Veterinary Medicine - February 2008 - (Page 100) Managing feline kidney transplant patients PEER-REVIEWED the ureter into the urinary bladder have been described. Using an extravesicular ureteroneocystostomy is associated with the quickest resolution of renal pelvic dilation after transplantation, and mucosal apposition of the ureter to the bladder signi cantly reduces the incidence of to assess urine speci c gravity and determine 24-hour urine output. Renal function and hemodynamic parameters usually return to normal within three to ve days after surgery.13 If the transplant recipient remains anorectic or depressed or the serum creatinine Successful long-term survival of transplant patients is achieved with good patient and client compliance and continued care. postoperative obstruction.44,45 To prevent torsion of the transplanted kidney on its pedicle, the renal capsule is attached to the abdominal body wall after creating a peritoneal-transverse abdominis muscle ap.42 One of the recipient’s diseased kidneys is biopsied for diagnostic and prognostic purposes, but the native organs are left in place and only removed at a later date if necessary. For postoperative nutritional support, a gastric or esophageal feeding tube is placed before recovery (if not already placed). Postoperative recovery Transplant patients are kept free of stress, and handling is minimized. Balanced electrolyte solutions are continued and supplemented as needed to correct acid-base or electrolyte abnormalities. Blood pressure must be monitored frequently during the rst 12 to 24 hours, as postoperative hypertension may be severe.46 Supplemental nutrition is provided through gastrostomy or esophagostomy tubes until oral food and water are accepted. PCV, total plasma protein concentrations, serum creatinine concentrations, serum electrolyte concentrations, and trough whole blood cyclosporine concentrations are assessed daily. Voided urine is collected concentration continues to rise with production of isosthenuric urine, then graft rejection should be suspected.37 An ultrasonographic examination of the urinary tract should be performed to assess renal graft perfusion, as well as to identify any hydronephrosis or hydroureter. These latter conditions usually suggest stricture at the site of ureter implantation rather than transplant rejection, and surgical intervention may be required rather than changes in medication regimen. No speci c protocol is required for recovery or monitoring of the donor cats in the immediate postoperative period. These patients are managed routinely as with any other post-laparotomy patient (e.g. incision care, analgesia). Transplant institutions will recheck donor patients’ serum creatinine concentrations before discharging the cats to their new owners. lograft rejection were noted in 12 of 66 (18%) cats, most commonly in the rst two months after surgery.13 Antirejection therapy in cats consists of methylprednisolone sodium succinate, with some transplant centers also giving intravenous cyclosporine to maintain therapeutic serum concentrations.38 Reactivation of chronic feline respiratory viral infections can also be a serious complication.32 Hypertension is a common complication that can occur intraoperatively as well as shortly after surgery. Severe postoperative hypertension requiring intervention (systolic blood pressure > 170 mm Hg) was documented in 62% of recipient cats.46 Managing hypertension has also been shown to signi cantly reduce the prevalence of neurologic complications.46 Central nervous system disorders have been reported in 21% of cats receiving transplants, with seizures occurring in 88% of these cases.47 LONG-TERM MANAGEMENT AND COMPLICATIONS Recipient cats. Patients are discharged from the hospital when the graft function appears satisfactory and blood cyclosporine concentrations are stable. Satisfactory graft function is indicated by an adequate nutritional intake and urine concentrating ability, a decreased serum creatinine concentration, and a good attitude. Successful long-term survival of transplant patients is achieved with good patient and client compliance and continued care by the transplant center, primary care veterinarian, and local emergency clinics. Perform weekly examinations for four weeks. At each visit, determine serum creatinine concentrations, PCV, total solids concentration, body weight, and whole blood cyclosporine concentrations. Subsequently, perform a complete blood count, serum chemistry pro le, urinalysis, urine culture, and cyclosporine concentration several times per year. Rechecks should occur frequently (every two to three months minimum) in the rst year after surgery, with more frequent rechecks in patients exhibit- Immediate postoperative complications Immediate postoperative complications including acute graft rejection, hypertension, and neurologic signs have been reported, although immunosuppressive protocols have vastly decreased the incidence of acute rejection episodes.13,46,47 Nineteen presumptive episodes of al- 100 February 2008 VETERINARY MEDICINE
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