organ transplant and recovery k. brooks, rn, msned

ORGAN TRANSPLANT and

RECOVERY

K. BROOKS, RN, MSNEd

The First Successful Transplant Dates Back To 1954!

• 28,000 transplants performed nationally

• Transplants can include liver, intestine, kidney, heart, liver, intestine, kidney, heart, and lungand lung

• Organs fail D/T progressive disease, abuse, or congenital malformations/dysfunction

• Donors: “living” or “deceased”. Who are living donors?

• Amazing facts …………..

# of organ

donors has

gone down!

# of pts waiting transplant has gone up!

19,621 donors in 2005

91,000 patients awaiting transplant in 2005

It’s up to US!!! NURSES!!!

Assess the Situation and Refer Early!

“One Legacy” comes in …

More To Be Covered By The Guest Speaker

Post Operative Care Needsof the Organ Recipient

• Vigilant routine assessments

• Careful planning

• Individualized interventions

• Infection control

• Anti - Rejection Treatment

Transplant Care: “Rejection and Infection”

Review: the Immune System (normal response)

What is Rejection?

When is the high risk period?

For how long do you need to monitor for rejection?

Immunosuppressant Medication

Advances in immunosuppressant medications have greatly improved the

success rate with deceased donors.

Induction

IV Route

Maintenance

PO route

Let Me Think …

What

immunosuppressants

am I already

familiar with?

Corticosteroids “OG Fighters”

Methylprednisone/prednisone

Solumedrol / Deltasone

Calcineurin Inhibitors*Cyclosporine

*Tacrolimus (Prograf)

Sandimmune

Antiproliferative

Cellcept

Striking a Balance

1) Combination Therapy

3) Low doses of each (to reduce the adverse side effects)

2) One drug ONLY from each of the (3) families

“Maintenance Immunosuppression”

4) Monitor therapeutic levels with troughs and monitor adverse SE

What does Rejection Look Like?

Key Nursing Assessments of Transplant Patients

All PatientsI. Vital SignsII. WeightsIII. Strict I / OIV. S/Sx infection

Specific OrgansI. HeartII. LiverIII. Renal

HEART

“30 – 40% of heart transplants experience a

rejection during the first year after

transplantation.“

Signs and Symptoms

Diagnosing rejection

LIVER

“Rejection occurs in up to 60% of all liver transplant recipients”

Signs and symptoms

Labs to monitor

Diagnosing rejection

RENAL

“Rejection rates in the first year after

transplantation have decreased to 15%”

More cost effective than dialysis over a ten year period

The most commonly performed type of solid organ transplant

Renal Transplant Procedure

Nursing Management - Post OpNursing Management - Post Op Infection precaution ***Adequate perfusion – hemodynamics /

CVP monitoring ***Fluid replacementBleeding Pain ManagementDrains

RENAL

Nursing Assessment“Rejection”

Nurses Educate!

Education Keys:

• Immunosuppressant Therapy

• S/Sx Organ Rejection

• Organ specific risks

Additional Resources

Barone, C., Martin-Watson, A., Barone, G. (2004, October). The postoperative care of the renal transplant recipient. MedSurg Nursing, 13 (5), pp. 296-303.

Good, E., RN, MSN. (2000). Caring for patients with donor. Nursing 2000, 30 (6), pp. 34-39.