Solid Organ Transplant Notes PDF

- Solid Organ Transplant - Organ tested for communicable diseases- why?  - Prevent CMV - VRE - HEP b and c - HIV - Types of transplant - Allograft - Same species - Autologous - Same indivi...

- Solid Organ Transplant - Organ tested for communicable diseases- why?  - Prevent CMV - VRE - HEP b and c - HIV - Types of transplant - Allograft - Same species - Autologous - Same individual - Syngenic - Identical twins - Xenogenic - Different species - Orthotopic - Donor tissue tissue to normal anatomic site - Heterotopic - Donor tissue to other area of body - Anti-rejection drugs- what are the concerns? And what do they d - Prevent Rejection, Infection, Inflammation - immunosuppression - Lymphedema vs edema - Not the same, lymphedema = chronic buildup of lymph - Is rehab safe after SOT? What muscles - Yes, prox muscles - GVHD- what is it? - Graft T lymphocytes and wbc attacks host tissue - Heart transplant- what should we do/not do? Differences in a transplanted heart - \>6 hrs oob, 30 min aerobic (maybe?) - Short bouts of walking in 2^nd^ or 3^rd^ week after - Sternal precautions - No push pull \>10lb - Orthotopic vs heterotopc - Ortho = previous heart removed - Hetero = not removed - Its denervated so go slow (have Bainbridge reflex), hr doesn't change rapidly - The transplant processes - CA - Radiation- effects, concerns, what do we need to know and why? - Can be internal and external - Ionizing radiation - All tissue effected - Spreading doses out is best (fractionation) - Hypo fract = larger doses, less tx (lower total dose) - Radiated tissue never the same - Fibrosis, osteoporosis, mucositis - Multiple myeloma - Tumor of plasma cells (from B-lymph) that are in bone marrow - Affects bones, BONE PAIN and eventually the kidney - Gradual and insidious onset - Why is CA a new collection of diseases? - SI, thyroid going up, lung was up - Men more likely, get prostate, women breast. Both die lungs - Infections predisposing to CA - Epstein-Barr, Hep b and c (HBV, HCV,) HHV - Stem cells- what are they? Where do they come from? - Embryonic = into any cell type - Adult/somatic = only be used in that type of tissue - Bone marrow (lower GVHD) - Peripheral blood stem cells (more rapid engraftment ) - Cord blood (delayed engraftment) - Thrombocytopenia - Low platelets, less than 150,000 - Neutropenic fever - Leading cause of death in oncology - Long lasting immunosuppression - Signs of redness, discharge, inflammation - This is what he says to wash hands, use soft tooth brushes, etc - Signs of tissue rejection - Flu like - Peripheral edema - Tumor staging - Higher stage = more severity - T = number and size of primary tumor - 1 = 0-2 cm - 2 = 2-5 Cm - 3 = \> 5 cm - 4 = broken through skin or on chest wall - N = amount of spread to nearby lymph nodes - 0 = cant feel nodes - 1 =can feel swollen nodes - 2 = swollen and lumpy - 3 = swollen nodes located near collarbone - M = whether its metastases or not - 0 = cancer free - 1 = nodes have cancer - X = cannot be assessed - chemo effects - harms cells that divide rapidly (could include bone marrow, GI tract, hair) - immunosuppression - apetite (long term) - memory change (long term) - diabetes (long term) - cardiopul (late aka past acute and long term) - Impaired balance (also late) - Frailty (late) - Fertility (also late) - CA related fatigue - Begins about 3 weeks into tx (with radiation) - Most distressing symptom for some - Could last for years after - 70-100% get it - Does NOT improve with rest - Affects cognitively too - Use BFI (mod = 5-6) - What labs mean - Normal WBC = 4500-11,000 - ANC - Severe neutropenia = \< 500 - \>2000 = normal - CHOP - Drug cocktail ( chop has prednisone whereas CAV doesn't) - Non HL - Cav = lung cancer - What is CA? (cellular level) - abnormal and damaging cell growth - in cell dna - Leukemia - Cancer of blood or bone marrow (leukocytes or myelocytes) - All (acute) = 70% of pediatric, 20% of all - CLL (chronic) = 25% of all, only adult (10-14 year survival - - CA induced peripheral neuropathy - Radiation damages peripheral nerves - Usually sensory, but could be motor/autonomic - Decreased pain sensation, vibration threshold, reduced nerve conduction - Usually in stocking glove pattern with fingers and toes worst, then hands, then wrist - Can heal 1 inch per month - Formula for total energy expenditure aka HRPAS - \%HRR \* exercise minutes (this is volume)