Management and Evaluation of Post-transplant Patients

Introduction:

Organ transplantation is a procedure that involves removing an organ from one person, who is called an organ donor, and surgically placing it in another person, who is known as an organ recipient. Organ transplantation is indicated when the recipient’s organ has failed or has been damaged due to injury or disease. The organs that can be transplanted include the liver, kidney, heart, pancreas, lung, corneas, bone marrow, and skin, among others.

What Are the Complications in Post-transplant Patients?

The following complications can be experienced by the patient after going through the organ transplantation surgery:

• Wound Problems: The incision made during the surgery may not be completely healed when the patient goes back home. The doctor’s advice is to keep the area of the incision clean and dry, avoid bathing or swimming until it is healed, and examine the incision every day.

• Infection: Patients after organ transplantation are kept on immunosuppressants that increase their risk of developing an infection. Immunosuppressant drugs weaken the immune system and the ability to fight infection. The infections can be caused by bacteria, viruses, and fungi. Symptoms of infection include diarrhea, vomiting, nausea, loss of appetite, increased body temperature with chills, shortness of breath, skin rashes, difficulty urinating, and unexplained pain. The prevention methods to follow are to get enough rest, have a healthy balanced diet, wash hands properly with soap and water frequently, not touch open sores, wear gloves when gardening, do not share personal items like toothbrushes or razors, and avoid contact with anyone who has an active infection.

• Rejection: It is the natural process of the human body to itself from any foreign body. The immune system gets confused and attacks the organ transplanted, thinking that a group of bacteria has infected the body. Rejection is very common, and if diagnosed early, it can be treated and controlled. To reduce the risk of rejection, patients are advised to take medications as directed by the doctor, learn the early signs of rejection, and attend all the scheduled appointments with the doctor. There are three types of rejection:

1. Hyperacute Rejection - It happens suddenly, maybe during the surgery or a few hours after the surgery. This type of rejection is rare and difficult to treat.

2. Acute Rejection - It is the most common type of rejection. It may develop in a few days or weeks.

3. Chronic Rejection - This type of rejection occurs slowly and over a long period of time. The visible signs of chronic rejection are rarely seen within the first year.

• Cancer: Patients with organ transplants are at higher risk of developing certain types of cancers, such as lymphoma and skin and cervical cancer. Lymphoma is very rare, and skin cancer is very common but can be treated if detected early. The factors that influence the types of cancer seen in transplant patients. These include the use of immunosuppressive therapy to prevent rejection of the donated organ and viral infections acquired either before or after the transplant.

How to Manage the Health of Post-transplant Patients?

• Anti-rejection drugs or immunosuppressant drugs are given after the organ transplant surgery. They have to be taken for the lifetime of the transplanted organ. They help in preventing the immune system from attacking the transplanted organ. Other medications have also been prescribed that help in enhancing the function of immunosuppressants or controlling their side effects.

• Medications are also given for other health conditions if present. After the organ transplant surgery, it is important for the patients to have all the prescribed medications, visit the doctor on all scheduled appointments, and take all the recommended lab tests. The symptoms of organ rejection and the diagnostic methods vary depending on the type of organ transplant. It is important for the patient to familiarize himself or herself with the early signs of rejection specific to his or her transplant.

• On identifying an organ rejection, the doctor will try to reverse it with medications, for example, by switching to a new drug, adding another drug, and taking a smaller or larger dose of the prescribed medication.

• The transplant team will monitor the patient with the transplant for the initial few months. They will urge the patient to monitor their blood pressure, weight, and cholesterol, keep all wellness checkups and get all recommended health screenings on time.

• Side effects of medications:

  • Infection.

  • High blood pressure.

  • High cholesterol.

  • Increased blood sugar levels.

  • Weight gain.

  • The hair growth or hair loss.

  • Acne.

  • Mood swings.

  • Diarrhea.

• On noticing any of these side effects, the patient should not stop taking the prescribed medications. Inform the concerned doctor about the side effects and do as suggested by the doctor.

What Are the Self-Monitoring Steps to Be Taken at Home by Post-transplant Patients?

Some self-monitoring at home is important, along with the tests that the patients undergo on regular follow-up visits. The parameters to be monitored are:

• Temperature: The patient should regularly take his or her body temperature and should inform the doctor in case the temperature increases.

• Weight: The patient should weigh himself or herself on a daily basis early in the morning and inform the doctor if he or she gains two pounds in a day or five pounds in total.

• Pulse: Daily monitoring of the pulse is suggested, and inform the doctor if it is higher than the resting heart rate of 60 to 100 beats per minute.

• Blood Pressure: The patient should check his or her blood pressure as recommended by the doctor.

• Blood Sugar: The doctor should be informed if the patient has a high blood sugar level by checking regularly.

• Dental Problems: Anti-rejection drugs may cause a few dental problems, such as mouth ulcers, swollen gums, tumors, and dry mouth. The patient is advised to brush and floss his or her teeth regularly, twice every day.

Conclusion:

Patients after organ transplant surgery should maintain a healthy lifestyle. They should have a balanced diet, should do light exercise and stress management. They should avoid smoking and excessive drinking of alcohol. Transplant patients show a wide range of health issues, and they can lead to stress. But getting proper rest and following a healthy lifestyle should help.