1. Kidney Trnasplantation

2. Introduction Treatment of choice for ESRD.
Kidney taken from well matched living donors who are related to the patient those with compatible ABO and HLA antigens
Kidney from a living donor or human cadaver
Nephrectomy of the patient’s kidneys may be performed before kidney transplantation.
The transplanted kidney is placed in the patient’s iliac fossa anterior to the iliac crest
The ureter of the transplanted kidney is transplanted into the bladder or anastomosed to the ureter of the reciepient

5. Preoperative Management
Metabolic status of the patient is made as normal as possible
Free of infection
Prepare for surgery and the post operative course

6. Medical Management Tissue typing Blood typing Antibody screening
are done to determine the compatibility of the tissues and cells of the donor and recipient
Lower urinary tract is studied
Assess bladder neck function
Look for ureteral reflux

7. A psychosocial evaluation – to assess
The patient’s ability to adjust to the transplant,
Coping styles,
Social history,
Social support available
Financial resources
Presence of any psychiatric illness
Haemodialysis done on the eve of transplantation
However initiation of dialysis is preferably avoided before transplantation, when a donor kidney is available

8. Nursing Mangement
Preoperativ care nutrition fluid and electrolyte balance preoperative antibiotic prepare the parts for anaesthesia and surgery
Teach about postoperative pulmonary hygiene, pain management options, dietary restrictions, intravenous and arterial lines, tubes (urinary caths, Ryle’s tube) and early ambulation
Alleviate anxiety about donor

9. Postoperavive Management
The patient whose kidney functions immediately has a more favourable prognosis.
Immunosuppressive therapy
Survival of the kidney depends on the ability to block the body’s immune response to the transplanted kidney
Immunosuppressant agents used : - azathioprine corticosteroids cyclosporine OKT-3 (a monoclonal antibody) sirolimus
Doses of immunosuppresant agents are gradually reduced over several weeks
Some form of antirejection medication for the entire time that he or she has the transplanted kidney

10. Rejection
Renal graft rejection and failure may occur within 24 hours – hyperacute within 6 to 14 days – acute or after many years – chronic within the first year – not uncommon
Usgm
Percutaneous biopsy
The rejected kidney may or may not be removed

11. Postoperative Nursing Management
Assessing the patient for transplant rejection
Signs and symptoms of transplant rejection: oliguria edema fever ↑ BP wt gain swelling and tenderness over the transplanted kidney
With cyclosporin the classical symptoms absent asymptomatic ↑ in creatinine; > 20% rise  acute rejection

12. Monitor TC urea creatinine platelet count monitor for infection – because of immunosuppression (shaking chills, fever, tachycardia, tachypnoea ↑ or ↓ in TC

13. Preventing Infection
Infection through urinary tract respiratory tract surgical site drainage site drainage tips and catheter tips may be cultured
Reverse isolation
Careful hand hygiene
Wearing mask by all

14. Monitoring Urinary Function
Take care of the vascular – patency
Haemodialysis may be needed until the new kidney starts functioning
The kidney from a relative donor may start functioning immediately producing large quantities of dilute urine – fluid and electrolyte balance to be maintained
Kidney from cadaver – take many weeks to funtion – ATN - dialysis needed
Urine measured hourly

15. Addressing Psychological Concerns
Fears of rejection have to be alleviated
Complications of immunosuppresive therapy : Cushing’s syndrom, diabetes, capillary fragility, osteoporosis, cataract, glaucoma, acne – all have an effect on the patient
The family’s stress considered
If needed the nurse should refer the patient or the family members to counselling.

16. Monitoring and Managing Potential Complications
Post operative complications to be expected and taken care of.
Promote surgical recovery : breathing exercises, early ambulation, care of the surgical incision
Look for and manage peptic ulceration due to steroid
Fungal colonization of the gut dealt with (due to immunosuppressive therapy and antibiotics)

17. Promoting Home andCommunity-Based care
The patient and family taught about ther signs and symptoms of rejection, infection, side effects of immunosuppressive therapy
The family is instructed to monitor the urinary output and the vital signs
Continuing care : the patient is made to realise that the care of the transplanted kidney is to be continued life long.