Kidney transplant is, by far, the most common type of transplant procedure performed and therefore the most commonly seen in clinical practice. Dr. Norman Silas, MD, transplant nephrologist, discusses pertinent topics for clinical nurses such as the pre-transplant work-up, post-transplant medications, and potential pitfalls when caring for transplant recipients.
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When is the ideal time to start working a patient up for kidney transplant?
When the patient has advanced chronic kidney disease but is not on dialysis. Ideally, a patient would start their work-up when their GFR is 25, placed on a transplant waiting list when their GFR<20, and receive a transplant before their GFR is 10 (often when dialysis is started).
How can nurses advocate for a patient to get worked-up for a kidney transplant?
As a trusted resource, nurses can inform patients with chronic kidney disease about the option of transplant. A referral to a transplant center doesn’t have to come from a physician — it can come from the patient themselves.
What is involved in a transplant evaluation?
An evaluation may include, but is not limited to, the following:
- An assessment of cardiovascular status i.e. ECHO, cardiac stress test
- Cancer screening i.e. colonoscopy, mammography
- Dental evaluation
- CT pelvis to determine if the patient’s vasculature is sufficient for surgery
- Psychosocial evaluation i.e. support systems, emotional preparedness of the patient
What is paired donation?
Per the United Network for Organ Sharing (UNOS):
Sometimes a transplant candidate has someone who wants to donate a kidney to them, but tests reveal that the kidney would not be a good medical match. Kidney paired donation, or KPD, also called kidney exchange, gives that transplant candidate another option. In KPD, living donor kidneys are swapped so each recipient receives a compatible transplant.
These medications will start ate a high dose and eventually tapered down to an long term maintenance dose.
- Calcineurin Inhibitors: Tacrolimus, Cyclosporine
- Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine
- Steroids: Prednisone
These medications are administered to prevent opportunistic infection and are usually prescribed for only 1-6 months post-transplant.
- Phosphorus: levels may be low after transplant
- Vit. D and calcium: for bone health
What should nurses know when caring for transplant recipients?
Transplant recipients are at a high risk for skin cancer
Anti-rejection medications can interact with other medications such as Azithromycin, Dilantin and Paxlovid.