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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
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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-
708
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