Organ Transplant, An Issue of Critical Care Nursing Clinics

Darlene Lovasik

Description

This issue of Critical Care Nursing Clinics, Guest Edited by Darlene Lovasik, RN, MN, CCRN, CNRN, will feature such article topics as: Evaluation and Work-up for Transplant; Basic Immunology; Pharmacology; Liver, Pancreas, Kidney Transplants; Living Donor Kideny, Liver Transplants; Heart, Lung, Intestinal and Multivisceral Transplants; Complications After Transplant ; Patient Education; Psychosocial Concerns; Ethical Issue; Financial/Operational Considerations; Organ Donation.

Sujets

• Critical Care
• Medical
• Médecine
• Nursing
• Intensive Care

Informations

• Publié par: Saunders
• Date de parution: 28 septembre 2011
• Nombre de lectures: 0
• EAN13: 9781455712021
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Critical Care Nursing Clinics of North America , Vol. 23, No. 3, September 2011
ISSN: 0899-5885
doi: 10.1016/S0899-5885(11)00049-9

Contributors
Critical Care Nursing Clinics of North America
Transplant
Dr. Darlene Lovasik, RN, MN, CCRN, CNRN
UPMC Presbyterian, N1274, Unit 12 North, MUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
ISSN  0899-5885
Volume 23 • Number 3 • September 2011

Contents
Cover
Contributors
Forthcoming Issues
Transplantation: Past, Present, and Future
A Review of Transplant Immunology
Pharmacology of Immunosuppressive Medications in Solid Organ Transplantation
Nursing Care of the Pancreas Transplant Recipient
Liver Transplantation: Issues and Nursing Care Requirements
An Overview of Intestine and Multivisceral Transplantation
Heart Transplantation
Lung Transplant
Helping Hands: Caring for the Upper Extremity Transplant Patient
Transplant Infectious Disease: Implications for Critical Care Nurses
Index
Critical Care Nursing Clinics of North America , Vol. 23, No. 3, September 2011
ISSN: 0899-5885
doi: 10.1016/S0899-5885(11)00051-7

Forthcoming Issues
Critical Care Nursing Clinics of North America , Vol. 23, No. 3, September 2011
ISSN: 0899-5885
doi: 10.1016/j.ccell.2011.09.003

Preface
Transplantation: Past, Present, and Future

Darlene Lovasik, RN, MN, CCRN, CNRN, Email: [e-mail]
UPMC Presbyterian, N1274, Unit 12 North, MUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA


Darlene Lovasik, RN, MN, CCRN, CNRN, Guest Editor
A kidney was transplanted from one healthy identical twin to his twin who was dying of renal disease on December 23, 1954. The operation was successful; renal function was restored in the recipient, and the donor remained in good health. This pioneering surgery kept the recipient alive for eight years; the donor lived a healthy life and died at age 79 in 2010, and lead surgeon Dr Joseph Murray went on to win the Nobel Prize. The early drugs used to treat rejection for kidney transplant, azathioprine and corticosteroids, were also used in the initial efforts at liver, heart, and pancreas surgery, but patient mortality was high. In the early 1980s, cyclosporin, a calcineurin inhibitor, was introduced and led to a striking reduction in rejection for kidney transplants as well as marked improvement in outcomes for liver and heart transplant recipients. Other immunosuppressive drugs, tacrolimus, mycophenolate mofetil, and sirolimus (with different profiles and efficacy), were introduced in the 1990s. To a great extent, transplantation advanced through the work of Thomas E. Starzl, MD, PhD, whose foresight, perseverance, and commitment made him the modern-day father of organ transplantation, and none of these triumphs would have been achieved if our transplant leaders had not first undertaken exacting laboratory work to show that these operations would be feasible and effective. The success and progress in transplantation are also irrevocably linked to the developments in immunosuppressive therapy and immunomodulation strategies.
These advancements in the field of transplantation have given hope to thousands of patients facing organ failure. Since January 1, 1988, over 518,000 organ transplants have been performed in the United States. More than 406,000 organ-transplant recipients received organs from deceased donors, and over 112,000 recipients received organs, usually kidneys, from living donors. The medical specialists and surgeons who guide people to new lives as organ recipients, the nurses, clinical coordinators, and physicians who provide care and support before and after surgery, and the researchers who move the field forward have continued to innovate and lead efforts to discover new and better therapies to help reduce the potential for organ rejection.
This issue of Critical Care Nursing Clinics of North America is a collection of articles on transplantation. The authors provided vital information for organ-specific assessment and nursing interventions for recipients of pancreas, liver, intestine/multivisceral, heart, lung, and upper extremity transplant, discussed aspects of care that are common in all transplant recipients, including organ rejection, risk of infection, and physical and psychosocial problems, and reviewed immunosuppressive drug therapy and, the potential complications.
As graft and patient survival improves, it is no longer necessary for these patients to return to their transplant center for hospital admissions that are not related to their transplanted organ; however, the patient's transplant status must be a significant part of the plan of care. Transplant recipients will develop the same health problems as other aging individuals; however, they are likely to develop these conditions earlier and their diseases will progress at an accelerated rate. Optimal patient care is achieved through close collaboration between community health care providers and the transplant centers.
As the guest editor of this issue of Critical Care Nursing Clinics of North America , I would like to thank each of the contributing authors for sharing their time, energy, and clinical expertise on caring for the transplant patients with their professional colleagues. I am grateful for the supportive relationships that I have with the physicians, nurses, pharmacists, and other health care professionals who work with this challenging patient population and hope that you also have the benefit of true collaboration in your work environment. For her patience and support, I would also like to thank Katie Hartner from Elsevier. And a final “thank you” to the patients and families, whose courage, grace, and dignity continue to inspire us.
Critical Care Nursing Clinics of North America , Vol. 23, No. 3, September 2011
ISSN: 0899-5885
doi: 10.1016/j.ccell.2011.08.004

A Review of Transplant Immunology

Deanna McCaffery, RN, MSN, CCTN ⁎ , Email: [e-mail] .
Transplant ICU, UPMC Presbyterian, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
⁎ Corresponding author

Keywords
• Transplant immunology • Allografted organs • Immunosuppression • Nursing considerations
Transplantation has been an accepted treatment for end-stage organ disease for more than 30 years. Advances in transplant immunology are the cornerstone to the success of the body's ability to accept the allografted organ while continuing to perform immune functions such as tumor surveillance and fighting pathogenic organisms. The history of transplant immunology has been written through the work of physicians such as Medewar, Gorer, Murray, and Starzl. Modifying the immune response to promote tolerance and chimerism through pharmacology has greatly extended the survival rates of liver transplant recipients. Current trends in immunosuppression focus on both allograft function and the recipient's quality of life.
Following the determined efforts of transplant pioneers, transplantation is now considered a viable therapeutic modality for kidney, pancreas, liver, intestine, heart, and lung end-stage organ disease as well as composite tissue allotransplantation (face, hands, larynx, muscle flaps, and others). Success in the field of transplantation was built on the scientific advances in immunology. Suppressing the immune system's ability to recognize self from nonself is the key to survival of the transplanted organ and, ultimately, the patient. Advances in transplant immunology have led to short-term survival rates being replaced with long-term survival rates as clinical indicators of success. Immunosuppressive regimens that prevent rejection and prolong allograft survival often carry serious side effects to both the allografted organ and the recipient. Greater understanding of the immune response has shifted the focus of transplant immunology to tolerance and chimerism, concepts that are key to long-term allograft survival and the recipient's quality of life. 1

The Immune Response
In animals, lymphocytes are the cells responsible for the immune response and can be divided into five groups. These groups are based on function and specific surface compounds: B lymphocytes, accessory cells (macrophages), natural killer cells (NK and NKT cells), and mast cells. Each of these groups performs specific functions correlated to the surface receptors that they possess. When the appropriate antigen is encountered, the lymphocyte produces immunoglobulins (antigen-specific antibodies), proliferates, and differentiates. Because the lymphocyte's reaction is greater the second time it encounters the antigen, it demonstrates that immune responses are specific and acquire memory. This function is an integral theory in transplant immunology.
B cells and macrophages break down proteins, including bacteria, and display antigens (short peptide chains) on the cell's surface through the major histocompatibility complex (MHC). Both normal proteins (self) and microbial pathogens (nonself) are present ( Fig. 1 ). The MHC signals the immune system that nonself or foreign substance is there. The T cells or NK cells survey the surface and if a MHC peptide is recognized, it activates the immune cell, producing an immune response. Helper T cells then stimulate B cells to develop antibodies. B cells divide and differentiate to form antibody-secreting plasma cells that bind to bacteria so that they can be ingested by macrophages. This is the key to producing monoclonal antibodies.

Fig. 1 Old and new views of transplantation immunology. ( a ) Early