Pathology- Organ Transplant

immediately to months to years post transplant

for how long is graft rejection a risk

fever, graft tenderness, fatigue, decreased exertional tolerance, or asymptomatic

what are organ related symptoms

decrease in the lumen size and ischemia of the distal tissue and perpetrates the inflammatory reaction

in the presence of a chronic immune/inflammatory process within the donor organ, the intimal lining of the vascular tissue undergoes fibrosis and vascular remodeling... this leads to

adherence to immunosuppressive therapy

what is a key factor that contributes to transplant failure that occurs within 2 years after surgery

financial barriers

what are the most common reasons for non-compliance or spreading out antirejection medications, taking them less often

chronic rejection

irreversible cellular damage within the donor organ and leads to graft dysfunction and eventually failure

diabetes and accelerated hyperlipidemia with associated atherosclerosis, subsequent cardiovascular disease, decreased bone density and osteoporosis, neurotoxic reactions (fine tremor, parasthesias- foot drop, seizure), myopathies, avascular necrosis, musculoskeletal injuries

what are side effects of long term immunosuppressions

osteoporosis

has become a silent contributor to mortality in organ transplantation

reversible

most of these dose relates side effects are

colon and rectum (diverticulitis, perforation, malignancy)

what gastrointestinal problems should the attending PT be on the look out for in a post transplant client

wound complications

one of the most common types of post transplantation surgical complications

immunosuppression and obesity

what are the two most important risk factors for wound complications

burning, stabbing, or dull, may be linked with depression

pain associated with post-transplantation syndrome is described as

chest discomfort and/or shoulder and arm pain

individuals who experience partial sympathetic reinnervation following heart transplantation may experience

severe deconditioning and exercise intolerance

by the time of organ transplantation, candidates usually have experienced a period of long term ill health leading to end stage organ failure accompanied by

weakness, dyspnea on exertion, fatigue, little motivation for exercise and sport, limitation in peak anaerobic and aerobic capacity

most transplantation candidates experience

lumbar spine bone fractures (due to osteoporosis)

up to 35% of transplant recipients develop

sympathetic nerves to the organs

denervation of the transplanted heart, pancreas, liver, or kidneys results in a loss of

impaired

without a balance in parasympathetic-sympathetic responses heart rate variability during and after exercise is

increase in exercise capacity

the restoration and reinnervation of nerves after transplantation results in an

graft versus host disease

recipient not graft recognized as foreign, primarily involves integument; liver and GI may be invilved

kidney transplantation

most common solid organ transplantation; 1/2 of adults have kidney diabetes too

liver transplantation

hepatitis B not resolved with transplantation but may be lessened; few absolute contraindications

heart transplantation

cardiomyopathy is most common cause for

exercise VO2

what is a major criterion for heart transplantation candidacy

<12 ml/kg/min

a VO2 of what indicated a decreased survival rate

vascular assist device

bridge transplant; transplant substitute

lung transplantation

ECMO

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndromes, cardiac or pulmonary toxicity, pre-existing comorbidities, infections, hypertension, diabetes, congestive heart failure, dyslipidemia, joint hemorrhage, graft verses host disease

post transplant risks and threats for hematopoietic cell transplantation

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndromes, cardiac or pulmonary toxcity, pre-existing comorbidities, infections, hypertension, diabetes, congestive heart failure, dyslipidemia, joint hemorrhage, graft versus host diseases, potentially global comorbidities

post transplant risks and threats for graft versus host disease

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndromes, cardiac events, cerebrovascular events, hypertension, osteoporosis, cancer, pelvic congestion syndrome, tendon injuries, elevated BP response with exercise

post transplant risks and threats for kidney transplantation

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndrome, nervous system complications

post transplant risks and threats for liver transplantation

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndrome, cancer, polyneuropathies, osteopenia, osteoporosis, renal dysfunction, gout, depression, PTSD

post transplant risks and threats for heart transplantation

device malfunction

post transplant risk and threats for vascular assist devices

matching, ischemic reperfusion injury, histocompatibility, graft rejection wound healing, pain syndromes, osteopenia, osteoporosis, GI disorders, steroid induced diabetes, lymphatic disruptions, abnormal swallowing and dysphasia, cardiac, cancer

post transplantation risk and threats for lung transplantation

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndromes, surgical complications, vascular disease

post transplantation risk and threats for pancreas transplantation

matching, ischemic reperfusion injury, histocompatibility, graft rejection, GI problems, wound healing, pain syndrome

post transplantation risk and threats for skin transplantation

weakness, dyspnea and exertion, fatigue, unmotivated, fall risk, arrhythmias, altered consciousness, headaches, motor/sensory deficits, visual disturbances, involuntary movements, cranial nerve palsies, seizures, anxiety, depression, somatic distress, suicidal thoughts

signs and symptoms following hematopoietic cell transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk

signs and symptoms of graft versus host disease

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk, hypertension, osteoporosis, tendinopathies

signs and symptoms following kidney transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk, ascites, imbalance, uncorrdination, sleep disturbances

signs and symptoms following liver transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk, mobility, balance prevention , airway clearance, sternotomy pain, rate deviations associated with high rate of rejection, exertional hypertension, abdominal vitals

signs and symptoms following heart transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk, mobility balance prevention, airway clearance, sternotomy pain, heart rate deviations associated with high rate of rejection, exertional hypertension, abnormal vitals

signs and symptoms following vascular assist devices

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk, conditioned breathlessness

signs and symptoms following lung transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk

signs and symptoms following pancreas transplantation

weakness, dyspnea on exertion, fatigue, unmotivated, fall risk

signs and symptoms following skin transplantation