Kidney transplant is the treatment (ttt) of choice for ptns with ESRD. TR require close monitoring after transplant as they are on complex immunosuppr
Care of the adult kidney transplant recipient (TR)
Kidney transplant is the treatment (ttt) of choice for ptns with ESRD. TR require close monitoring after transplant as they are on complex im/m. ( immunosupp-ressive) protocols that render them vulnerable for infection, malignancy, & CVS. Furthermore, ptns usually have multiple co-morbidities owing to, or as a result of, their underlying end-stage kidney disease.
Infections like upper respiratory or UT infection are commonly observed in kidney TR (transplant recipients). Decongestant medications as well as NSAID members should be prohibited. Ptns are also at a higher risk for the opportunistic infection particularly cytomegalovirus (CMV), Pneumocystis jirovecii (formerly carinii) pneumonia (PCP), as well as polyomavirus (BK & John Cunningham [JC] viral infection). CVD-in particular- is the major cause of death and graft loss in diabetic kidney TR. Potentially modifiable risk factors for CVD like HT, hyperlipidemia, & obesity should be considered. Many risk factors could be induced or even exacerbated by immunosuppressive (im/m) agents.
DM commonly observed within the 1st few months after transplantation, but there is persistent risk for the life of the TR as well as his allograft. Ptns should be regularly monitored with a fasting blood sugar in a
o Weekly basis for the 1st 4 mo post-tx, and then
o Every 3 and 6 months &
o Yearly, thereafter.
An HBA1c can be revised starting at 3 mo. post-tx instead of FBS if these values are hardly obtained. Bone disease is commonly seen after RTx. Ptns should be regularly evaluated for the presence of:
o Vit. D deficiency,
o Hypercalcemia, and
Moreover, kidney TR should undergo evaluation of BMD (bone mineral density) before commencing transplantation, and subsequently monitored according to the presence and magnitude of osteoporosis related changes.
Malignancy is more commonly observed among TR than its prevalence in general population. Renal tx ptns should have the same routinely monitored for cancer screening as those advised for general population, EXCEPT for skin cancer screening, which should be underwent on monthly basis by self-skin examination, with total-body skin examination should be implemented every 6 mo to every year by an expert clinician/dermatologist. Pregnancy in a TR lady is considered a high risk situation. The major risks to the ptn may include (1) risk of rejection as well as, (2) Graft loss. The major risks to the fetal maturity may include the impact of im/m (immunosuppressive) drugs in addition to the increased risk of infection transmission. ALL im/m medications carry certain risk in pregnancy; particularly, MMF/sodium & mTORi (mammalian (mechanistic) target of rapamycin inhibitors) are contraindicated in a pregnant women. The most effective safety plan of contraception should be commenced to prevent unplanned pregnancy in a transplanted lady.