文档C10.Transplantation2.ppt

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1、Chapter 10 Transplantation,-,Transplantation,cell,tissue,organ,-,It is the act or process of moving a whole or partial organ from one body to another by surgery for the purpose of replacing the recipients damaged or failing organ.,Organ transplantation,Classification-1,Classification-2,Orthotopic tr

2、ansplantation: grafts occupy their normal anatomical site Auxiliary transplantation: grafts occupy their ectopic site,Viable transplantation Structural transplantation,Classification-3,Classification-4,Single transplantation Combined transplantation Multiple organ transplantation,Preparation,A. Dono

3、r selection B. Organ preservation C. Criteria for recipient D. ICU,A. Donor selection,Sibling or parent -survival rate of kidney is greater; preferred for transplantation. Cadaver -greater rate of rejection following transplantation, although majority of transplantations are with cadaver organs.,B.

4、Organ preservation,Hypothermic preservation Preservation solution,HTK solution,UW solution,B. Organ preservation,limit of cold ischemia Pancreas 20h Kidney 25h Liver 12h Heart 5h,C. Criteria for recipient,Irreversible kidney function Under 70 yr of age Patent and functional lower urinary tract Free

5、of serious cardiovascular complications,D. ICU,Rejection,The recipients body fails to accept a transplanted tissue or organ as the result of immunological incompatability, i.e. immunological resistance to foreign tissue.,Rejection and immunosuppression,Rejection process Cellular immunity mechanisms(

6、T. B cell lymphocytes) Humoral immunity mechanisms(circulating antibody) Important compatibility system ABO blood group HLA (human leukocyte antigen) class leukopenia; anemia. (c) Development of malignant neoplasms. (d) Infection. (e) Liver damage.,(2)Prednisone -believed to affect lymphocyte produc

7、tion : anti-inflammatory action helps prevent tissue damage if rejection occurs.,Side effect: (a) Stress ulcer with bleeding (give with food). (b) Decreased glucose tolerance (hyperglycemia). (c) Muscle weakness. (d)Osteoporosis. (e) Moon faces. (f) Acne and striae (g) Depression and hallucinations.

8、,(3) Cyclosporine (Neoral, sandimmune) -polypeptide antibiotic used to prevent rejection of kidney, liver, or heart allografts; PO dose given with room temperature chocolate milk or orange juice in a glass dispenser.,Side effect: (a) Nephrotoxicity (increased BUN, creatinine). (b) Hypertension. (c)

9、Tremor. (d) Hirsutism, gingival hyperplasia. (e) GI-nausea, vomiting, anorexia, diarrhea, abdominal pain. (f) Infections-pneumonia, septicemia, abscess,Types of organ transplant,Kidney transplantation,Quality of life:,The longest-surviving kidney transplant recipients worldwide are 40 years after re

10、ceiving a living-related kidney 34 years after receiving a cadaveric kidney transplant.,Preparation before kidney transplantation,1. Mental nursing:,Relative knowledge: Nature of surgery; placement of kidney. Postoperative expectations: deep breathing, coughing, turning, early ambulation; reverse is

11、olation. Medications: immunosuppressive therapy: purpose, effect. Confidence: encourage expression of feeling: origin of donor, fear of complications, rejection,2.General preparation:,Abrosia Clean Coloclysis 4) General test 5) ICU preparation,3. Auxiliary examination:,1) Blood test 2) ECG 3) Chest

12、X-ray,4. Others :,Hemodialysis Operation consent Pre-operation injection,Operation,Kidney transplantation: placement of a donor kidney(from sibling, parent, cadaver) into the iliac fossa of a recipient and the anastomosis of its ureter to the bladder of the recipient,Postoperative Care,1. Strict iso

13、lation,1) Prohibition of family visit 2) Ultraviolet lamp irradiate ICU 3) Mask and lid, Wash hands,2. Vital sign detection,1) Blood pressure Slightly high level:140-150/90-100 mmHg 2) Heart rate Predict the congestive heart failure,2. Vital sign detection,3) O2 saturation Assess the respiratory fun

14、ction 4) Temperature A good sign of infections,3. Maintenance of fluid and electrolyte balance,I (3)Chronic -occurs several months to years.,7. Rejection,Observe for signs of rejection,Assessment: (a)Subjective data: (i)Lethargy, anorexia. (ii)tenderness over graft site. (b)Objective data: (i)Lab da

15、ta: Urine: decreased-output, creatinine clearance, sodium; increased-protein. Blood: increased-BUN, creatinine. (ii)Rapid weight gain;. (iii)Vital signs: BP, temperature-elevated.,8. Immunosuppressive therapy,1) Every patient should take immunosuppressive drugs. 2) A combination of different drugs.

16、3) Take immunosuppressive drugs actually and punctually.,9. Health education,Daily life guidance Medication: time, dose self-inspection : temperature, blood pressure, I&O, weigh daily, urine specimen collection. infection prevention 5) further consultation & Scheduled blood work,Live transplantation

17、,Liver transplantation is surgery to remove a diseased liver and replace it with a healthy liver from an organ donor.,Post-Operative Considerations,Hemodynamics Vasodilation followed by hypotension may occur during the warming phase of hypothermia. Hypovolemia hemorrhage, sepsis, low oncotic pressur

18、e due to hypoalbuminemia, or complement activation after liver graft reperfusion Hypertension physiologic stress, shivering, anxiety, pain, hypothermia, cyclosporine therapy, or fluid overload in patients with renal failure.,B. Respiratory Status Extubation may be delayed by: Right hemidiaphragm par

19、alysis d/t surgical damage to the phrenic nerve Lung expansion/ventilation compromise d/t ascites, pulmonary edema, atelectasis, and the high incidence of pleural effusions, causing decreased compliance of the lungs. Oxygenation may be compromised by bacterial, viral, or pneumonia, smoking history,

20、atelectasis, or ARDS.,Post-Operative Considerations,C. GI and Nutrition Malnutrition d/t pre-existing liver failure. Monitor Albumin and prealbumin levels. These are usually low in liver patients. Contact Nutritional Support Services to consult.,Post-Operative Considerations,D. Renal Status Patients

21、 who experience renal insufficiency/failure pre-op in conjunction with ESLD have what is known as hepatorenal syndrome. Risk factors for continued post-op renal problems are: Nephrotoxic drugs: Cyclosporine, Abelcet, aminoglycosides, etc. Intra/post-operative instability coupled with hypoperfusion.

22、Recurring hepatorenal syndrome related to primary nonfunction or acute liver failure.,Post-Operative Considerations,E. Dermatology Poor skin integrity related to pre-op malnutrition. They may have pruritis which may respond well to Sarna lotion. They are often subject to skin tears. These patients tend to ooze serous fluid from any skin breaks d/t low serum albumin levels. Protection of the skin includes sheepskin booties, turning, and keeping the skin as dry as possible. Air mattresses may also be used.,Post-Operative Considerations,Thank you!,