Chapter 21: Transplants

Ventricular assist device (VAD)

A mechanical pump that helps the ventricles pump blood, easing the workload of the heart in patients with heart failure.

Histocompatibility

A state of mutual tolerance between tissues that allows them to be grafted effectively

pain syndromes

Burning, stabbing, dull; linked with depression correlation between organ rejection and pain intensity primary MS pain: after solid organ transplant, linked with immunosuppressive medications (cyclosporine) partial sympathetic reinnervation following heart transplantation: experience chest discomfort and or shoulder/ arm pain

ECMO

Extracorporeal Membrane Oxygenation. Modification of cardiac bypass. Large-bore catheters are inserted, blood is removed, oxygenated, CO2 is removed, and then returned to body.

hematopoietic cell transplantation

IV infusion of hematopoietic progenitor cells designed to establish marrow and immune function in patients with a variety of acquired and inherited malignant and nonmalignant disorders

chimerism

Two or more genetically different cell lines within a single individual derived from different zygotes

homologous transplant

allogenic transplant; from another person

ischemic reperfusion injury

an attempt to restore blood flow to ischemic tissues or organs potentially causing further damage such as inflammation

graft vs host disease

condition that might occur after an allogeneic transplant. In GvHD, the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body.

GI problems

disorders of colon and rectum diverticulitis (inflammation of pouches of intestines), perforation, malignancy pseudo obstruction, benign anorectal disease barriers to rehab: acute nausea, vomiting, weight loss, restrictions to diet and eating

orthotopic transplant

graft placed in its normal anatomic location

wound healing problems

immunosuppressive drug therapy: impairs and prolongs wound healing risk factors: -immunosuppression, obesity -DM, advancing age, malnutrition, uremia preventative management, inform patients of longer healing time

immunosuppression

impaired ability to provide an immune response

human performance limitations

long recovery period; reintegration into family and work roles lifelong changes: drug compliance, changes in diet stress, anxiety, depression, decreases in cognitive performance pain syndromes decrease in max vo2 decrease in exercise tolerance and capacity extreme weakness and fatigue lumbar spine bone fractures

denervation

loss of sympathetic nerves to the organ lung: reduced tidal volumes and decreased lung compliance -delay in broncodilation response: requires extended warm up period reinnervation does occur to some extent

how long is a graft rejection risk?

most often caused by histocompatibility hyperacute: immediate rejection; antibodies acute or late rejection: days to years after transplantation; cellular and humoral reactions acute: first 3-6 months chronic: 3 months posttransplantation, usually months-years

immunosuppressive complications

pretransplantation: effects of immunosuppression- steroid myopathies, neuropathies, immobility, weakness, renal failure -increases risk of infections and activates latent viruses posttransplantation: infection, graft vs host disease, recurrence of malignancy, sterility, cystitis, veno occlusive liver disease, fatigue, hearing loss, delayed effects of radiation (visual loss)

graft rejection

process in which a recipient's immune system attacks a transplanted organ or tissue

PT Tx evidence to disrupt long-term effects of immunosuppression

side effects: diabetes, accelerated hyperlipidemia, atherosclerosis, CVD; MS effects: decreased bone density, OP, loss of bone density neurotoxic reactions: fine tremor, paraesthesia, seizures, sensorimotor demyelinated polyradiculoneuropathy fine motor difficulties

heterotopic transplant

the transfer of tissue from one part of a body of a donor to another area of the body of a recipient; also called "piggyback" transplantation, is accomplished by leaving the recipient's heart in place and connecting the donor heart to the right side of the chest.

allogenic transplant

transferring the stem cells from a healthy person (the donor) to the patient's body after high-intensity chemotherapy or radiation.

allograft transplant

transplant between genetically different individuals within a species

syngenic transplantation

type of allogeneic transplant, meaning it comes from a donor. You can only receive a syngeneic transplant if you have an identical twin or triplet who can donate stem cells.

xenogenic transplant

use of tissue from another species Originating outside an organism and being introduced.

autologous transplant

using the patients own bone marrow that was harvested before treatment began