Running head: KIDNEY TRANSPLANT

Kidney Transplant
Stephanie Rebeiro
California State University, Stanislaus

Kidney Transplant

KIDNEY TRANSPLANT

There were 17,500 kidney transplant recipients in 2010 (Lewis, Dirksen, Heitkemper, &
Bucher, 2011). Although this procedure is fairly uncommon, due to the disparity of donors, it is
important as a nurse to know how to take care of these patients. A nurse needs to know why a
patient may be receiving the transplant, the process a patient must go through, and the clinical
significance of a kidney transplant. Medical management of the patient, possible nursing
diagnoses, and patient teaching are also vital knowledge when providing care to kidney
transplant recipients. Each of these will be discussed in the following.
Etiology
The most common reason for a patient to receive a kidney transplant is the presence of
end stage renal disease (ESRD). This disease is defined as an irreversible loss of kidney function
(Kidney Transplant, 2013). A patient with ESRD typically uses dialysis to filter their blood due
to the lack of the ability of the kidney. Diabetes remains the number one cause of ESRD, but it
may also be caused by uncontrolled hypertension, multiple kidney infections, smoking, or even
genetics (Kidney Transplant, 2013). A kidney transplant allows for the return of kidney
function to filter the blood and reverses the effects of kidney disease (Lewis et al., 2011). It is
also less expensive than dialysis after the first year (Lewis et al., 2011). The reason why there are
not more patients receiving kidney transplants is the lack of kidney donors. Kidneys are a rare
find for patients and therefore there is a very specific process in order to receive one.
Pathogenesis
The process of receiving a kidney transplant begins with being on a transplant list.
Transplant centers evaluate patients medical and psychosocial health to determine candidacy
and their placement on a transplant list (Lewis et al., 2011). Those first on the list will receive the
first kidney that is a match for them. Contraindications for receiving a kidney include patients

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with untreated cardiac disease, extensive vascular disease, chronic infection, psychosocial
disorders, some even exclude those who are morbidly obese and smokers. HIV, however, is not a
contraindication (Lewis et al., 2011).
Kidney donors may be a living person such as a friend, family member, or even a
complete stranger. The donor may be non-heart beating, such as someone who is being kept on
life support and is an organ donor. Lastly, the donor may be a cadaver, or from someone who has
recently passed (Kidney Transplant, 2014). Once a donor is found, multiple blood and tissue
tests will be ran between the donor and the recipient to test for compatibility.
The recipient will now need to prepare for surgery. Several tests will be ran to make sure
the patient is safe for the operation. The patient will have multiple lab tests drawn, including a
complete blood count, complete metabolic panel, clotting times, urine culture, and blood type
(Lewis et al., 2011). An EKG and chest x-ray will be completed prior to surgery to ensure there
are no heart or lung abnormalities (Lewis et al., 2011). The patient may also be given a dose of
prophylactic antibiotics in order to decrease the risk of infection from the surgery.
Immunosuppression therapy may also be started in order to reduce the risk of rejection of the
kidney (McDonnell, 2015). Dialysis, if needed, is done within 24 hours of surgery, so that the
patient has freshly filtered blood (Lewis et al., 2011). The patient is now ready for surgery.
Clinical Significance
A kidney transplant is clinically significant in that it may add years to a patients life
(Kidney Transplant, 2014). It eliminates the need for dialysis and may even reverse the effects
of kidney disease on the body (Lewis et al., 2011). It is important as a nurse to know how to care
for a patient who has received kidney transplant.
Management: Medical

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When caring for a patient who is post-operative from a kidney transplant, there are
several things that a nurse may need to watch for.
The first is maintenance of fluid and electrolyte balance. Monitoring these labs is vital to
patient care. The donor kidney may not be functioning fully or accurately, resulting in a fluid
volume deficit or an electrolyte imbalance (Lewis et al., 2011). Certain electrolyte imbalances
are lethal and maintaining equilibrium is vital to the patients life.
Central venous pressure may be monitored in a kidney transplant patient. This will help
the nurse and doctor determine fluid volume in the post-operative patient. Fluid volume may be
as high as a one liter per hour after surgery (Lewis et al., 2011). This may be due to the new
kidneys ability to filter BUN which would act as an osmotic filter, the abundance of fluid
administered during surgery, or the initial renal tubular dysfunction which inhibits the kidneys
from concentrating urine normally (Lewis et al., 2011). It is also important to watch for a sudden
decrease in urine output. This may be related to an obstruction in the urinary catheter,
dehydration, urine leak, or rejection (Lewis et al., 2011).
It is also important to monitor for signs and symptoms of rejection. There are three
different types of rejection. The first is hyperacute and it occurs within 48 hours of the transplant
surgery. The patient will develop fever, hypertension, and pain at the incision. The only treatment
for this type of rejection is removal of the organ (Lewis et al., 2011). The next type of rejection is
acute, it occurs anywhere between one week to two years postoperative. The patient will develop
oliguria, anuria, low-grade fever, and hypertension. Tenderness over transplant site, lethargy, and
fluid retention may also be present. This can be treated with an increase in immunosuppressant
medication (Lewis et al., 2011). The last type of rejection is chronic which occurs gradually over
a few months to a few years. The patient will develop fluid retention, electrolyte imbalance, and

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fatigue. The only treatment for this is to continue to monitor the patient until dialysis is needed
again (Lewis et al., 2011).
Nursing Diagnoses
There are several considerations that the nurse may need to be aware of when caring for a
kidney transplant patient. A few nursing diagnoses that may apply to a renal transplant patient
include:

Risk for infection related to inadequate secondary defenses or immunosuppression.

Risk for fluid volume excess related to renal insufficiency or steroid therapy.
Risk for ineffective renal perfusion related to complications from transplant procedure.
Anxiety related to possible rejection.
Impaired urinary elimination related to impaired renal function.
Knowledge deficit related to proper health in preventing kidney damage.
Patient Teaching
It is important to teach the patient about life-long immunosuppression. Anyone who

receives a transplant from a donor will have to undergo this lasting treatment (McDonnell, 2015).
Immunosuppression is the use of medication to suppress the immune system from rejecting the
kidney, while maintaining sufficient immunity to prevent infection (Lewis et al., 2011). It will
also be important to teach the patient to report any signs or symptoms of infection such as a fever
or sore throat.
The patient needs to understand the signs of rejection and the importance of notifying
their provider is rejection is suspected (McDonnell, 2015).
Diabetes is the number one cause of renal failure. Thus, it is very important to keep blood
glucose under control in order to prevent damage to the new kidney (McDonnell, 2015).
Smoking cessation is another important topic to cover with a transplant patient. Smoking
causes vasoconstriction, which causes poor perfusion to the transplanted kidney. Good
circulation is needed for any organ to function properly (McDonnell, 2015).

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Being a teacher is one of a nurses most important roles. This, along with the ability to
provide safe and effective care to patients, make it important for nurses to stay educated on such
material.

References
Kidney transplant: MedlinePlus Medical Encyclopedia. (2013, May 27). Retrieved March 18,
2015, from http://www.nlm.nih.gov/medlineplus/ency/article/003005.htm

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Kidney transplant: National Kidney Foundation. (2014). Retrieved March 18, 2015, from
https://www.kidney.org/atoz/content/kidneytransnewlease
Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2011). Medical-Surgical Nursing:
Assessment and Management of Clinical Problems (8th ed.). St. Louis: Mosby.
McDonnell, M. (2015). Kidney Transplant Causes, Symptoms, Treatment - Kidney
Transplantation - eMedicineHealth. Retrieved March 18, 2015, from
http://www.emedicinehealth.com/kidney_transplant/page7_em.htm