ORGAN TRANSPLANT and RECOVERY

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ORGAN TRANSPLANT and RECOVERY

• K. BROOKS, RN, MSNEd

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The First Successful Transplant Dates Back To
1954!

• 28,000 transplants performed nationally
• Transplants can include liver, intestine, kidney,
  heart, and lung
• Organs fail D/T progressive disease, abuse, or
  congenital malformations/dysfunction
• Donors living or deceased. Who are living
  donors?
• Amazing facts ..

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Crisis!
of organ donors has gone down!
of pts waiting transplant has gone up!
91,000 patients awaiting transplant in 2005
19,621 donors in 2005
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Its up to US!!! NURSES!!!
Assess the Situation and Refer Early!
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One Legacy comes in
More To Be Covered By The Guest Speaker
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Post Operative Care Needsof the Organ Recipient

• Vigilant routine assessments
• Careful planning
• Individualized interventions
• Infection control
• Anti - Rejection Treatment

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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?

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Immunosuppressant MedicationAdvances in
immunosuppressant medications have greatly
improved the success rate with deceased donors.

• Induction
• IV Route
• Maintenance
• PO route

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Let Me Think

• What
• immunosuppressants
• am I already
• familiar with?

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• Corticosteroids OG Fighters
• Methylprednisone/prednisone
• Solumedrol / Deltasone
• Calcineurin Inhibitors
• Cyclosporine
• Tacrolimus (Prograf)
• Sandimmune
• Antiproliferative
• Cellcept

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Striking a Balance
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Maintenance Immunosuppression
1) Combination Therapy

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

3) Low doses of each (to reduce the
adverse side effects)
4) Monitor therapeutic levels with
troughs and monitor adverse SE
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What does Rejection Look Like?
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Key Nursing Assessments of Transplant Patients

• All Patients
• Vital Signs
• Weights
• Strict I / O
• S/Sx infection
• Specific Organs
• Heart
• Liver
• Renal

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HEART

• 30 40 of heart transplants experience a
• rejection during the first year after
• transplantation.
• Signs and Symptoms
• Diagnosing rejection

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LIVER

• Rejection occurs in up to 60 of all liver
  transplant recipients
• Signs and symptoms
• Labs to monitor
• Diagnosing rejection

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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

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Renal Transplant Procedure
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RENAL

• Nursing Management - Post Op
• Infection precaution
• Adequate perfusion hemodynamics / CVP
  monitoring
• Fluid replacement
• Bleeding
• Pain Management
• Drains

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Nursing AssessmentRejection
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Nurses Educate!

• Education Keys
• Immunosuppressant Therapy
• S/Sx Organ Rejection
• Organ specific risks

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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.