these meds must be taken for life by recipient
immunosuppressants
cadaver donors
those who have suffered irreversible brain injury; are maintained w/ mechanical ventilation & must have adequate perfusion to kidneys
preop interventions
histocompatibility tests
immunosuppressive meds
verify hemodialysis of recipient was completed 24 hrs before transplantation
postop interventions for recipient
transplanted kidney is placed in anterior iliac fossa [usually, recipient's diseased kidneys are left in place except w/ polycystic kidney disease]
monitor for signs of complications:
rejection
thrombosis
renal artery stenosis
wound problems
monitor urine
what is the primary cause of death in the first year post transplantation?
infection
graft injection
is a major postop complication except if donor is identical twin
hyperacute rejection
occurs w/in 48 hrs after transplant
remove rejected kidney
acute rejection
most common
mostly occurs w/in 1 week post op
potentially reversible w/ increased immunosuppression
chronic rejection
occurs slowly [months - years]
mimics CKD
immunosuppressive meds & retransplantation if necessary
clinical signs of renal transplant [graft] rejection
fever >100 [37.7]
pain or tenderness over grafted kidney
2-3lb weight gain over 24 hrs
edema
HTN
malaise
elevated BUN & serum creatinine
decreased creatinine clearance
elevated WBC count
rejection indicated by ultrasound or biopsy