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ORGAN TRANWLANTATlOr-.; 707

cess, and ,t may take years before the organ fails, but eventually

rerransplantation is required.

Chronic rejection in patients with renal transplanrs presenrs as a

gradual 1I1crease in serum crearinine and BUN, electrolyte imbalance,

weight gain, new-onset hypertension, decrease in urine output, and

peripheral edema·"

In patients with liver transplants, chronic rejection is seen as a

gradual rise in serum bilirubin and elevation of serum glutamicoxaloacetic transaminasc.19 Progressive thickening of the hepatic aneries and narrowing of the bile ducts occur and eventually lead to

progressive liver failure.

In patients with cardiac transplants, chronic rejection manifests

III the form of coronary allograft vasculopathy, in which there is

accelerated graft atherosclerosis or myocardial fibrosis and increasing blockage of the coronary arteries, which leads to myocardial ischemia and infarction.b

Chronic rejection in patients with lung transplants is manifested as

hronchult.tis obliterans with symptoms of progressive dyspnea secondary to increasing airflow obstruction and a progressive decline in the forced expiratory volume in one second (FEV,)]"

In patients with pancreas transplants, the pancreatic vessels

thicken, leading to fibrosis, and there is a decrease in insulin secretion

with resultant hyperglycemia.b

bl(eelioll

Supprc!o,sion of the Immune response prevents rejection of the transplantcd organj however, the recipient is more susceptible to infection.

Infection may occur in the lungs, liver, colon, and oral mucous membrane. In addition to a surgical wound infection, the recipient is at risk for bacterial, fungal, and viral infections. Bacterial infections may

occur in the urinary tract, respiratory tree, and indwelling devices,

such as a central venous catheter.'" The highest risk for infection is

during the first 3 months after transplantation." If infection is noted,

fewer immunosuppressive drugs are given, and antibiotic treatment is

initiated. Antibacterial, antiviral, and antifungal medications are

often given prophylactically. Bacterial infections are treated using

antibiotics. The use of trimethoprimlsulfamethoxazole (Bactrim) in

prophylactic doses has been effective in preventing Plleul1Ioeyslis ear-

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AClJrE CARE HANDBOOK FOR PHYSICAL Tf-IERAI'ISTS

111t1 pneumonia in cardiac transplant reCIpients. Fungal infection is

caused by yeast and can be treated with amphotericin. Nystatin, an

oral antifungal mouthwash, is used for prevention of mucosal candidiasis that often occurs due to immunosuppression. Viral infection, sllch as cytomegalovirus, is very problematic. Cytomegalovirus causes

different clinical syndromes, including pneumonitis, hepatitis, nephritis, and gastrointestinal ulceration.17 If not detected and treated early with ganciclovir, it can result in the loss of the graft. While in the hospital, proper hand washing, before and after direct cOntact with transplant recipients, is the most important and effective way to prevent infection.

General signs and symptOms of infection include the following7:

• Temperature greater than 38°C (lOO.SOF)

• Fatigue

• Shaking chills

• Sweating

• Diarrhea lasting longer rhan 2 days

• Dyspnea

• Cough or sore throat

Renal Transplantation

Renal or kidney transplants are the most common organ transplant

procedure.6 Renal transplantation is a means of restoring normal

renal function to patients with irreversible end-stage renal failure.

The most frequent causes of end-stage renal disease requiring

transplantation include the followingS. II:

• Primary uncontrolled hypertension

• Glomerulonephritis

• Chronic pyelonephritis

• Diaberic nephropathy

• Polycystic kidney disease

ORGAN TRANSPLANTATION 709

Conrraindicarions ro renal transplantation include the following12:

• Advanced cardiopulmonary disease

• Active vasculitis

• Morbid obesity

Cadaveric versus Liv;,'g 001l0r Re1lai Transpiantati01l

Kidney transplants may be cadaveric or living donor. Cadaveric kidneys may be maintained for as long as 72 hours before transplantation and, as a result, are the last organs to be harvested. Although less commonly performed, living donor kidney transplants are preferred to cadaveric transplantation. Because the body can function well with one

kidney, the kidney donor can lead a normal, active life after recovering

from the surgery. There is no increased risk of kidney disease, hypertension, or diabetes, and life expectancy does not change for the donor?

The benefits for the recipient include a longer allograft and patient

survival from a living donor kidney transplant. The recipients of living