Organ and Tissue Transplant

1
Organ and Tissue Transplant
2
Tissue transplantation

• Skin
• Bone
• Cornea
• Tendon
• Blood vessels
• Blood

3
Organ transplantation

• Heart
• Lung
• Liver
• Kidney
• Intestine

4
Before the Transplant

• Brain death
• Donor registry
• Legal responsibility of nurse
• Approaching donor family
• Organ Procurement Organization representative
• Nurse or physician trained by OPO
• Maintenance of donor organs

5
Posttransplantation Complications

• Technical complications
• Graft rejection
• Immunosuppressant-related problems

6
Technical complications

• Vascular thrombosis
• Blood clot in the vasculature of the graft
• Bleeding
• Managed as in any post-op patient except with
  liver transplant
• Must decide whether bleeding is surgical or a
  result of poor liver function
• Anastomosis leakage
• Usually 1 to 3 weeks after surgery
• Usually from inadequate healing (low blood
  supply, steroids)
• Surgically repaired

7
Graft Rejection
Figure 41-1 on page 994 Figure 41-2 on page
995 Figure 41-3 on page 996 Figure 41-4 on page
996 Table 41-1 on page 997

• Immunology of Transplant Rejection
• Immune Mechanism
• 3 Phases
• Hyperacute rejection
• Acute rejection
• Chronic rejection

8
Hyperacute rejection

• B cells activated to produce antibodies
• Minutes to hours after transplant
• Now rare due to improved screening and matching

9
Acute rejection

• Sudden onset days or months after transplant
• Graft antigens recognized as foreign which
  triggers T cells
• T cells and macrophages of the host attack and
  destroy the graft tissue

10
Chronic rejection

• Antibodies slowly attack the graft
• May begin at any time after transplant
• Same immune response as hyperacute but much
  slower
• Eventually the organ dies from ischemia

11
Immunosuppressant-related problems
Table 41-2 on page 998

• Immunosuppressive Therapy
• Goal is to suppress activity of helper and
  cytotoxic T cells
• Corticosteroids
• Antimetabolites
• Azathioprine (mostly targets T cells)
• Mycophenolate mofetil (B and T cells, less toxic
  than azathioprine)
• Antibodies (attack T cells)
• OKT3 may premedicate with diphenhydramine,
  methylprednisolone, and acetaminophen to avoid
  cytokine-release syndrome
• Macrolide antibiotics (class of antibiotics like
  erythromycin inhibit T cell proliferation)
• Tacrolimus
• sirolimus

12
Immunosuppressant-related problems

• Infection
• Immunosupression (duh)
• Watch for temp gt 38 C
• Early, fast identification and treatment
• Organ dysfunction
• Nephrotoxicity
• Hepatotoxicity
• Malignancy
• Increased risk
• Steroid-induced problems
• Hyperglycemia, infection, weight gain, decreased
  healing, bone disorders, cataracts

13
Box 41-16 on page 1014 Box 41-17 on page 1015

• Post-Operative Medical and
  Nursing Management
• Immunosuppression medications
• Rejection surveillance
• Biopsy (heart 1 week periodically)
• Lab tests
• Signs and symptoms
• Infection surveillance
• Assessment of organ function