
a) Corticosteroids
b) Calcineurin inhibitor.c) Antiproliferative agents
4. Plasmapheresis
Not enough
Not enough
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CHRONIC REJECTIONCHRONIC REJECTION
yGradual decline in renal function
associated with interstitial fibrosis
& vascular changes
yFactors associated with chronic
rejection are both immunological +non-immunological
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ManagementManagement
y Irreversible & cannot be prevented.
y Only treatment is a new transplant
after 10 years
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2.Acute occlusion of transplant renal
artery or vein.y Occurs in first transplant week (0.5-8%).
y Causes oligo/anuria andARF.
y
With renal vein thrombosis, graft tenderness,darkHematuria and decreased urine volume.
y Diagnosis is via doppler ultrasound or
radioisotope scanning to demonstrate lack of
blood flow.y Treatment is surgery.
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3.Peritransplant haematoma
y Early post- op complication
y Severe pain over allograft, decreased Hb
orHct, increased serum creatinine.
y Recurrent increased K+ due to lysis ofRBC in haematoma.
y Diagnosis via USG or CT.
y Treatment is surgical and usually leads toallograft nephrectomy.
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4.Urinary Leak
y First transplant month. (2-5%)
y Patient presents with urine extravasation and
ARF, fever, pain and distended abdomen.
y Diagnosis is via ultrasound which demonstrates
a peri-transplant fluid collection or via
radioisotope scanning.
y Treatment is foleys catheter insertion and
surgery.
5 Lymphocoele
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5.Lymphocoele
y Occurs within the first 3 post transplant
months and is due to lymph leaking frominjured lymphatics (5-15%).
y It causes:
Pain
ARF Ipsi-lateral lower extremity oedema,
Occasionally iliac vein thrombosis. Most ofthe signs and symptoms are due to pressure
effects.
y Diagnosis - ultrasound.
y Treatment- percutaneous drainage.
6 Ob t ti U th
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6.Obstructive Uropathy
y Occurs in early post transplant period (3-
6%).y Causes are:
extrinsic compression of the ureter by a
lymphocoele a technical problem with the ureteric
anastomosis to the bladder.
yDiagnosis - ultrasound demonstratinghydronephrosis.
y Treatment is surgical.
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7.Renal artery stenosis
y Late presentation.
y Patients present with uncontrolled HT,
allograft dysfunction and peripheral
oedema.
y Diagnosis is via ultrasound or MRA.
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8.Post-transplant lymphoproliferative
disorder.
9.Imbalances in electrolytes.
10. Infections and sepsis due to the
immunosuppressant drugs that are
required to decrease risk of rejection.
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11. Malignancy11. Malignancy
y Transplant recipients are at significantlyhigher risk for cancers than the generalpopulation because of
(1) ChronicImmunosuppression,
(2) Chronic antigenic stimulation,
(3) Increased susceptibility to oncogenicviral infections, and
(4) Direct neoplastic action ofimmunosuppressants.
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ImmunoImmuno suppressionsuppressiony Combination of drugs are given:
Triple drug regimen
y a glucocorticoid ; eg; prednisolone
y a calcineurine inhibitor ,e.g; cyclosporine, tacrolimus
y a purine antagonist, eg; azathioprine
ormycophenolate mofetil + antilymphocyte antibody,eg ;OKT3
M t i iM t i i
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Most common immunosuppressiveMost common immunosuppressive
protocolsprotocols
1.Cyclosporin/MMF/steroids
2.Tacrolimus/MMF/steroids
3. Cyclosporin/sirolimus/steroids
4. Tacrolimus/sirolimus/steroids
ImmunosuppressiveImmunosuppressive
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ImmunosuppressiveImmunosuppressive
medicationsmedicationsy The calcineurin inhibitors
Eg: cyclosporine , tacrolimus
MOA: formation of a complex with their
respective cytoplasmic receptor proteins. This
complex binds with calcineurin. Inhibition of
calcineurin impairs the expression of several
critical cytokine genes; eg:IL-2,IL-4, interferon
and tumor necrosis factor
ImmunoImmuno suppressive medicationsuppressive medication
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ImmunoImmuno suppressive medicationsuppressive medication
calcineurincalcineurin contconty Drug is primarily excreted through bile.
y Drug level monitoring
y Drug interactions
Drug concentration decreases with
x Rifampin,
x Barbiturates, phenytoin
Drug concentration increases with
x Calcium channel blockers
x Antifungal agents
ImmunoImmuno suppressive medicationsuppressive medication
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ImmunoImmuno suppressive medicationsuppressive medication
calcineurincalcineurin contconty Side effects ofcyclosporin
Nephrotoxicity: decreased GFR
Hypertension
Hepatic dysfunction
Hirsutism, hypertrichosis
Hyperlipidaemia
Hyperkalemia, hypomagnesemia
Hyperuricemia
Gum hypertrophy
ImmunoImmuno suppressive medicationsuppressive medication
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ImmunoImmuno suppressive medicationsuppressive medication
CalcineurinCalcineurin contcont
y Side effect of Tacrolimus
Visual and neurological disturbances
Hypertension
Tremor, headache, insomnia
Raised blood sugar level
Leukopenia
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ImmunoImmuno suppressive .suppressive .y Mycophenolate mofetil
Mechanism of action:
x Reverse inhibitor of enzyme inosine
monophosphate dehydrogenase.
Side effects
x Diarrhoea
x Vomitingx leukopenia
ImmunoImmuno suppressivesuppressive
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ImmunoImmuno suppressivesuppressivey Azathioprine
Mechanism of action
x Inhibits both DNA& RNA synthesis and prevents
growth of lymphocytes
Side effects
x Neutropenia (main)
x Alopecia
x Muscular pains
x Malignancy
x Altered liver function
x Pancreatitis , cholestatic jaundice (rare)
ImmunoImmuno suppressivesuppressive
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ImmunoImmuno suppressivesuppressive
y Prednisolone
Mechanism of action:
x Antiinflammatory responses with blocking of T cell
and interleukin-1
Side effects:
x Cushingoid appearance (facial swelling)
x Fluid retention
x Glaucoma
xIncreased appetite, peptic ulcer
x Hypertension, increased blood sugar level
x Psychosis , mood swings
ImmunoImmuno suppressivesuppressive
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ImmunoImmuno suppressivesuppressivey Orthoclone(OKT3) monoclonal antibody
y Mechanism of action:
x React with CD-3 molecules on the lymphocytes and depletes
them.
y Side effects:
x Chest pain
x Pulmonary edema
x Gastrointestinal disturbances
x Fever with Chills
x Dyspnoea
x Infections
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ImmunoImmuno suppressive..suppressive.. Antilymphocyte globulin- polyclonal antibody
Mechanism of action:
Inhibits and destroy circulatory lymphocytes through
antibody action
Side effects:
Rash
Fever with chills
Anaphylaxis
Thrombocytopenia, leukopenia
Myalgia
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Nursing Management.Nursing Management.
1. Assessing the patient for transplant rejection.
2. Preventing infections
3. Monitoring urinary functions
4. Providing psychological support to the patient &
family.
5. Monitoring & managing potential complications.
6. Patient & family education.
Post operative nursingPost operative nursing
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Post operative nursingPost operative nursing
managementmanagement
Ineffective airway clearance related to depressed
respiratory function, pain, and bed rest
Close monitoring of respiratory status
Assess respiratory pattern, auscultate for any
crackles or abnormal respiratory sounds
Early chest physiotherapy Encourage to do deep breathing& breathing
exercises
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Nursing managementNursing management
Acute pain related to surgical incision
Assess pain : patterns, any radiating pain
Administer analgesics as prescribed
Non pharmacological measures -
distraction , imagery, relaxation etc can be
used to supplement medication.
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Nursing managementNursing management
Risk for fluid and electrolyte imbalance related
to the post operative condition
Assess CVP and urinary output frequently
Hourly intake equal to previous hours output plus
50ml
Monitoring of serum biochemistry and hemoglobin
frequently
Oral fluids usually introduced in early post
operative period as paralytic ileus is rare
N i tN i t
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Nursing managementNursing management
y Risk for rejection of graft
Assessing the patient for transplantation rejection :
oliguria, edema , fever, increase BP, weight gain,
and swelling or tenderness over graft.
Those who receive cyclosporine the only sign may
be asymptomatic rise of serum creatinine >20% is
considered as acute rejection.
Differentiate between infection and rejection.
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Nursing managementNursing management
Potential for developing infection related to the
immuno suppressed state
Assess for Signs and symptoms of infection
Protect patient from exposure to infection: carefulhand hygiene& use of personal protective
equipment
Meticulous catheter care.
Urine cultures, wound drainage culture, catheter tip
culture etc.
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Research inputResearch input
Cytomegalovirus infection renal transplantrecipients: risk factors and outcome.
Kanter J, Pallard L, et al
Transplant Proc. 2009 Jul-Aug;41(6):2156-8
Recipient age older than 55 years, induction therapywith Thymoglobulin, and maintenance immuno
suppression with cyclosporine were the major risk
factors to develop CMV disease. Data showed that CMV
is a common complication after kidney transplantationassociated with older age, induction treatment with
antilymphocyte globulin, worse renal function, and
increased patient morbidity.
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Nursing managementNursing management
Monitoring and managing potential
complications
Assess for complications related to renal failure .
Assess for GI ulceration& bleeding related to
corticosteroid therapy
Monitor closely for signs and symptoms of
adrenal insufficiency
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NURSING MANAGEMENTNURSING MANAGEMENT
Pre operative teaching include:
Post operative pulmonary hygiene
Pain management options
Dietary restrictions Presence of indwelling catheters & IV &arterial
lines
Psychological concerns
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Promoting home based carePromoting home based care
Teach patient self care
Educate them about the need for continuing
immunosuppressive therapy.
Instruct family members to assess for signs
and symptoms of transplant rejection,
infection, & potential adverse effect of
immunosuppressant medication.
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Promoting home care.Promoting home care.
Continuing care
Explain the patient need for life long follow up
care.
Individual verbal & written instructions to be
provided to the patient concerning various
aspects.
Watch for malignancy as the patient is receiving
long term immunosuppressive therapy.
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Post transplant diet restrictionsPost transplant diet restrictions
Variety of foods
Limit sodium, saturated fat and cholesterol intake
Monitor weight on a daily basis
Avoid sugary snacks between meals
Eat 1000- 1500mg calcium daily
Regular exercise 30 mins at least 3 times a week Drink plenty of fluids 3 to 4 litres per day
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BehaviourBehaviour modificationmodification
Eating slowly
Have regular meal patterns with frequent interval
Dont skip breakfast.
Last meal should be taken around 8.30pm
Dont sleep immediately after taking meal
Eat always in pleasant atmosphere. Eat always in sitting down position
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Food hygieneFood hygiene
Raw vegetables should be washed properly
Dont cut vegetables until just before cooking
Dont overcook vegetables
Oil or ghee should not be reused
Cook food hygienically and freshly prepared
Dont eat uncooked foods and avoid eating out
Take only boiled water.
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In post-transplant
patient
P i 1 3 2 0 /k b d
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y Proteins: 1.3 to 2.0 g/kg body wt.
y Calories: 30- 35 kcal/kg
y Carbohydrates: 50% -70% of all calories.y Fat: 35% of calories.
y Sodium:
for normotensive= no restrictions otherwise,
restricted to 2g/day.y K+ : restricted in hyperkalemia
y Fluid:
normo-volumic = 2000ml/day
oliguric: urine output + ~500ml/day
R i l i i iR i l i i i
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Resuming normal activitiesResuming normal activities
Pregnancy
Work
Traveling
Dental care
Skin care
Exercise Vaccinations
A idi i f iA idi i f i
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Avoiding infectionAvoiding infection
Wash hands often
Stay away from people with cold or other infections
Screen visitors for infection
Wash hands after coughing and sneezing.
Avoid live vaccines such as polio, mumps..
Do proper dental care. Avoid contact with animals that roam outside
Si t t h t f
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Signs to watch out for
Fever
Shortness of breath
Cough
Skin changes
Pain or discomfort during micturation
Decrease in urine output, hematuria
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Clinic visits
Upto 2 months : twice a week
3rd month : once a week
4months to 1 yr : twice a month
More than 1 yr : atleast once in3months
Lab tests
Test for kidney function
Test for blood count
Test for liver function
Blood glucose
P iP i
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PrognosisPrognosis
y The donorkidney's
average life
time is 10 to15 years so it
needs second
transplantation
or for sometimes dialysis
again.
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yReferences Nicola Thomas ; Renal nursing ; Second edition, Page
no:337-400
Walch, Retik vaughan and Wein; Campbells
Urology; 8thedition; Page no: 345-373
Dr. Meenakshi Kamboj, Ms Shwetha Mattur, Dr.
Sandeep Gularia; L
iving with a transplant.
www.wikipedia.com
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