Transplants

What is a medical transplant?

The process of transferring an organ, tissue or group of cells removed from one person and transplanted into another person

How often is a person added to the transplant waitlist?

every 8 minutes

What are the most prevalent age groups for deceased donations?

• 50 to 64

• 35 to 49

• 18 to 34

What is the highest organ on the waiting list for transplants?

Kidney

What are the top three transplants performed by organ?

• kidney

• liver

• heart

Solid organ transplantation

includes heart, lung, kidneys, pancreas, liver, thymus, and intestines

organ trafficking

illegal trading of organs

transplantation tourism

process in which individuals travel to purchase organs

How can donor organs be procured?

Cadavers or from a living person

Allograft

tissue taken from a different person

isograft

tissue taken from a genetically identical donor

autograft

tissue transplanted from one site to another within the same person

xenograft

transplant between two different species

candidate criteria for transplants

• must have end stage disease organ disease that no longer responds to traditional medical interventions

• should have good psychological and emotional stability, good family and financial support, no cancer, disease, or recent history of tobacco, drug, or alcohol use

• prescreening tests

Donor criteria

• living → at least 18 years old, good mental and physical health, and free from cancer, DM, HTN, hepatitis, HIV, or organ specific diseases

• deceased → presence of infection, distance from recipient, blood and tissue type, donor age and body size, medical urgency

Kidney transplant

• most common type of transplant and the number on the waitlist continue to rise

• employed for patient with end stage renal disease that may be caused by diabetes or HTN

• 5 year survival following transplant

  • Kidney transplant offers better rate of life participation and quality of life

risks of kidney transplant

infection, blood clots, and failure or rejection of the donor kidney

Liver transplant

• second most common type of transplant

• the liver has the ability to regenerate, however, regeneration can take several months

• transplants may be partial or full organ

what could be some reasons for a liver transplant?

alcoholic liver disease, cancers originating in the liver, fatty liver disease, cirrhosis caused by Hep C, chronic viral Hep B or D, and acute liver failure

What is the 5 year survival rate for a liver transplant?

72 to 79%

What is hepatitis?

an infectious disease that causes inflammation of the liver

Hepatitis A

Type A is highly contagious. Source is feces, route of transmission is fecal-oral. Not a chronic infection. Prevention is pre/post exposure immunization

Hepatitis B

Source is from blood/blood-derived body fluids. Route of transmission is percutaneous per mucosal. Chronic infection. Prevention is pre/post exposure immunization

Hepatitis C

Source is from blood/blood-derived body fluids. Route of transmission is percutaneous permucosal. Chronic infection. Prevention through blood donor screening, risk behavior modification

Hepatitis D

Source is from blood/blood-derived body fluids. Route of transmission Percutaneous permucosal. Chronic infection. Prevention is risk behavior modification and immunization

Hepatitis E

source is from feces. Route of transmission is fecal-oral. Not a chronic infection. Prevention is ensuring safe drinking water.

Symptoms of hepatitis

jaundice, dark urine, light colored stools, decreased appetite, extreme fatigue

Pancreas and intestine transplant

• not life saving but may improve quality of life

  pancreas transplant may be indicated for severe kidney damage or poor blood sugar control

• intestinal transplant indicated with intestinal failure

• pancreas transplant can occur with kidney transplant or with portion of intestine

Benefits of pancreas transplant

can restore insulin production and improve blood sugar control

heart transplant

life saving procedure for end stage heart disease when all other measures have been exhausted. Heart transplant rate continues to increase even though there is a shortage of donor hearts.

What is being used to bridge the gap for heart transplants?

Ventricular assisted devices or total artificial hearts

Conditions treated by heart transplant:

cardiomyopathy, ischemic heart disease, CAD, valvular heart disease, CHF, congenital heart diseasesL

Lung transplant

• indicated for end stage respiratory failure due to severe cystic fibrosis, DOPD, bronchopulmonary dysphasia, pulmonary HTN, sarcoidosis, and other respiratory conditions

What are the three ways a lung transplant can occur?

unilaterally, bilaterally, or living donor transplant

Risks of a lung transplant?

infection, pulmonary edema, blood clots, rejection of donor organs

What is the median survival rate for lung transplants?

5.8 years?

most common transplanted tissues

1. bone

2. tendons

3. ligaments

4. skin

5. heart valves

6. blood vessels

7. corneas

Tissue transplant - skin graft

surgical transplant of a patch of skin from one site to another. Used with conditions such as burns, wounds, cancers, surgeries, cosmetic reasons. Skin may be harvested from multiple body areas such as abdomen, back, buttocks, and thighs

What are the two primary types of skin grafts?

split thickness skin graft and full thickness skin graft

Complications of transplants

• rejection of donor organ or tissue

• graft vs. host disease

• infection

• dialysis

• rehospitalization

• development of post transplant conditions such as DM, HTN, HLD, and kidney disease

• diarrhea, leukopenia

• the presence of comorbid conditions can add additional complications

transplantation impact on occupations

ADLs, IADLs, QoL, sleep, physical functioning, psychological impact, pain

OT may be present at each stage of treatment

OT considerations

• practice good hand hygiene to decrease risk of infection

• individuals may have changes in dietary needs, including need daily weight measurements, restrictions, or dietary changes

• activity or ROM restrictions

• assess and address psychological needs

• sternal precautions

• changes in vital signs

  • need for supplement oxygen

Assessments for transplants

OPHI-II

Role checklist

AMPs

Montreal Cognitive assessment

executive functional performance test

goal attainment scaling

health literacy assessments

What are some pretransplant tests and screening?

• blood and tissue typing

• complete blood count

• arterial blood gas analysis

• urinalysis

• imaging studies

• psychosocial evaluation

• financial resources

Hyperacute rejection of organs

is an immediate and rapid rejection of a transplanted organ due to pre-existing antibodies in the recipient, leading to acute kidney injury or graft failure. Occurs within the first 48 hours after solid organ transplantation

Acute rejection for organs

Most common form of rejection. Caused by a primary allogenic response. Occurs within the firs 6-90 days after transplantation. Patient may initially asymptomatic.

Chronic rejection for organs

occurs 2 months or more months after transplantation. The only definite treatment is transplantation.

Graft versus host disease

begins 6 or more days after transplantation. Characterized by a progressive rash and severe diarrhea. Occurs when the donor organ forms antibodies that attack the recipient’s tissues because it recognizes the host as a foreign body.