Intestinal Transplantation An Introduction

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.

An Introduction to Transplantation

Lauren Walker, RN, BSN, CCRN Other Contributors:

Lisa Dreyfuss, RN, BSN

Hilary Poan, RN, BSN

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

 First Successful Liver 1967

 First Successful Heart 1968

 First Successful Pancreas 1968

UNOS http://www.unos.org/whoWeAre/history.asp

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

Organ Allocation: Getting Listed

 United Network for Organ Sharing

(UNOS) maintains the transplant list

 Transplant centers do 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

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.

Who needs a Transplant?

people are waiting for transplants

16,487 waiting for a liver

Mean waiting time kids < 1 yr 223 days Mean waiting time kids 1-5 yrs 262 days

221 waiting for an intestine

Mean waiting time kids < 1 yr 358 days Mean waiting time kids 1-5 yrs 425 days

National pediatric (up to 17yrs) survival from 1 to 5 years:

over 83%

Liver Transplant

transplant seen on our unit include:

Signs of Liver Failure

 Increased Liver Function Tests (ALT, AST, Alk phos, bilirubin (direct and indirect)

Liver Transplant

A liver transplant can be done in 3 ways:

1) Cadaver

2) Living-Related Donor

(generally left lobe)

3) Cadaver Split Liver

Intestinal Failure: Definition

 The inability of the gastrointestinal

system to maintain fluid,

electrolyte, and nutritional balance

of the body

 Condition requires supplementation

from sources outside of the GI tract

History of Intestinal Transplant

 1988 1st successful transplant Why so late?

Diagnosis leading to a SB

Transplant

 Structural: NEC, Gastroschisis,

malformation/volvulus, trauma, atresia, tumor

 Functional: Pseudo-obstruction,

Megacystis, Microcolon, Intestinal

Hypoperistalsis, Hirschsrpung’s disease

Small Bowel Transplant

 Skin breakdown r/t diarrhea

 Liver failure and its signs and symptoms if TPN

cholestatis occurs

Signs of Intestinal Failure

Criteria for transplantation

Types of Intestinal Transplant

The transplanted organ

(intestine 10 hours or less, liver 24

Pre Transplant Care Issues

 Immune Suppression: Prograf,

Prednisolone, Rapamune, Cellcept, Baxiliximab

 Other Common Meds: Prevacid,

Imodium, Lomotil, Reglan, Norvasc, Propranolol

Post Transplant Issues

 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.

Early signs and

Liver Rejection

 Liver

 Bloody stools/ostomy output

 Pale, black, or bleeding stoma

 Output with clots or chunks of tissue

 Sepsis

 Rejection is treated with high dose

Steroids and Thymoglobulin

Major Complication: Infection

immunosuppression

up after pets

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 3 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

Lifetime Management Issues

immunosuppression levels

 Unos: http://unos.org/

 Georgetown University Hospital

Transplant Center for Children

http://www.georgetownuniversityhospit al.org/body.cfm?id=555650

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

a member for a noble cause Brought to you by

 Thank you viewers

collaboration, partners.

Brought to you by

011-25464531 ,

011-41425180

,

91-9818308353 +,

91-9818569476

othermotherindia@gmai

l.com www.other-mother.in

JOIN US

Saxbee Consultants Details :-www.parveenchadha.com