Renal Transplant Patient Education Prepared by:Menah Sharaf RN,CNC,RTNU,KFSH&RC

Overview The roll of the renal transplant team in the care of renal patients The collaboration between the multidisciplinary team in order to deliver holistic care for the renal transplant patient.

WHY TRANSPLANT IS NECESSARY Damage to the kidney can seriously affect the following: Removal of water and waste products from the body Production of red blood cells Regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus. If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life.

Criteria for accepting patients for renal transplantation Referral from another institution after determining that renal transplantation is the optimal treatment for the patient Medical report from the referring institution Referrals from other departments within our hospital

Renal Transplant Program Surgeons Operating Room Transplant Nephrologists I.C.U B-2 ward Surgical Nursing Transplant Coordinators OBG/YN DPC Renal Transplant Program Transplant Nurses Immunology ECHO lab Cardiac cath Radiology Transplant Social Workers Dental Admission Clinical Pharmacist Transplant Health Educators Nutritionist Other referrals

Pre-Renal Transplant Education Pre-Transplant testing and information regarding the patient's overall health status help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option for the patient. All of the above increase the likelihood of overall success.

Pre renal transplant workup: Recipient Laboratory investigations including Tissue Typing, Hematology, Serology/Virology, Chemistry, Urinalysis Chest X-Ray Abdominal Ultra-Sound Electrocardiogram (EKG) Vaccinations (if needed) PPD Skin Test Liver Biopsy (as required) Dental clearance Mammogram OB-GYN clearance (females only) Pre-renal transplant evaluation Other referrals as needed

Pre renal transplant workup: Donor Laboratory investigations including Tissue Typing, Hematology, Serology/Virology, Chemistry Chest X-Ray CT Scan abdomen angiogram Electrocardiogram (EKG) Vaccinations (if needed) PPD Skin Test Mammogram OB-GYN clearance (females only) Pre-renal transplant evaluation

Renal transplant committee meeting Recipients and potential donors will be presented at the Renal Transplant committee Members of the Committee Transplant Surgeons Transplant Nephrologist Clinical Pharmacist HLA Immunologist Transplant Nurses Social worker Transplant Coordinator Health Educator

Final acceptance of both recipients and donors will be made during the committee meeting . Any pending issues will be resolved prior to renal transplant surgery

Day of Admission 1. Transplant pair admitted to the renal ward. 2. Transplant pair to be assessed by surgeon 3. Pre and post-operative education begins 4. Continuation of health education commenced during pre-renal work-up

The Role of the Health Educator in Pre-Operative Teaching Identify the urinary system location & function. Understanding renal transplant surgery. Explains the need for pre-operative preparation. Understanding the importance of Immunosuppressive therapy & antibiotics. Understanding post operative expectations.

Post Operative Instructions Understanding the life long commitment of immunosuppressive medication. Correctly identifying medications {FK,Pred,…..} Understanding the correct time to take medications

Cont Understanding most common side effects. Proper storage of medications Appropriate hand hygiene

Discharge Instructions Reinforcing Post Operative Teaching. Importance of bringing all medications to all clinic visits. Dietary Instructions. Exercise . Hygiene Concerns. Social Concerns. Recreation/Work precautions. Religious duties. Sexual activity.

Health Care After You Leave The Hospital Monitor urine output daily. Avoid stopping or changing any medications without consulting a renal transplant physician . Report any signs & symptoms of rejection or infection to renal transplant physician. Increase fluid intake.

Post renal transplant follow up Donors will follow–up in the transplant surgical clinic Recipients will alternate follow–up in both the surgical and the post renal transplant clinic twice weekly with labs for the 1st three months Months 4 – 6 post transplant, patients will follow–up in the post renal transplant clinic every other week

Long term follow up After the 7th month post transplant, patients will be referred back to the original nephrologist and/or maintain follow-up in our renal transplant clinic as deemed necessary by our transplant physicians.

References Gabriel M. Danovitch. (2005). Handbook of Kidney Transplantation (4th ed.). Lippincott Williams & Wilkins. American Society of Transplantation: Screening of donor and recipient prior to solid organ transplantation, (2004) American Journal of Transplantation. 4(Suppl 10) (p. 10-20). Blackwell Munksgaard. American Society of Transplantation: Guidelines for vaccination of solid organ transplant candidates and recipients, (2004), American Journal of Transplantation. 4(Suppl 10) (p. 160-163). Blackwell Munksgaard.

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