N418 Final Exam New Material Organ Transplantation

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. · If it is a case of brain death and there is a good chance we can get some solid organs (like the heart and lungs) then they will probably send a representative to the hospital to look at the chart and evaluate the patient · ****The Uniform ____ ____ _____ (UAGA or the Act) was passed in the US in 1968 and has since been revised in 1987 and in 2006. The Act sets a regulatory framework for the donation of organs, tissues, and other human body parts in the US. The UAGA helps regulate body donations to science, medicine, and education.****

Anatomical Gift Act

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. · When you call the OPA make sure you are near the chart so you can answer their questions about the patient and provide them with any information that they need o At the very least they are going to want to know the diagnosis o If the patient is potentially an organ or a tissue donor then they are going to ask even more questions (what comorbidities they have, how much fluids they have gotten, what kind of treatments have they had)

Anatomical Gift Act

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions? a. "I need to be monitored closely for development of malignant tumors." b. "After a couple of years I will be able to stop taking the cyclosporine." c. "If I develop acute rejection episode, I will need additional types of drugs." d. "The drugs are combined to inhibit different ways the kidney can be rejected."

B

The following is information under kidney transplantation: Surgical Procedure: POST-OP Course: · 12 - 24 hours in ICU · 4 - 5 days in the hospital (average LOS) · Standard post-op care (wound care, anesthesia, etc.) · First priority is fluid/electrolyte balance o Pay attention to UO and _____/_____ o Careful intake and output

BUN/creatinine

When someone needs an organ transplant, the process is that they get referred to a transplant center and they get worked up there to see if they are a candidate for a transplant—lots of things go into it and there are some contraindications. Name some contraindications for organ transplantation.

Disseminated malignancies (any kind of cancer with metastasis), refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders (because follow up after a transplant is very important and the patient has to have a good support system and they have to take lots of medication and be compliant with taking their meds).

After a kidney transplantation (post-op), we have to monitor urine output because a sudden decrease in urinary output is a cause for concern. It may signal what 4 complications?

It may signal: 1. Dehydration 2. Rejection 3. Urine leak · Whenever they re-anastomose the kidney to the bladder they can leak at that anastomosis site which would mean urine is leaking into the peritoneal space, so you wouldn't see as much urine coming out of the bladder 4. Obstruction · Anytime they anastomose tissue there is a risk for hyperplasia or kinking

The following are ______'s transplant centers: · Ochsner o Liver, kidney, pancreas, heart and lung · Tulane o Kidney, liver, and pancreas · Willis-Knighton Health System o Kidney, kidney-pancreas, pancreas, liver · Children's Hospital New Orleans o Kidney? o Stem cell and bone marrow transplants

Louisiana

The following is _______'s waiting list for organ transplants: · All organs = 2,092 (1856—on voiceover) · Kidney = 1,806 (1584) · Liver = 169 (137) · Pancreas = 4 · Kidney/Pancreas = 39 (42) · Heart = 60 (73) · Lung = 14 (20)

Louisiana

What 2 scores/models are used to determine the urgency for liver transplants? · Deceased and live donor livers. · 12-15 hours (8-12 hours on diagram) to transplant o Longer than the heart and the lungs

MELD (Model for End-Stage Liver Disease) or PELD Score (Pediatric End-Stage Liver Disease) - determines urgency for transplant

What specific immunosuppressant therapy drug is described below? · anti-antigen receptor antibody that interferes with the function of the T lymphocyte, the pivotal cell in the response to graft rejection. o Used for the prevention and treatment of acute rejection episodes § So, if you have someone on immunosuppressant therapy and they have an episode of acute rejection then they might add some monoclonal antibodies until they get it under control

Monoclonal antibodies

What specific immunosuppressant therapy drug is described below? · CellCept® & Myfortic®)- lymphocyte specific inhibitor of purine synthesis o Suppressive effects on both T and B lymphocytes o Most effective when used with tacrolimus or cyclosporine (synchronous effects) o Limited by GI toxicities - N & V, diarrhea § Manage by lowering dose or giving smaller doses more frequently

Mycophenolate mofetil

What type of stem cell transplant is described below (BMT, PSCT, HSCT): · stem cells taken from the blood stream and then reinfused through the blood stream o ****These stem cells are a little more mature because they are already out in the peripheral circulation*****

Peripheral stem cell transplantation (PSCT)

What specific immunosuppressant therapy drug is described below? · lymphocyte immune globulin o Induction therapy (when you are trying to get someone's immune system suppressed) or to treat acute rejection.

Polyclonal antibody

What specific immunosuppressant therapy drug is described below? o Immunosuppressant o Renal transplants o Used in combination with cyclosporine/tacrolimus and corticosteroids

Sirolimus

T or F. When talking about liver transplants, the liver is subject to a less aggressive immunologic attack than other organs. o Odd because it's usually our liver that produces a lot of our immunoglobulins

T

T or F. the success of lung transplant is the ability to wean the patient off the vent (once they can breathe on their own). The success of heart transplant is the ability to maintain hemodynamic stability (once you get them off the drips like epinephrine or other drugs that support heart function).

T

The following is information under kidney transplantation: Surgical Procedure: POST-OP Course: · May be putting out as much as ____ liter per hour—that is a lot of volume · They can get prerenal and ATN causing injury to their kidney if their vascular volume is not maintained o Replace fluids to maintain their vascular volume and maintain blood flow to the new kidney · ATN (acute tubular necrosis) may occur requiring dialysis

1

there are 3 different types of rejection of the graft with organ transplantation. What are the 3 different types?

1. hyperacute 2. acute 3. chronic

When talking about Graft versus Host disease, what are the 3 target organs: o __1___—painful pruritic rash starting with hands and feet. Can become generalized. o __2____ - mild jaundice with elevated liver enzymes to hepatic coma o __3____ - mild to severe diarrhea, severe abdominal pain, GI bleeding, and malabsorption

1. skin 2. liver 3. GI

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o Occurs within days to months o Mediated by T-cytotoxic lymphocytes o Can be reversed with immunosuppressive drugs o Not uncommon for most organ recipients to have at least one episode

acute

What type of stem cell transplant is described below (BMT, PSCT, HSCT): · stem cells taken from the bone marrow. o Stem cells are brand new cells that haven't differentiated yet o Take stem cells from the bone marrow if a donor and transplant them into the bone marrow of a recipient

Bone marrow transplant (BMT)

An older adult patient has a prescription for cyclosporine following a kidney transplant. Which information in the patient's health history has implications for planning patient teaching about the medication at this time? a. The patient restricts salt to 2 grams per day. b. The patient eats green leafy vegetables daily. c. The patient drinks grapefruit juice every day. d. The patient drinks 3 to 4 quarts of fluid each day.

C

Immunosuppressant therapy for organ transplants includes ______ ____ which prevent cell mediated attacks against transplanted organs. o Tacrolimus [Prograf' Astragraf XL] o Cyclosporine [Gengraf; Neoral; SandImmune]

Calcineurin Inhibitors

One of the main signs and symptoms of a heart transplant rejection includes a _____ _____ _____ which includes the following: · Is characterized by vascular injury induced by a variety of noxious stimuli, including the immune system response to the allograft, ischemia-reperfusion injury, viral infection and immunosuppressive drugs, and classic risk factors such as hyperlipidemia, insulin resistance, and hypertension · An accelerated form of CAD—the process of those coronary arteries becoming narrowed happens much quicker · Can lead to MI · Beyond the first year, ____ ____ _____ (CAV, also called transplant coronary artery disease or cardiac transplant vasculopathy) is among the top three causes of death, after malignancy as shown in the reports of the Registry of the International Society of Heart and Lung Transplantation

Cardiac allograft vasculopathy (CAV)

human leukocyte antigen (HLA) is a gene complex encoding the major histocompatibility complex (MHC) proteins in humans. These cell-surface proteins are responsible for the regulation of the immune system in humans. This is important for them to match this as best as the can to try and prevent and minimize the degree of rejection. ____ HLAs are important for transplant: A, B and DR antigens. · Everybody gets 3 from mother and 3 from father o Example: A2 (mother), A30 (father) B8, B70 DR3, DR8 o 25% (1 in 4) chance that a sibling will be an exact match o Identical twins are exact matches

6

Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of the rash? a. The donor T cells are attacking the patient's skin cells. b. The patient needs treatment to prevent hyperacute rejection. c. The patient's antibodies are rejecting the donor bone marrow. d. The patient is experiencing a delayed hypersensitivity reaction.

A

Name 2 advantages of kidney Live donors.

Advantages are: 1. Better graft survival rates—because its elective and they can try to find the best match 2. Elective surgery—it can be scheduled to where we know the patient is in good health at the time of the surgery whereas whenever someone is waiting on an organ. Whenever that organ becomes available then that is when that surgery has to occur so the patient may not be in the best of health at that particular time

Name some adverse effects of immunosuppressant therapy for organ transplants.

Adverse reactions: o Infections, malignancy, nephrotoxicity, neurotoxicity (tremors, HA, paresthesia) § Monitor their renal function

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. § Anytime we are expecting a person to die (like if we are withdrawing support) then we can call LOPA at that time § Even if you know that patient is not a candidate for organ donation, you still have to call LOPA—it is the OPA that is going to make the decision whether or not the patient is a candidate for transplant or not

Anatomical Gift Act

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. § This is where we use the Glasgow Coma trigger scale of 5 to call (anytime a patient has a score of 5 or less we are supposed to notify the organ procurement agency) § Should also notify the OPO/OPA (organ procurement organization) if anyone passes/dies

Anatomical Gift Act

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. § We make the call, we get a referral number, and that referral number needs to be documented in the chart o much fluids they have gotten, what kind of treatments have they had) · When you call, you will get someone that screens the calls, and they have a protocol that they follow—if the patient is a potential organ or tissue donor, then that will get transferred to one of the nurses who will follow up and see if the patient is someone that could potentially be an organ donor

Anatomical Gift Act

Organ/tissue donation is regulated by the _____ _____ _____. This is a federal law and part of that law is the requirement that HCPs report all deaths to the local organ procurement agency. § We make the call, we get a referral number, and that referral number needs to be documented in the chart · Most places will also make you call the nurse supervisor and give them that referral number as well to ensure that it is documented appropriately · When you call the OPA make sure you are near the chart so you can answer their questions about the patient and provide them with any information that they need

Anatomical Gift Act

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o ______ rejection is a process that occurs over months or years and is irreversible. ________ rejection can occur for unknown reasons or from repeated episodes of acute rejection. The transplanted organ is infiltrated with large numbers of T and B cells characteristic of an ongoing, low-grade, immune-mediated injury. ______ rejection results in fibrosis and scarring. In heart transplants it manifests as accelerated coronary artery disease. In lung transplants it manifests as bronchiolitis obliterans. In liver transplants it is characterized by loss of bile ducts. In kidney transplants it manifests as fibrosis and glomerulopathy. o There is no definitive therapy for this type of rejection. Treatment is primarily supportive. This type of rejection is difficult to manage and is not associated with the optimistic prognosis of acute rejection.

chronic

When someone needs an organ transplant, the process is that they get referred to a transplant center and they get worked up there to see if they are a candidate for a transplant—lots of things go into it and there are some ________s. · _________s—these are ever evolving in that they are doing transplants on more people with comorbidities and other problems (ex: now doing an HIV donor to an HIV positive recipient or hepatitis patients who used to not be a candidate for a transplant, but they could be now) o Disseminated malignancies (any kind of cancer with metastasis), refractory or untreated cardiac disease, chronic respiratory failure, extensive vascular disease, chronic infection, and unresolved psychosocial disorders (because follow up after a transplant is very important and the patient has to have a good support system and they have to take lots of medication and be compliant with taking their meds).

contraindications

human leukocyte antigen (HLA) is a gene complex encoding the major histocompatibility complex (MHC) proteins in humans. These cell-surface proteins are responsible for the regulation of the immune system in humans. This is important for them to match this as best as the can to try and prevent and minimize the degree of rejection. _____ is a test done just before transplant. A crossmatch determines if your body already has antibodies formed against the donor's antigens. It is very important to know if you have antibodies against a possible donor, because if you are incompatible with that donor you would not be able to safely receive a transplant from him/her.

crossmatching

the following is information about a ______ donor for organ transplant: · Have a patient who is brain dead and they have 2 kidneys that we need to place in two recipients · Patients with the most "points" in the local area are offered the organ first, if not one in the local area matches that kidney then regional, then national o Typically, the more critical the patient is, the higher they are on the list · If a perfect match exists, one of the donor kidneys must go to that patient no matter the location and no matter where they are on the transplant list

deceased

The following is extra information about _______s: · Hands and faces have recently been added to the list of organs that can be successfully transplanted. · These complicated surgeries are technically called vascularized composite allografts (VCAs) because they are surgeries composed of grafting many kinds of tissue: bone, muscle, nerves, skin, and blood vessels. · In 2005, the first hand transplants were performed, and in 2007, the first face transplant was performed. Developments in immunosuppressive drugs help to keep these and all transplants from being rejected. · Fewer than 125 hand and face transplants have been performed worldwide. But for the people who now have hands to use or a face to show the world, VCA transplants are transforming lives.

donor

The following is extra information about _______s: · Heart valves can be transplanted to save the lives of children born with heart defects, and adults with damaged heart valves. · Skin can be used as a natural dressing for people with serious burns. It can even save lives by stopping infections. · Bone is important for people receiving artificial joint replacements, or replacing bone that has been removed due to illness or injury, for example in hand and face transplants. · Tendons, the elastic-like cords that attach bones and muscles to each other, can be donated to help rebuild damaged joints.

donor

The following is extra information about _______s: · Most people can be tissue ______s when they die. The local tissue bank (a tissue recovery organization) will be notified by the hospital, medical examiner or funeral home. · Tissue donation must be initiated within 24 hours of death. However, tissue can be processed and stored for an extended period of time. · Each year, about 30,000 donors provide lifesaving and life-enhancing tissue.

donor

______s are indicated on your drivers license. A Brain Death ______ includes the following: o OPA would approach the family members and ask if they would donate the organs—the OPAs ask that nurses and HCPs do not approach the patient about it § OPAs have specific training on how to manage the patients that are emotionally upset § If the family approaches you then you can educate them on it but don't be the one to bring it up until the OPA has made a determination

donor

______s are indicated on your drivers license. A Brain Death ______ includes the following: o Someone who has been in some kind of accident, usually a traumatic accident, and ended up being brain dead but we have kept them alive on ventilatory support and maybe medications—so we have kept their organs alive so we can retrieve them o Only about 3 in 1,000 deaths would qualify for organ donation o Organs—heart, lung, kidney, pancreas, intestine, liver

donor

______s are indicated on your drivers license. A Brain Death ______ includes the following: o This retrieval is done in the OR as well, but they don't take the patient off the vent until the organs is retrieved § The patient is declared brain dead by two physicians (so theoretically they are dead and we are just keeping their organs alive)

donor

the following are ______ organs: · Liver, lungs, pancreas, and intestines can be used in part (don't have to take both lungs—can take a lobe) o Can takes pieces of these · If 0 antigen mismatches (they are a perfect match), one kidney must be sent to that recipient regardless of where they are in the region, in the nation, or on the waiting list

donor

When talking about the _____ and organ transplants: · Continuously evolving · Usually a 1:1 patient in the ICU · The OPA will send nurses out o Can take 24-48 hours for OPA to evaluate the patient/organs and find recipients · Make sure you have the meds for the patients in the hospital who have had a transplant in the past (immunosuppressive drugs may not be routinely carried in the pharmacy)

future

______ verses Host Disease: · A little different from rejection o When a body rejects an organ, it is the recipient's body rejecting the _______ that is put in them · Newly transplanted donor's cells attack the recipients body · Commonly associated with stem cell transplants but can occur with other tissue ______ transplants. · Can occur with blood products containing lymphocytes. o That's why a lot of times we will give leukocyte poor RBCs—so they try to remove a lot of the antibodies form the blood

graft

______ verses Host Disease: · Biggest problem is infection. · No adequate treatment for it. Steroids are used but that increases the patient's risk for infections even more.

graft

______ verses Host Disease: · May begin 7 to 30 days after transplant · Once reaction has start there is little that can be done to modify its course. · Target organs are skin, liver and GI tract o Skin—painful pruritic rash starting with hands and feet. Can become generalized. o Liver - mild jaundice with elevated liver enzymes to hepatic coma o GI - mild to severe diarrhea, severe abdominal pain, GI bleeding, and malabsorption

graft

A ______ tranplant includes: · Time - 4 to 6 hours to transplant · Consideration for body size—want to make sure the donor ______ is going to fit into the rib cage of the recipient · Biatrial approach o Damaged ______ removed at midatrial level and donor _______ connected at the left atrium, pulmonary artery, aorta, & right atrium · Bicaval approach o The right atrium of the recipient's heart (with SA node and maintenance of atrial conduction) is preserved, and then donor _______ is connected. § So they end up with two P waves on their EKG (the native atria is still conducting)

heart

The following are signs and symptoms of a ______ transplant rejection (basically signs and symptoms of HF): · Shortness of breath · Fever · Weight gain due to water retention · Not urinating as much as usual (don't have good blood flow to the kidneys) · Fatigue · ______ failure S/S · Cardiac allograft vasculopathy (CAV)—usually a result of rejection o Basically, a very accelerated coronary artery disease process

heart

the following are interesting facts about _____ transplants: · May have two P waves on ECG · _______ slower to respond to hemodynamic changes (because the ______ is de-nervated—cutting all those nerves) o Absent direct sympathetic and parasympathetic innervation. § So, having someone bear down or cough—that vagal maneuver probably won't work on these patients

heart

the following are interesting facts about _____ transplants: · _______ slower to respond to hemodynamic changes (because the ______ is de-nervated—cutting all those nerves) o Compensation for abrupt decreases in blood pressure is slow—because of the absent direct sympathetic and parasympathetic innervation § Takes the system longer to respond to a drop in BP o Atropine and ephedrine will not work - agents that work on vagolytic mechanism (but the heart is de-nervated so this won't work).

heart

the following are interesting facts about _____ transplants: · _______ slower to respond to hemodynamic changes (because the ______ is de-nervated—cutting all those nerves) o Will respond to catecholamines - heart tends to be extra sensitive § Part of the sympathetic NS § The release of catecholamines will increase HR

heart

What type of stem cell transplant is described below (BMT, PSCT, HSCT): **new terminology · Goal is to eradicate diseased tumor cells and/or clear the marrow of its components to make way for engraftment of the transplanted, healthy stem cells. o Basically, they are wiping out the bone marrow and then putting new stem cells in it hoping that the new healthy ones will take over · Go through very high doses of chemotherapy with or without radiation therapy in preparation for a stem cell transplant.

hematopoietic stem cell transplantation (HSCT)

What type of stem cell transplant is described below (BMT, PSCT, HSCT): **new terminology · After chemo, "healthy" stem cells are infused with the goal of rescuing the damaged bone marrow. · High for infection, bleeding dyscrasias, and problem like that o Because they are wiping out the bone marrow and giving chemo o Very high risk—have to way the risk vs the benefit

hematopoietic stem cell transplantation (HSCT)

What type of stem cell transplant is described below (BMT, PSCT, HSCT): TYPES: · Allogenic - stem cells are acquired from a donor who, through HLA tissue typing, has been determined to be HLS matched to the recipient. · Syngeneic - allogenic from one identical twin to the other. *they are perfect matches) · Autologous - patients receive their own stem cells back after myeloablative chemotherapy. Use when there is no suitable allogenic donor. (doing it more an more because there are less problems of rejection and less problems of graft versus host disease)

hematopoietic stem cell transplantation (HSCT)

What type of stem cell transplant is described below (BMT, PSCT, HSCT): · Many risks · Many patients die from treatment-related complications or from recurrence of the original disease. · Risk vs benefits must be weighed because of the high risks. o If someone is end stage and chemo isn't helping anymore and there is nothing else they can do then it is probably worth taking the risk

hematopoietic stem cell transplantation (HSCT)

To receive a transplant, both the recipient and the donor have to be matched—because you don't want to give them an organ that they will reject right off the bat. They go off of the ABO group and ______ _____ ____. The more ___ ____ ____ matches you have, the LESS LIKELY you are to experience rejection. · **____ ____ ____ matches are most important for kidney and bone marrow (although they are important for all organs); Matches of 5-6 are least likely to be rejected.

human leukocyte antigen (HLA)

o A gene complex encoding the major histocompatibility complex (MHC) proteins in humans. These cell-surface proteins are responsible for the regulation of the immune system in humans. o Important for them to match this as best as the can to try and prevent and minimize the degree of rejection

human leukocyte antigen (HLA)

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o Antibody mediated o Occurs within minutes to hours of the transplant happening o No treatment o Graft is removed - results in irreversible damage from ischemia

hyperacute

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o Doesn't happen very often—the better the matching processes the less likely that is going to happen o Can be life threatening to the recipient if not removed o _______ rejection occurs minutes to hours after transplantation because the blood vessels are rapidly destroyed. It occurs because the person had preexisting antibodies against the transplanted tissue or organ. There is no treatment for ______ rejection, and the transplanted organ is removed.

hyperacute

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o _______ rejection occurs minutes to hours after transplantation because the blood vessels are rapidly destroyed. It occurs because the person had preexisting antibodies against the transplanted tissue or organ. There is no treatment for ______ rejection, and the transplanted organ is removed. o Fortunately, ______ rejection is a rare event because the final crossmatch just before transplant usually determines whether the recipient is sensitized to any of the donor HLAs. On occasion, for unclear reasons, the final crossmatch does not detect these preformed antibodies, and ______ rejection occurs.

hyperacute

The following is information for ______ therapy: · 1. Calcineurin Inhibitors - Prevent cell mediated attack against transplanted organ o Tacrolimus [Prograf' Astragraf XL] o Cyclosporine [Gengraf; Neoral; SandImmune] · Most effective _________ · Foundation of most regimens · Heart, liver, and kidney transplants · Adverse reactions: o Infections, malignancy, nephrotoxicity, neurotoxicity (tremors, HA, paresthesia) § Monitor their renal function · Monitor drug levels closely

immunosuppressant

With _______ drugs, the goal is to prevent rejection while maintaining sufficient immunity to prevent overwhelming infections o Trying to find the sweet spot to where they are immunosuppressed enough but not too much to where they are going to have other problems with infections or even malignancies · Have to suppress their immune system so they don't have this immune mediated response · Patients are at risk for infection and malignancy and cancer · Many patients are on triple therapy: 1. calcineurin inhibitor, 2. a corticosteroid, and 3. mycophenolate mofetil

immunosuppressive

The following is information under ______ Live Donors: · We have 2 ______s, and we can live on about 50% function of our ______s—so we can live with one _______ and survive perfectly fine · About 27% of all _____ transplants—people chose to donate their _______ to a loved one · Advantages are: o Better graft survival rates—because its elective and they can try to find the best match o Elective surgery—it can be scheduled to where we know the patient is in good health at the time of the surgery whereas whenever someone is waiting on an organ. Whenever that organ becomes available then that is when that surgery has to occur so the patient may not be in the best of health at that particular time

kidney

______ transplantation is extremely successful. · 1-year graft survival rate o 90% are doing well for cadaver transplants o 95% are doing well for live donor transplants

kidney

the following is information under _____ transplantation: · First _______ transplant performed in 1954 between identical twins. · Only about 4% of patients with ESRD receive a transplant o Supply/demand issue—a lot of people with end stage renal disease need a transplant

kidney

A ______ transplant includes the following: · Disease secondary to virial hepatitis often experience reinfection of the new ______. o If someone needs a ______ transplant because they have viral hepatitis o Not something that would make them ineligible for a transplant · Long term survival depends on cause of _____ failure

liver

A ______ transplant includes the following: · MELD (Model for End-Stage ______ Disease) or PELD Score (Pediatric End-Stage ______ Disease) - determines urgency for transplant · Deceased and live donor ______s. · 12-15 hours (8-12 hours on diagram) to transplant o Longer than the heart and the lungs

liver

A ______ transplant includes the following: · Post-op complications include bleeding, infection and rejection o _______ is very important in manufacturing coagulation products so if someone's _______ is not working well, they often have prolonged clotting studies o *********Signs and symptoms of rejection would be that the ______ is not working well so prolonged coagulation studies would be one of those things you look for******

liver

A ______ transplant includes the following: · _____ is subject to a less aggressive immunologic attack than other organs o Odd because it's usually our ______ that produces a lot of our immunoglobulins · Approximately 78% of patients survive more than 5 years after _____ transplant

liver

Donors are indicated on your drivers license. The following is information about a ______ donor (usually a family member): o Kidney, bone marrow/stem cell, one or two lobes of liver, lung or part of a lung, part of a pancreas, part of the intestines o When a _______ person donates an organ, usually to a family member

living

A ______ transplant includes the following: · Heart-_______ transplant o Maintained on both heart and ______ transplant wait lists (they are on two transplant lists so their chances of something becoming available is a little better) o If a matching heart becomes available the ______ comes with it o If a matching ______ becomes available the heart comes with it.

lung

A ______ transplant includes the following: · ______ allocation score—this is the way they do their waiting list · Time - 4-6 hours to transplant o Newer technology (______ in a box) where they can perfuse the lungs and that can extend that window a little but if that technology is available · Heart-_______ transplant o Maintained on both heart and ______ transplant wait lists (they are on two transplant lists so their chances of something becoming available is a little better) o If a matching heart becomes available the ______ comes with it o If a matching ______ becomes available the heart comes with it.

lung

The following are signs and symptoms of a ______ transplant rejection: · Unable to extubate · Flu-like symptoms · Cough/chest pain · Fatigue · Fever · Shortness of breath · Decreased incentive spirometry · Decreased oxygen saturation

lung

To receive a transplant, both the recipient and the donor have to be ________—because you don't want to give them an organ that they will reject right off the bat. · Body size—don't want to transplant an adult lung in a pediatric patient or vice versa · Severity of condition of the recipient o Recipients are kind of scored based on their degree of illness or how critical they are o Typically, the more critical patients are at the top of the list so they would be considered first · **HLA matches are most important for kidney and bone marrow (although they are important for all organs); Matches of 5-6 are least likely to be rejected.*****

matched

To receive a transplant, both the recipient and the donor have to be ________—because you don't want to give them an organ that they will reject right off the bat. · Geographic location—consider this due to the window of time that you have from when you receive the organ from the donor to when you transplant it into the patient o The heart is about 4-5 hours so if you are all the way across the country then they may not be able to get it all the way across the country in a timely enough manner o The OPA will try to place the organ in a recipient in the regional area—so they try to keep LA donated organs in LA but if there is not a match then they will widen out the area (so you could have an organ going to another state)

matched

To receive a transplant, both the recipient and the donor have to be ________—because you don't want to give them an organ that they will reject right off the bat. · ABO group · HLA (human leukocyte antigen)** o**** The more HLA matches you have the less likely you are to experience rejection***

matched

The following is information under Kidney transplantation: Surgical Procedure a LIVE donor: o _________ performed by a urologist or transplant surgeon—it is scheduled § The donor would go into surgery o Begins an hour or two before the recipient's surgery is started o The procedure for the donor and the recipient will probably be done in the same hospital if it's a live donor o Rib may need to be removed for adequate view if its an open kidney resection o Takes about 3 hours o More and more they are doing laparoscopic nephrectomies § Laparoscopic donor _______ · Alternative to conventional _______ · Primary method of live kidney procurement (procurement=retrieving the organ)

nephrectomy

The following is information under kidney transplantation: Surgical Procedure: POST-OP Course--> Monitoring ________: · ****A sudden decrease in urinary ______ is cause for concern.**** o *****It may signal:***** § ***Dehydration*** §*** Rejection*** § ****Urine leak**** · Whenever they re-anastomose the kidney to the bladder they can leak at that anastomosis site which would mean urine is leaking into the peritoneal space, so you wouldn't see as much urine coming out of the bladder § ****Obstruction**** · Anytime they anastomose tissue there is a risk for hyperplasia or kinking o Check their volume status, BUN and creatine, etc.

output

The following is information under Kidney transplantation: Surgical Procedure: Kidney Transplant _______: o Typically, will leave there native kidneys in place—unless they have some type of malignancy or for some other reason the kidney needs to be taken out (will stay in there and just be nonfunctioning) o The donor kidney is usually placed extra-peritoneally in the iliac fossa—can put it on either side for transplantation § Connected to the internal iliac artery and the internal iliac vein o Left kidney of the donor preferred due to longer renal vein (but they can still use the right) o Either side for transplantation

recipient

The following is information under ____ _____ transplant: · Bone marrow transplant (BMT) - ____ ____s taken from the bone marrow. o _____ ____s are brand new cells that haven't differentiated yet o Take ____ _____s from the bone marrow if a donor and transplant them into the bone marrow of a recipient · Peripheral _____ _____ transplantation (PSCT) - _____ _____s taken from the blood stream and then reinfused through the blood stream o These _____ ____s are a little more mature because they are already out in the peripheral circulation

stem cell

The following is information under ____ _____ transplant: · New terminology - hematopoietic ____ ____ transplantation (HSCT) · Umbilical cord blood contains large numbers of ____ ____s—now have some companies that will cryofreeze umbilical cord _____ _____s (parents can choose to have their baby's umbilical cord stem cell stored so that if later on in life the child gets sick and needs a stem cell transplant or if someone else in the family might need one) o Some ethical issues with this

stem cell

the following is information about a _____ful lung transplant: · ______ of lung transplant is the ability to wean the patient off the vent (once they can breathe on their own) · ________ of heart transplant is the ability to maintain hemodynamic stability (once you get them off the drips like epinephrine or other drugs that support heart function)

success

There are 3 types of hematopoietic stem cell transplantation (HSCT): allogenic, syngeneic, and autologous. Which of these 3 is described below? · allogenic from one identical twin to the other. *they are perfect matches)

syngeneic

Organ _______s includes: · Cornea · Tissues o Skin o Bone o Heart valves o Connective tissues · Hands and face · Bone marrow, Blood stem cells, cord stem cells · Blood and blood products (done quite often—blood transfusions, PRBCs, fresh frozen plasma) o Do type and match for patients who give blood but the process is not quite as arduous as it is when doing an organ or tissue _________

transplant

There are 2 sides to organ ________. 1. The donor side—the procurement of the organs § The process to retrieve the organ (and get it transferred and placed in a patient in a ______ center) 2. The recipient side—(the ______ side) caring for a patient who has had a ________ § Post op care of that patient

transplant

the. most commonly ______ organs are the kidneys, liver, and heart. · The lungs, pancreas and intestines may also be transplanted. · The above are solid organs · There is also a lot of tissue donation and other things that go along with an organ transplant—managed by LOPA (Louisiana Organ Procurement Agency)

transplanted

The following is information under kidney transplantation: Surgical Procedure: POST-OP Course: · ****Success is the ability of the kidneys to concentrate _____***** · *****Large volumes of ______ may be produced as soon as the blood supply to the transplanted kidney is established****** o Diuretic type phase initially when the kidney is transplanted · May be putting out as much as 1 liter per hour—that is a lot of volume

urine

the following is information about a transplant _______: · There are now some methods for preserving the organs for even longer o Lung in a box or kidney in a box (becoming more available to extend that transplant widnow) · These time _______s are for an organ without any preservation methods

window

definition: A surgical graft of tissue from one species to an unlike species (or genus or family). Such as a graft from a baboon to a human is a _______. o The prefix "xeno-" means foreign. It comes from the Greek word "xenos" meaning stranger, guest, or host. (Xeno- and xen- are variant forms of the same prefix.) **future; continuously evolving

xenograft

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o _______ rejection most commonly manifests in the first 6 months after transplantation. This type of rejection is usually mediated by the recipient's lymphocytes, which have been activated against the donated (foreign) tissue or organ (Fig. 14-12). In addition to cell-mediated rejection, another type of _______ rejection occurs when the recipient develops antibodies to the transplanted organ. o It is not uncommon to have at least one rejection episode, especially with organs from deceased donors. These episodes are usually reversible with additional immunosuppressive therapy, which may include increased corticosteroid doses or polyclonal or monoclonal antibodies. Unfortunately, immunosuppressants increase the risk for infection. To combat acute rejection, all patients with transplants require long-term use of immunosuppressants, putting them at a high risk for infection, especially in the first few months after transplant when the immunosuppressive doses are highest.

acute

There are 3 types of hematopoietic stem cell transplantation (HSCT): allogenic, syngeneic, and autologous. Which of these 3 is described below? · stem cells are acquired from a donor who, through HLA tissue typing, has been determined to be HLS matched to the recipient.

allogenic

definition: a tissue graft from a donor of the same species as the recipient but not genetically identical. **future

allograft

There are 3 types of hematopoietic stem cell transplantation (HSCT): allogenic, syngeneic, and autologous. Which of these 3 is described below? · patients receive their own stem cells back after myeloablative chemotherapy. Use when there is no suitable allogenic donor. (doing it more an more because there are less problems of rejection and less problems of graft versus host disease)

autologous

With a heart transplant, there is a biatrial approach and a bicaval approach. Which approach is described below? o Damaged heart removed at midatrial level and donor heart connected at the left atrium, pulmonary artery, aorta, & right atrium

biatrial approach

With a heart transplant, there is a biatrial approach and a bicaval approach. Which approach is described below? o The right atrium of the recipient's heart (with SA node and maintenance of atrial conduction) is preserved, and then donor heart is connected. § So they end up with two P waves on their EKG (the native atria is still conducting)

biclaval approach

Donors are indicated on your drivers license. The following is information about donation after death or ______ donor (cadaveric): o Organs (hands and face new to list), tissue, cornea o Tissues—heart valves, bone, skin (on the voiceover) o This is done after death—these tissues can be retrieved 24-48 hours after death

cadaver

Donors are indicated on your drivers license. The following is information about donation after a ______ death (DCD): o Can be done on patients who we are withdrawing support from and we expect them to pass within a certain amount of time (about an hour) o Organs—heart, lung, kidney, pancreas, intestine, liver o The number of these are even smaller because there is more criteria that you have to consider and the patient has to die within the expected time frame

cardiac

Donors are indicated on your drivers license. The following is information about donation after a ______ death (DCD): o The patient is taken down to the OR, the OR team is there and available, they withdraw the support (extubate them, turn off the medicines) and then they wait to see if the patient dies (have to let the patient pass before we can take their organs) § If the patient dies within the hour, then they can retrieve the organs § Often times the transplant surgeon will come to that hospital to retrieve or procure the organs because they want to look at it to make sure it looks okay before they take it

cardiac

there are 3 different types of rejection of the graft with organ transplantation. 1. hyperacute, 2. acute, and 3. chronic. Which of these 3 types is described below? o Occurs over months to years o Organ is infiltrated with T and B cells characteristic of ______, like a ______ low-grade immune mediated injury o Common in the lung, rare in the liver o The graft is often lost § There is nothing they can do to reverse it—they can try some immunosuppressants to slow the process a little but they will eventually lose the graft

chronic