POSTOPERATIVE MILESTONES IN THE PROGRESS AND MANAGEMENT OF THE TRANSPLANT RECIPIENT
- Early phase (first week) problems will most often relate to the potential for failure of the transplanted kidney due to complications. Some kidneys may have a delay up to 10 days in the onset of function (delayed graft function). It is during this period that the cat may encounter acute life-threatening problems. These are more likely in the debilitated cat. A cat that is doing well after surgery will usually be in the hospital 3-4 weeks. Usually the latter half of the stay just involves blood sampling which is required daily until we have determined that the cyclosporine A blood levels have stabilized. Sutures are removed 7-10 days after surgery so this may occur while the cat is still in the hospital.
- Ureteral problems. If stricture, or narrowing by scarring, of the ureter is going to occur it will become apparent usually within 10 days to 6 weeks after surgery. This is assessed by an ultrasound examination and measurement of serum creatinines after the transplant. Significant blockage of the ureter, as indicated by dilation of the ureter, would require a second surgery for revision of the opening of the ureter into the bladder. The ureter may also leak at its point of attachment. This is one of the most problematic areas in the surgery. Urine leakage would require additional surgery for revision of the ureter implant.
- Rejection can occur at any time after surgery and is a threat for the remainder of the cats life. The risk of rejection is greatest in the first month after surgery. During this time, cyclosporine A levels are maintained at a trough level of 500 ng/ml when measured just before the next dose of cyclosporine. If all is well by the first month, then the dose is adjusted to attain trough levels of 250 ng/ml. Adjustment of cyclosporine dosages is customized to each individual patient by measurement of blood cyclosporine concentrations using HPLC.
- Anemia is managed by erythropoeitin injections 2-3 times a week. This is continued until the kidney assumes its role in production of this hormone. The time for needing erythropoeitin may vary from days to months. In general, if the PCV is 25 or better we will forego erythropoeitin treatments.