✆ Common Calls ✆
Transplant

Admit Patient

History & Physical Examination

• Evaluation for signs and symptoms of infection

  • Elevated temperature, general malaise, upper respiratory infection and urinary symptoms

• Assess indwelling catheter sites

• hemodialysis line

• peritoneal catheter site

Labs (STAT) - to determine readiness and assess need for pre-transplant dialysis

• HLA at time of Work-Up

• 1 red and 1 yellow top (minimum of 2 mL in each)

• Complete Blood Count with Differential (CBCd)

• Complete Metabolic Panel (CMP)

• Urinalysis (UA) and Urine Culture

• HCG if female >12 yo

  • Urine (blood if oliguric or anuric)

• PT/ PTT/ INR

• If PD catheter:

  • PD Cell Count

  • Gram Stain and Culture

• If HD catheter:

  • Blood culture from both lumens

Procedures: as determined at the transplant selection meeting for individual patient

• Plasmapheresis

• HD

• Eculizumab

• CVVH in OR?

Consent

• Surgical Consent Obtained by Transplant Surgery

  • If donor is classified as high risk, high risk consent must be obtained by transplant surgery.

Diet

• NPO on arrival, unless otherwise instructed by surgeon

Fluid management

• STRICT I&O’s

• If polyuric, keep patient with positive fluid balance.

• If oliguric/anuric, give more than insensibles to make slightly positive over time.

• Potassium Free fluid.

Medication

• Antihypertensives:

  • Discontinue Lisinopril and other antihypertensives if indicated.

  • Aim for Blood Pressure on higher end of normal.

• Consider IVIG:

• For patients that are undergoing desensitization prior to transplant and in patients with preformed DSAs, treatment as follows:

• 1 g/kg over 12 hours, administered immediately prior to transplant (do not give if patient has received IVIG 2 mg/kg in the last 7 days.) Remaining 1 g/kg given after transplant. Administer thymo intraop, IVIG administered immediately after if concerned about sensitization.

• Pre-medication: Administer the following medications 30 minutes before infusion and Tylenol/ Benadryl every 6 hours during infusion:

  • Decadron (0.15 mg/kg max 8 mg)

  • Tylenol (15 mg/kg max 650 mg)

  • Benadryl (1 mg/kg max 50 mg)

Immunosuppression

• Thymoglobulin (ATG):

  • Coordinate with pharmacy for Thymoglobulin and Methylprednisolone to go with patient to the OR (not to be administered on the floor). Ensure pharmacy does not receive order until donor anatomy is reported and is satisfactory.

• Methylprednisolone:

  • Intra-operative single dose of 10mg/kg is given immediately prior to reperfusion. The full dose, ordered with the preoperative admission orders, should accompany the patient to the OR. Maximum 500 mg.

• CellCept® (MMF):

  • One dose 600 mg/m2/dose given IV, preferably after anatomy is known.