Intestinal Transplantation An Introduction to Transplantation Lauren Walker, RN, BSN, CCRN Other Contributors Lisa Dreyfuss, RN, BSN Hilary Poan, RN, BSN Brought to you by Goals and Objectives By t.Intestinal Transplantation An Introduction to Transplantation Lauren Walker, RN, BSN, CCRN Other Contributors Lisa Dreyfuss, RN, BSN Hilary Poan, RN, BSN Brought to you by Goals and Objectives By t.
Brought to you by An Introduction to Transplantation Lauren Walker, RN, BSN, CCRN Other Contributors: Lisa Dreyfuss, RN, BSN Hilary Poan, RN, BSN Brought to you by Goals and Objectives: *By the end of the lecture, students will have an understanding of: -The history of pediatric GI transplant -The qualification of being listed for transplant -Common diagnosis indicating a need for a liver or small bowel transplant -Signs and symptoms of liver and small bowel failure -Common preop/postop medications -Signs and symptoms of organ rejection -Lifetime management concerns after transplant Brought to you by History Transplants have been performed for over 50 years in United States: 1950s First Successful Kidney 1954 1960s First Successful Liver 1967 First Successful Heart 1968 First Successful Pancreas 1968 UNOS http://www.unos.org/whoWeAre/history.asp Brought to you by Transplant History Then nothing until… 1980s Why? CYCLOSPORIN (early generation Prograf) introduced 1983 First Successful Single Lung 1983 First Successful Double lung 1986 First Successful Intestine 1987 First Living donor liver 1989 UNOS www.unos.org/whoWeAre/history.asp Brought to you by Organ Allocation: Getting Listed United Network for Organ Sharing (UNOS) maintains the transplant list Transplant centers a thorough evaluation of a candidate When a person is accepted for transplant by a transplant center, the center contacts UNOS and they are added to the list Once listed, the transplant center contacts the candidate to let them know they are listed Brought to you by Organ Allocation: Allocation When an organ is available, UNOS tracks and allocates the organ Organs are allocated by status For Georgetown criteria is based on the Pediatric End Stage Liver Disease (PELD) Scoring System Status 1A – fulminant liver failure (no previous liver failure) Status 1B – liver failure necessitating the need for a blood transfusion within a 24 hour period for liver candidates Score from 1-40 based on labs including bilirubin, albumin, INR, age, growth failure Pt in need of SB get an automatic 23 points Priority is as follows: Local Regional (DC is in region , which also includes - Delaware, Maryland, New Jersey, Pennsylvania, West Virginia) National Brought to you by Who needs a Transplant? As of 06/6/11 111,502 people are waiting for transplants 16,487 waiting for a liver Mean waiting time kids < yr 223 days Mean waiting time kids 1-5 yrs 262 days 221 waiting for an intestine Mean waiting time kids < yr 358 days Mean waiting time kids 1-5 yrs 425 days National pediatric (up to 17yrs) survival from to years: over 83% Brought to you by Liver Transplant Common indications for liver transplant seen on our unit include: Biliary Atresia Alagille’s Syndrome Hepatitis B Hepatoblastoma Hemochromatosis Brought to you by Signs of Liver Failure Increased Liver Function Tests (ALT, AST, Alk phos, bilirubin (direct and indirect) Jaundice Bleeding Ascites Spleno/Hepatomegaly Glucose Intolerance Increased Infection Malnutrition (Vit A, D, E, K) Dark Urine Puritis Osteoporosis/Fractures Brought to you by Liver Transplant A liver transplant can be done in ways: 1) Cadaver 2) Living-Related Donor (generally left lobe) 3) Cadaver Split Liver Brought to you by Pre-transplant Medications Vitamins (ADEK) Calcitriol Nystatin Iron Brought to you by Post-Transplant Medications Immune Suppression: Prograf, Prednisolone, Rapamune, Cellcept, Baxiliximab Other Common Meds: Prevacid, Imodium, Lomotil, Reglan, Norvasc, Propranolol Brought to you by Post Transplant Issues Immunosuppression Rejection Infection Education Adherence Support Brought to you by Rejection The immune system protects the body from anything that is not self Because a transplant is foreign to the body, without intervention, the immune system will attempt to destroy it Goal of immunosuppressants is to inhibit immunological response and therefore prevent rejection Brought to you by Early signs and Symptoms of rejection General Fever greater than 38°C Tachycardia High or low immunosuppressant levels Lethargy/irritability Abdominal pain or distention Brought to you by Liver Rejection Liver Increased liver function tests Nausea and/or vomiting Dark urine Jaundice Itchy skin Brought to you by Intestine Rejection Intestine Increased stools and/or ostomy output Dehydration Increasing WBC Falling hemoglobin, albumin, or iron saturation Weight loss Bloody stools/ostomy output Pale, black, or bleeding stoma Output with clots or chunks of tissue Sepsis Rejection Monitoring LFTs for Liver Output and stoma for SB, appearance during scopes ONLY SURE WAY TO KNOW is through a biopsy Rejection is treated with high dose Steroids and Thymoglobulin Brought to you by Major Complication: Infection Most common complication because of immunosuppression HAND WASHING Avoid sick contacts No raw foods, no live vaccines, no cleaning up after pets Prophylactic Meds Surveillance labs for EBV, CMV, Adenovirus Brought to you by Life after Transplant Scope twice a week for the first month Once a week for the next two months Annual scope Blood draws twice a week for the first months Labs once a week until labs are stable Labs at least once every three months Lifetime of immunosuppressants Rejection can happen at any time Brought to you by Lifetime Management Issues Quality of Life Lifetime medication regime Lifetime laboratory surveillance of immunosuppression levels Lifetime surveillance for rejection Annual visits to transplant center Brought to you by Resources Unos: http://unos.org/ Georgetown University Hospital Transplant Center for Children http://www.georgetownuniversityhospit al.org/body.cfm?id=555650 This platform has been started by Parveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India We need lots of funds manpower etc to make this vision a reality please contact us Join us as Brought to you by a member for a noble cause Our views have increased the mark of the 25,000 Thank you viewers Looking forward for franchise, collaboration, partners Brought to you by Brought to you by Contact ,011-41425180 :-Us ,011-25464531 011-66217387 91-+,91-9818308353 + 9818569476 othermotherindia@gmai l.com www.other-mother.in Saxbee Consultants Details :-www.parveenchadha.com https://cparveen.wix.com/other-mother https://twitter.com/othermotherindi http://www.linkedin.com/profile/view?id=326103341&trk=nav_responsive_tab_profile https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?ref=hl A WORLDWIDE MISSITION JOIN US ... bowel transplant -Signs and symptoms of liver and small bowel failure -Common preop/postop medications -Signs and symptoms of organ rejection -Lifetime management concerns after transplant Brought... Intestinal Transplant Brought to you by Signs of Intestinal Failure Diarrhea Constipation Emesis Fluid Imbalance and signs and symptoms of fluid imbalance Electrolyte Imbalance... person is accepted for transplant by a transplant center, the center contacts UNOS and they are added to the list Once listed, the transplant center contacts the candidate to let them know