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INTRODUCTION

  • Health care personnel caring for transplant patients should be competent in such care.

  • Postoperatively, we observe recipients in the postanesthesia care unit until stable to be transferred to the designated transplant floor.

  • Recipients who require thorough monitoring and management are admitted to the intensive care unit.

  • Recipients are under the continuous care of our multidisciplinary transplant team.

  • Urinary output is replaced with an equivalent volume of intravenous fluids (routinely normal saline) for the first 24 hours after transplantation.

    • Warming intravenous fluids postoperatively helps maintain a normal body temperature, especially in patients with high urine outputs.

    • In cases where the recipient has adequate oral intake, intravenous fluids are discontinued after the first 24 hours.

    • Recipients with marginal oral intake remain on maintenance intravenous fluids (routinely 100 mL/hr) for a few hours until able to tolerate an adequate oral intake.

  • Urinary catheters are routinely removed 72 hours after transplantation.

    • They can be kept in place for longer periods based on specific indications or surgical preference.

    • They can be removed as early as 24 hours after transplantation in instances where the surgeon feels comfortable with the anastomosis between donor ureter and bladder and the recipient is willing to void on an hourly basis when awake.

      • In our experience, full-thickness anastomoses between the donor ureter and the recipient bladder can allow for this early removal.

  • We advance intake to a solid diet as tolerated immediately after transplantation once the recipient is fully awake.

    • In instances of adequate renal function, we eliminate any renal diet restrictions immediately after surgery.

  • Constipation is a frequent finding in the end-stage renal disease population that is worsened by pain and discomfort associated with the surgery.

    • We routinely administered oral agents (such as magnesium citrate or lactulose), as well as enemas and suppositories, in order to achieve bowel function within the first 24 hours after transplantation.

  • Patients are encouraged to ambulate as soon as tolerated.

    • Although this occurs usually the day after transplantation, earlier ambulation is not discouraged.

  • Subcuticular skin closures avoid the need to remove staples in the postoperative period.

    • Furthermore, applying a glue on top of the skin closure avoids the use of wound dressings

  • In instances where staples are used, they can be removed 4–6 weeks after transplantation.

  • In instances where retroperitoneal drains are left in place at the time of transplantation, we usually remove them once the output is below 50 mL/day.

    • When there are questions of urinary leaks, obtaining a creatinine level from the drain fluid allows for a rapid determination.

      • If the drain fluid creatinine is greater than the serum creatinine value, a leak should be suspected until proven otherwise.

    • In instances where the drain output remains ≥50 mL/day at the time of discharge, the drain can be removed in the outpatient setting.

TRANSFER OF CARE FROM INPATIENT TO OUTPATIENT

  • In many recipients with immediate graft function, a safe transfer of care from inpatient to outpatient can ...

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