Organ Transplants

Organ transplantation is a treatment for what?

End-stage renal failure

Why has the success of transplants been increasing?

• Improved surgical techniques

• Better understanding and management of the rejection process

• More immunosuppressant med options

• Advancements in prevention and management of infections post transplant

What is the 5 year survival rate of organ transplantation?

70%

List the general criteria for transplantation

• End stage organ disease

• Alternative medical or surgical management has failed

• Life expectancy of 1-3 years

• Absence of untreatable malignancy or irreversible infection

• Absence of disease that would attack the transplanted organ or tissue

What is the top organ transplantation?

Kidney

List in descending order, the most common organ transplantations performed

1. Kidney

2. Liver

3. Heart

4. Lung

5. Pancreas

6. Intestine

List in descending order, the most common tissue transplantations

1. Bones

2. Tendons

3. Ligaments

4. Skin

5. Heart valvles

6. Blood vessels

7. Corneas

What is the most common to be transplanted?

Bone

How many hospitals in Michigan can perform transplantations?

8 (6 adults, 2 peds)

How many hospitals in Michigan can perform a heart transplant?

4

What is the name of the national registry that tracks transplantation center process and outcome?

Organ Procurement and Transplant Network (OPTN)

What is the name of the organization that is responsible for procuring and distributing donor organs in an appropriate and ethical manner?

United Network for Organ Sharing (UNOS)

The UNOS has the country divided into how many regions?

11

What are the responsibilities of an organ procurement organization (OPO)?

• Recover and transport organs to transplantation hospitals

• Provide medical and public educationa bout organ donation

• Promote donation

What are the guidelines for donor candidates?

• Gotta be less than 50

• Smoking history less than 30 pack years w/ acceptable O2

• No evidence of malignancy, HIV, hep B/C, or sepsis

• Some organ specific guidelines

How long do hearts and lungs last after death?

6 hours

How long does the liver last after death?

24 hrs

How long do the kidneys last after death?

72 hrs

What are the criteria for organ candidates?

• Preference given to most critical status from same geographic region as donor

• Updated medical eval

Name the medical considerations for ogran candidates

• Matched blood type

• Body weight

• Presence of other illness or disease that’s contraindicated

• End-stage organ disease

  • Irreversible renal insufficiency

  • Irreversible hepatic insufficiency

  • Severe pulmonary disease

  • Fixed pulmonary HTN

• At risk for cardiac problems

• Decrease in chest wall mobility

• Uncontrolled infection or acute sepsis

• HIV

• Malignancy w/ metastasis

• Malignancy w/ an expected 5 year survival rate of 75%

• Irreversible neuromuscular or neurologic disorder

• Severe PVD or cerebrovascular Dx

• Non-ambulatory w/ poor rehab potential

What are some nonmedical considerations for an organ candidate?

• History of noncompliance w/ medical therapy in last 5 years

• History of ongoing alcohol or drug dependence

• Active or recent (within last 6 months) cigarette smoking (when they are gonna have a lung transplant)

• History of psychologic instability

• Financial resources

• Fam and community support available

How many drugs are sued to control rejection after a transplant?

3

What is name of the 3 drugs used to control rejection?

• Calcineurin inhibitor (Cyclosporine or tacrolimus)

• Antimetabolite (azathioprine, mycophenolate mofetil, cyclophosphamide)

• Corticosteroid (prednisone)

How long are peeps on a high dose of anti-rejection drugs after a transplant?

30ish days

What are some benefits of exercise for peeps after a transplant?

• Increased work capacity

• Increased efficiency of O2 utilization in muscles

• Improved func

• Improved QoL

• Improved depression

In PT, what should you focus on pre-transplant w/ a pt?

• Improved aerobic capacity pre-transplant to help w/ surgical recovery post-transplant

• Focus on function

• Focus on proximal muscle strengthening

• Find activities the person likes to do

When does PT start post-transplant?

POD#1

Transplant recipients are advised to not engage in what?

Contact sports

Describe the denervation that occurs to transplanted organs

• Lose efferent input from ANS

• No direct afferent input to CNS

Loss of ____ response in denervated heart

vagal

If doing PT w/ a peep w/ a denervated heart, what part of the session do you need to elongate?

Warm up time

What will be impaired in a denervated kidney?

Insulin release

What response will be altered in a denervated kidney?

Renin response

A denervated lung has reduced ____ volumes and decreased lung ____ compliance

• Tidal volumes

• Lung compliance

In PT, you are working w/ a peep who has a denervated lung. What part of the session do you need to elongate?

Warm up