Post-kidney transplant rejection and infection complications

The care of a patient after kidney transplant is multifactorial and complex, often involving other organ systems. The clinical picture can frequently be complicated with symptoms that may be misleading, and hence, challenging to assess. The nephrology nurse caring for the recipient of a transplant should be able to assess the entire clinical situation, rather than focus only on renal function. When caring for recipients of transplants, nephrology nurses need to use their extensive knowledge base and employ critical thinking skills. Although all members of the multidisciplinary team are important for success, the patient remains the focal point of the team. Post-transplant management will be successful when patients actively participate in their care. Patient teaching plays a critical role in this success, and it starts when a transplant is anticipated and continues as long as the grafted kidney is functioning.

[Caring for a patient before a kidney transplant]

Renal transplantation is one of the possible substitution treatments for end-stage chronic renal failure. Nurses have an important part to play both before and after the transplant through their technical, interpersonal and educational role.

Ethical issues in live donor kidney transplant: views of medical and nursing staff

OBJECTIVES

The ongoing development of live donor kidney transplant has generated many ethical dilemmas. It is important to be aware of the attitudes of transplant professionals involved in this practice.

MATERIALS AND METHODS

An anonymous and confidential questionnaire was sent to 236 members of the medical and nursing staff of the West London Renal and Transplant Centre, to assess their views on the ethics of the current practice of live donor kidney transplant.

RESULTS

Of the 236 questionnaires, 108 (45.8%) were returned. Respondents considered live donor kidney transplant ethically acceptable between blood relatives (100%), nonblood relatives and friends (92.6%), and strangers (47.2%). Most respondents were willing to donate a kidney to a blood relative (92.6%) or a nonblood relative or friend (81.5%), and 12.0% were willing to donate to a stranger. Considering themselves as potential recipients if they had end-stage renal disease, most would accept a kidney from a blood relative (91.7%) or nonblood relative or friend (85.2%),while 44.5% would accept a kidney from a stranger. The highest number of respondents (43.5%) believed that the recipient should approach the potential donor. About one-third believed there should be no financial reward, not even compensation for expenses, for donors; 8% favored direct financial rewards for donors known to recipients, and 18% favored rewards for donors not known to recipients. Slightly more than half were in favor of accepting donors with mild to moderate medical problems.

CONCLUSIONS

Live related and unrelated kidney donation are considered ethically acceptable procedures, and nondirected donation is gaining support among transplant professionals. A substantial minority favored direct financial rewards for donors, especially in the case of nondirected donation.

Caring for patients after kidney transplantation

This article examines the care and management of patients following solid organ transplantation. It focuses on kidney transplantation and the nursing role in optimising long-term patient outcomes and quality of life.

Clinical management of the HIV-positive kidney transplant recipient

Tremendous progress has been achieved in the management of HIV, allowing individuals infected with this virus to live longer, healthier lives; however, the result of this progress is that HIV-infected individuals are developing end stage liver and kidney disease, and many are either dying from organ failure or living on dialysis. HIV infection was once a contraindication to transplantation, but transplantation is now a possibility for carefully selected patients at several transplant centers in the United States. This article provides an overview of transplantation in patients with HIV infection and describes the evolving clinical management of HIV-infected transplant recipients.

[Comparison of quality of life between kidney transplant and hemodialysis patients]

PURPOSE

The purpose of this study was to discover kidney transplant and hemodialysis patients' quality of life(QOL) and provide basic data to improve their QOL.

METHOD

One hundred two hemodialysis patients and 106 kidney transplant patients were given a self-administered questionnaire from Mar. 6 to Mar. 31, 2006. The instrument consisted of demographic variables, therapeutic-related characteristics and QOL. Collected data was processed using the SPSS 12.0 statistical program for real numbers, percentages, ANCOVA, t-test, ANOVA, Stepwise multiple regression and the Scheffe test.

RESULTS

Kidney transplantpatients' QOL was higher than hemodialysis patients. The demographic variables which showed a significant difference in overall QOL were religion, children and monthly income for kidney transplantpatients and educational background for hemodialysis patients. The therapeutic-related variable which showed a significant difference in overall QOL was the patients' perceived health condition for both groups. The influencing factor on overall QOL for both groups was the health condition perceived by themselves. The total variance of the variable for QOL was 42% for kidney transplant patients and 19% for hemodialysis patients.

CONCLUSION

This study revealed that kidney transplant patients have a higher QOL and how patients perceive their health is the strongest influencing factor for QOL. However, there is a large difference between the demand and supply of kidney donors. To solve this problem the standards for donation should be reviewed and revised.

The role of the nurse post-renal transplantation

The previous article explored the role of the nurse pre-renal transplantation, which addressed the physical, psychological and educational support that the patient and family members require prior to this life-changing surgery. The following article explores the continual role of the nurse in caring for and educating the patient post-renal transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end-stage renal failure (ESRF) and who are receiving dialysis. The nurse plays a pivotal role in assisting the patient in facing the many challenges that are associated post-renal transplantation, including the complications and the long-term physical and psychosocial implications.

Renal nursing and the Human Tissue Act 2004

The Human Tissue Act of 2004 was introduced in the UK on 1 September 2006. It replaced all Acts that previously governed the procurement and utilization of tissues, cells and organs. It has promoted changes in requirements predominantly in transplantation settings. Past research has highlighted a shortage of organs for transplantation, particularly in renal donation. The new act hopes to remedy this so that future renal transplantations will occur more frequently, therefore improving choice and quality of life for patients with end stage renal disease. For UK renal nurses, the implementation of the Human Tissue Act 2004 presents challenges requiring adaptations of prior learning with new nursing roles. Recommendations can be made to help during the change process. Kurt Lewin's model of change provides a foundation for the understanding and recognition of change processes that occur in the implementation of individual and organizational change.

The role of the nurse in pre-renal transplantation

The following two articles explores the role of the nurse in caring for and educating the patient both pre- and post-renal transplantation. The nurse plays a pivotal role in assisting the patient facing the many challenges that are associated with transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end stage renal failure (ESRF) and who are receiving dialysis. This first article will explore the role that nurses play regarding the care of the patient pre-transplant, including the physical, psychological and educational support required to assist the patient and family members deal with the many challenges associated with transplantation.