Transplant Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common organ transplant types and their indications.

2. Understand preoperative assessment and surgical procedures.

3. Recognize post-operative complications, including graft rejection and infection.

4. Apply nursing and medical principles for care of transplant patients.

 Key Glossary Terms

1. Kidney Transplant

• Definition: Surgical replacement of a diseased kidney with a healthy donor kidney.

• Indications: End-stage renal disease (ESRD), chronic kidney failure

• Post-Op Considerations: Immunosuppressive therapy, monitor urine output, renal function, infection prevention

2. Liver Transplant

• Definition: Replacement of a diseased liver with a donor liver

• Indications: Cirrhosis, liver failure, hepatocellular carcinoma (selected cases)

• Post-Op Considerations: Liver function tests, bile drainage, infection prevention, immunosuppression

3. Heart Transplant

• Definition: Replacement of a failing heart with a donor heart

• Indications: End-stage heart failure, cardiomyopathy, congenital heart disease

• Post-Op Considerations: Cardiac monitoring, arrhythmia surveillance, immunosuppressive therapy

4. Immunosuppressive Therapy

• Purpose: Prevent graft rejection by suppressing the immune response

• Common Drugs:

  • Calcineurin inhibitors: Cyclosporine, Tacrolimus

  • Antiproliferatives: Mycophenolate mofetil

  • Corticosteroids: Prednisolone

• Nursing Focus: Monitor for infection, hypertension, nephrotoxicity, and drug interactions

5. Graft Rejection

• Types:

  • Hyperacute: Minutes to hours, immediate graft failure

  • Acute: Days to weeks, treatable with immunosuppressants

  • Chronic: Months to years, gradual loss of graft function

• Signs: Fever, tenderness over graft, decreased organ function

6. Infection Prevention

• Definition: Transplant patients are immunocompromised and prone to infection

• Nursing Measures: Strict asepsis, hand hygiene, monitoring for early signs of infection, vaccination where appropriate

7. Nursing & Medical Student Focus

• Nursing: Monitor vital signs, organ function, fluid balance, wound care, medication adherence, patient education

• Medical Students: Understand surgical indications, immunosuppressive protocols, recognize rejection signs, interpret lab results, manage complications

8. Transplant Surgery Mnemonics

• “KILL” for transplant types:

  • Kidney

  • Intestine (less common)

  • Liver

  • Lung/Heart (cardiothoracic)

• “HAR” for acute rejection signs:

  • Hypertension

  • Anuria/decreased organ function

  • Rigidity/tenderness at graft site

 Tables

Table 1: Common Organ Transplants

Table 2: Post-Operative Nursing Care for Transplant Patients