Download Worksheet for Kidney Transplant

Worksheet for Kidney Transplant:
1. When does one become a consideration for a kidney transplant?
2. Are there any requirements/restrictions for kidney transplantation?
3. Describe the different types of kidney transplantation?
4. What medical personnel are typically involved in the kidney transplant process?
5. Are there blood compatibility requirements for kidney transplantation?
6. Describe the kidney transplant process.
7. How long does the kidney transplant surgery last?
8. Describe “sleepy” kidney.
9. What medications are usually prescribed following transplantation?
10. What are the advantages of kidney transplant?
11. What are the risks/complications of kidney transplant?
12. Who pays for the kidney transplant?
13. Does the patient receiving a kidney transplant have any restrictions to the
following:
a. diet
b. exercise
14. What is the expected lifetime of the donated kidneys?
Answers to Worksheet on Kidney Transplant:
1. End Stage Renal disease (a decrease of 20-25% in glomerular filtration rate) is the
indication for a kidney transplant.
2. The patient must meet the following requirements:
Note: these requirements vary considerably in different programs and countries
a. age: must be less than 69 yrs of age
b. good physical health: terminal diseases, cancer, etc. are immediate
exclusion criteria
c. good mental health
d. no substance abuse
e. cardiac and pulmonary insufficiency
f. morbid obesity
g. tobacco use
h. must adhere to prescribed medical regimens
3. There are 2 types of kidney transplants: living donors and non-living donors.
a. living donors – a family member, spouse, friend, etc. who are willing to
donate a kidney
b. non-living donors – a deceased person who donated a kidney
4. The transplant team should consist of a nephrologist, transplant surgeon,
pharmacist, dietitian, social worker and most importantly your family and friends.
5. Usually the kidney donor and recipient must be ABO blood group compatible and
share as many antigens as possible.
6. The old kidneys are usually not removed because it puts the patient at an
increased risk. The new kidneys are usually placed in the iliac crest region and
utilize the blood supply of the external iliac artery and drainage from the external
iliac vein. The ureter is attached to the bladder. In diabetic patients, the kidney is
many times transplanted with the pancreas. Also, a living donor can undergo
Laproscopic kidney removal surgery, which is a new procedure that results in less
pain and a shorter hospital stay (from five to two days).
7. Surgery lasts from two to four hours. Recovery room time is a few hours.
Hospital stay is from two to five days.
8. Some recipients have “sleepy” kidney, meaning the kidney is slow to begin
functioning. This condition may require a few dialysis sessions until the kidney
functions properly (two to four weeks).
9. Rejection medications (i.e. cyclosporin, rapamycin, etc.) and some form of
steroid. Common side effects from these medications are weight gain,
hypertension, infections, etc.
10. Transplant patients typically have more energy and strength, can follow a less
restricted diet and fluid intake, are not limited to dialysis sessions and have fewer
problems controlling anemia and blood pressure.
11. Complications include rejection of the new kidney, infections, post-transplant
lymphoproliferative disorder, bleeding, breathing problems, electrolyte
imbalances, hair loss, acne, obesity, type two diabetes mellitus, increase
cholesterol, gastrointestinal ulcers/infections, etc.
12. Most recipients are on Medicare, which cover eighty percent of the surgery.
Medicare Part B will also cover eighty percent of the medication needed after
surgery. Most patients carry private health insurance to cover the medication not
covered by Medicare.
13.
a. The kidney transplant recipient will still need to follow a special diet. The
patient should watch his/her carbohydrate intake since many steroid drugs (anti
rejection medication) will make it difficult to break them down. The patient
should also still follow a low salt diet to limit fluid retention. Steroids also cause
an increase in body fluid. By limiting the fluid retention, the patient will find it
easier to control blood pressure. Initially, protein intake will increase to offset the
muscle loss prior to receiving the new kidneys, however; with time this
requirement will decline to normal levels. The patient should watch his/her
potassium intake since because some transplant medications increase it while
others decrease it. The patient will also need to pass attention to the calcium and
phosphorus levels in the blood.
b. The kidney recipient should follow a generalized exercise prescription
including cardiovascular, flexibility and strength regimes. Ideally, the patient
should be able to resume his/her past level of activity. Currently, there are three
professional athletes who returned to their sport after kidney transplantation, i.e.
Alonzo Mourning. Immediately after surgery, these restrictions apply: no lifting
greater than ten to twenty pounds (until three months post surgery), after three
months there are no lifting restrictions, no jogging/running on hard surfaces for
three months, avoid activities that create a bouncing effect (horseback) for three
months and avoid swimming/bathing until the surgical incision is completely
healed.
14. The expected average lifetime for a donated kidney is ten to fifteen years.
References for transplant:
http://en.wikipedia.org/wiki/Kidney_transplantation#Indications
http://kidney.niddk.nih.gov/kudiseases/pubs/transplant/#process
http://www.kidneytransplant.org/
http://www.kidney.org/atoz/atozItem.cfm?id=86
http://www.kidney.org/atoz/atozItem.cfm?id=98
http://www.ohsu.edu/transplant/r-patman-ohsu0806.pdf?fix