Transplant Rejection
Transplantation
Tissue and organ transplants are typically done when an
organ is no longer able to function despite medical Types of Grafts
intervention, as a result of traumatic injury such as
Autograft – transplantation of tissue from one area of
burns, or disease has rendered it nonfunctional.
the body to another.
Heterograft – transplantation of tissue from two
Heart Transplant different species.
Lung Transplant Allograft – transplantation of tissue between the same
species using either live or cadaver donors.
Liver Transplant
Isograft – transplants, between individuals who are HLA
Pancreas Transplant
identical, for example monozygotic twins.
Cornea Transplant
Trachea Transplant
Transplantation Rejection
Kidney Transplant
Rejection occurs because the acquired immune system
Skin Transplant recognizes the antigens on the surface of the
transplanted organ as foreign and so begins to attack it.
Vascular Tissues Transplant
Types of Rejection
Histocompatibility Tests
Histocompatibility is the ability of the transplanted
tissue or organs to live without attack by the immune
system. The closer the histocompatibility antigens
match between donor and recipient, the less likely the
immune system is to recognize transplanted tissue as
nonself.
Donor – Recipient compatibility testing Hyperacute rejection – humoral, hypersensitivity
response, occurs within minutes to hours of transplant,
rare due to better donor-recipient screening.
Tissue typing – determines the degree to which the
donor and recipient tissue match. Also known as HLA
(Human Leukocyte Antigen) typing/matching. HLA are
actually proteins that are expressed in all cells of our
body okay and these cells actually help our body to
differentiate self from non-self.
Cross-matching – tests the recipient for antidonor
antibodies that may have developed from a prior organ
transplant, blood transfusion, or pregnancy.
ABO Typing – blood group typing
Acute rejection – cell-mediated response: sudden onset,
days or months following transplant.
Corticosteroid: Prednisone-methylprednisolone
(SoluMedrol)
Suppress inflammatory response
Cytotoxic drug: mycophenolate mofetil (CellCept) or
cyclophosphamide (Cytoxan)
Suppress immune response by inhibiting proliferation of
T and B cells.
Monoclonal Antibodies: muromonab-CD3
Chronic rejection – humoral, can begin any time after Used for preventing and treating acute rejection
transplant and take years to make the transplant episodes
nonfunctional.
Polyclonal Antibodies: Atgam
Clinical Manifestations
Used as induction therapy or to treat acute rejection
•Fevers and rigors
•Inflammation around the transplant site
Immunosuppressive Therapy Side Effects
•Fluid retention
•Nephrotoxicity
•Weight gain
•Increased risk of infection
•Hypertension
•Lymphoma
•Hepatoxicity
Medical Management
•Neutropenia
Blood tests should be monitored and, depending on the
•Thrombocytopenia
organ transplanted, should include the white cell count,
urea and electrolyte levels and liver function tests. •Diarrhea/Nausea/Vomiting
Treatment may involve adjustments or changes in Nursing Management: Reducing Infection
immunosuppressant medications and their
administration. •Nurse the patient in a single room, away from other
patients with infections.
•Those not allowed access to patients are:
Pharmacology Therapy
o Individuals with infections.
Cyclosporine
Prevent a cell-mediated attack (helper T-cells) against o Individuals exposed to contagions, e.g., viruses such
the organ as chickenpox or measles.
o Young children (as they have greater likelihood of
exposure o infections) Employ hand hygiene on
•Monitor blood tests for signs of an increased white cell
entering and leaving the patient's room.
count as this may indicate the presence of infection.
•Ensure patient hygiene as one of the greatest sources
of infection is the patient's own body flora.
•Educate patients on hand hygiene after using the toilet
and before meals.
•Monitor the vital signs for indications of infection.
•A rise in temperature may be the first indicator of
infection.
•Ensure regular oral hygiene:
o Patients should use a soft, small-headed
toothbrush, especially after eating and at night.
•Educate patients to report soreness or ulcers in the
mouth.
•Aseptic techniques must be used when managing
wound dressings or any break in the skin's integrity.
•Monitor intravenous (IV) cannulas for signs of
inflammation and infection.
•Change IV cannulas at least every 72 hours (and in line
with local policy).
•Change IV giving sets at least every 48 hours to reduce
the risk of bacterial contamination.
•Liaise with the dietitian as a good diet is essential to
promote wound healing and strengthen the immune
system.
