Care for the organ transplant recipient on the intensive care unit

All transplant recipients receive tacrolimus, mycophenolate and glucocorticoids and these drugs have many side-effects and drug-drug interactions. Common complications include surgical complications, infections, rejection and acute kidney injury. Infections as CMV and PJP can be prevented with proph...

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Bibliographic Details
Published in:Journal of critical care 2021-08, Vol.64, p.37-44
Main Authors: van den Hoogen, M.W.F., Seghers, L., Manintveld, O.C., Roest, S., Bekkers, J.A., den Hoed, C.M., Minnee, R.C., de Geus, H.R.H., van Thiel, R.J., Hesselink, D.A.
Format: Article
Language:English
Subjects:
Anemia
Critical care
Cytomegalovirus
Diabetes
Disease prevention
Drug dosages
Enzymes
Glucose
Heart transplantation
Heart transplants
Hypertension
Immunosuppression
Infectious diseases
Intensive care
Kidney transplantation
Kidney transplants
Liver transplantation
Liver transplants
Lung transplantation
Lung transplants
Neurotoxicity
Nosocomial infections
Pneumonia
Thrombocytopenia
Transplants & implants
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Summary:All transplant recipients receive tacrolimus, mycophenolate and glucocorticoids and these drugs have many side-effects and drug-drug interactions. Common complications include surgical complications, infections, rejection and acute kidney injury. Infections as CMV and PJP can be prevented with prophylactic treatment. Given the complexity of organ transplant recipients a multi-disciplinary team of intensivists, surgeons, pharmacists and transplant specialists is essential. After heart transplantation a temporary pacemaker is required until the conduction system recovers. Stiffening of the heart and increased cardiac markers indicate rejection. An endomyocardial biopsy is performed via the right jugular vein, necessitating its preservation. For lung transplant patients, early intervention for aspiration is warranted to prevent chronic rejection. Risk of any infection is high, requiring active surveillance and intensive treatment, mainly of fungal infections. The liver is immunotolerant requiring lower immunosuppression. Transplantation surgery is often accompanied by massive blood loss and coagulopathy. Other complications include portal vein or hepatic artery thrombosis and biliary leakage or stenosis. Kidney transplant recipients have a high risk of cardiovascular disease and posttransplant anemia should be treated liberally. After postmortal transplantation, delayed graft function is common and dialysis is continued. Ureteral anastomosis complications can be diagnosed with ultrasound. •The complexity of transplant recipients makes a multi-disciplinary team essential.•Immunosuppressive drugs are nephrotoxic and have many drug-drug interactions.•Heart transplant recipients have conduction system ischemia necessitating pacing.•In lung transplant recipients prevention of aspiration reduces chronic rejection.•Liver transplant recipients require less immunosuppression than other organ recipients.•The high cardiovascular risk of renal transplant recipients warrants liberal anemia correction.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2021.03.003