Preoperative Preparation

When an operation is planned in advance, preparation of the transplant recipient does not differ substantially from other patients. Maintenance medications, especially the immunosuppressants, antihypertensives and cardiac drugs should be administered with a minimal volume of water. Diabetics should reduce the dose of long and intermediate acting insulin, usually by one half. If hypoglycemia occurs or the start of the operation is delayed, intravenous dextrose must be initiated. When bowel...

Medicare Reimbursement Basics

Reimbursement for chronic hemodialysis and kidney transplantation was scarce until the mid-1960s and haphazard until 1972, when Congress amended the Social Security Act to include coverage for end-stage renal disease for qualified patients. Because the amendment made Medicare the primary kidney transplantation insurer for more than 90 of the United States population, it was Congress and the U.S. Department of Health and Human Services, rather than the commercial health insurance industry, that...

Immunosuppression

Clinical immunosuppression has always been a problem of balancing prevention or control of rejection with loss of protection against an array of infectious agents and mutant cells. Immunosuppression is intense immediately after trans plantation and then diminishes during the first year as the allograft loses some of its immunogenicity and the recipient's immune system begins to adapt to the graft in various ways. That is, homeostasis appears but almost never to the point that immunosuppression...

Pathophysiology Of Chronic Liver Disease

The pathophysiology of advanced liver disease results in two cardinal pathophysiological abnormalities hepatocellular failure and portal hypertension. In acute liver failure, portal hypertension is seldom a clinical problem while in cirrhosis, an increased portal pressure may give rise to complications while hepatocellular function is preserved. The importance of these two factors is recognized in the Child-Turcotte-Pugh classification, a prognostic tool in patients with cirrhosis.(Table 9.7)...

Pretransplant Treatment

Ideally, before transplantation, all active dental disease should be treated and acute and chronic infection eradicated. Impacted, periodontally involved and unrestorable teeth should be extracted. Nonvital teeth and those with periapical pathology should be endodontically treated or if a predictably successful outcome cannot be guaranteed, then extracted. Meticulous oral hygiene regimes should be established, taught and constantly reinforced for all patients. While the pretransplant goals for...

Clinical Presentation

Cytomegalovirus disease is found most commonly one to four months after transplantation. Manifestations of CMV range from asymptomatic viremia to lethal disseminated disease. Mild to moderate disease presents with fever, malaise, headache, arthralgias and myalgias. Laboratory abnormalities include leucopenia and thrombocytopenia. End organ involvement usually correlates with the type of transplant, thus, hepatitis occurs in liver recipients, glomerulopathy in renal transplants, pancreatitis in...

Causes Of Kidney Failure

According to the 1998 USRDS, the annual incidence of pediatric ESRD is 1,087, or 13 per million.1 Many causes of pediatric ESRD are unique (Table 13B.1). Alport's syndrome is the association of nephropathy, deafness, and cataracts. Infantile polycystic kidney disease (ARPKD) is autosomal recessive, occurs one in 10,000 to one in 40,000 live births, and involves both kidneys and liver. Adult or autosomal dominant polycystic kidney disease (AKPDK) occurs one in 250 live births, but only 10...

Vaccination In Transplant Recipients

Two issues limit the overall effectiveness of vaccination strategies in transplant recipients. First, transplant recipients may have declining antibody levels and diminished antibody responses to previous vaccine antigens once they become severely immunosuppressed (loss of previous immunity). Secondly, available evidence suggests that transplant recipients have diminished, although not absent, responsiveness to immunization (reduced vaccine efficacy). This is best demonstrated in kidney, liver...

Info

The number of patients in the U.S. waiting for a kidney transplant, receiving a kidney transplant, and the number of cadaver organ donors per year. affected by prolonged waiting time on dialysis therapy. Therefore, patients early in the course of renal disease need information about, and access to transplantation services. One of the first steps is for the primary care physician or nephrolo-gist to orient the patient to the transplant process. This can occur with that physician or...

Outcomes

All transplant centers are required to report patient and graft survival (and much more) to UNOS. Data collected by UNOS are transferred to the Scientific Registry of Transplant Recipients for analysis and preparation of reports that have begun to appear on the Internet every six months in July and January (35). Each organ specific report covers a 30- month cohort of recipients followed for at least one year after transplantation. The reports list one-year patient and graft survival for the...

Evaluation Of Candidates For Pancreas Transplantation

There are significant pre-existing morbidities of pancreas transplant candidates with advanced renal disease. It should be assumed that coincident extrarenal disease is present. Diabetic retinopathy is a nearly ubiquitous finding in patients with diabetes and end-stage renal disease. Significant vision loss may have occurred. Also patients may be overtly blind. Blindness is not an absolute contraindication to transplantation since many blind patients lead very independent life styles. Although...

Cadaveric Donors

The Association of Organ Procurement Organizations (AOPO) estimates that potential cadaveric organ donors have stabilized at 11,000 to 14,000 yearly. A few (less than 5 percent) are non-heart-beating donors, but in the vast majority cardiovascular circulation remains intact until organs are removed. Despite broad public awareness of the need for and benefit from organ transplants, less than half of the immediate relatives of potential cadaveric donors give their consent to remove vital organs....

Essay 10 Dental Issues before and after Organ Transplantation

Despite the dramatic reduction in dental disease over the past three decades, resulting principally from fluoridation of public water supplies and increased public education, the mouth remains the most commonly infected site in the body. Almost all adults have some subacute, asymptomatic source of oral infection, arising most frequently as a result of chronic periodontal disease. Added to this is the fact that less than half the population chooses to receive regular maintenance care and instead...