Kidney Transplantation

  1. General information
    1. Transplantation of a kidney from a donor to recipient to prolong the life of person with renal failure
    2. Sources of donor selection
      1. Living relative with compatible serum and tissue studies, free from systemic infection, and emotionally stable
      2. Cadavers with good serum and tissue crossmatching; free from renal disease, neoplasms, and sepsis; absence of ischemia/trauma.
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Discuss the possibility of post-op dialysis/ immunosuppressive drug therapy with client and significant others.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Monitor fluid and electrolyte balance carefully.
      1. Monitor I&O hourly and adjust IV fluid administration accordingly.
      2. Anticipate possible massive diuresis.
    3. Encourage frequent and early ambulation.
    4. Monitor vital signs, especially temperature; report significant changes.
    5. Provide mouth care and nystatin (Mycostatin) mouthwashes for candidiasis.
    6. Administer immunosuppressive agents as ordered.
      1. Cyclosporine (Sandimmune): does not cause significant bone marrow depression. Assess for hypertension; blood chemistry alterations (hypermagnesemia, hyperkalemia, decreased sodium bicarbonate); neurologic functioning.
      2. Azathioprine (Imuran): assess for manifestations of anemia, leukopenia, thrombocytopenia, oral lesions.
      3. Cyclophosphamide (Cytoxan): assess for alopecia, hypertension, kidney/liver toxicity, leukopenia.
      4. Antilymphocytic globulin (ALG), antithymocytic globulin (ATG): assess for fever, chills, anaphylactic shock, hypertension, rash, headache.
      5. Corticosteroids (prednisone, methylprednisolone sodium succinate [Solu-Medrol]): assess for peptic ulcer and GI bleeding, sodium/water retention, muscle weakness, delayed healing, mood alterations, hyperglycemia, acne.
    7. Assess for signs of rejection. Include decreased urinary output, fever, pain/ tenderness over transplant site, edema, sudden weight gain, increasing blood pressure, generalized malaise, rise in serum creatinine, and decrease in creatinine clearance.
    8. Provide client teaching and discharge planning concerning
      1. Medication regimen: names, dosages, frequency, and side effects
      2. Signs and symptoms of rejection and the need to report immediately
      3. Dietary restrictions: restricted sodium and calories, increased protein
      4. Daily weights
      5. Daily measurement of I&O
      6. Resumption of activity and avoidance of contact sports in which the transplanted kidney may be injured.