Quote from Pam RN
Hi, first time here since I'm in the OR and usually post there. I have some questions about post-transplant in elderly patients. My MIL had a liver transplant a week ago Monday at the age of 75. She has autoimmune hepatitis and two days before her transplant nearly died but had a central line inserted and dialysis cath inserted and had a round of dialysis.
Now post op she is in the ICU, reintubated for pneumonia. She had progressed as expected for her age and condition preop. Was extubated I think, on post op day 4 or 5, eating full liquids, doing poorly on her incentive spriometer, edema in all her extremities, making urine.
From info through the family, the doctors will be doing a bronch with lavage to clear out the secretions. She had dialysis yesterday and a liver biopsy. Her Bili was in the 7's and is now down in the 6's.
I have no experience with transplants what-so-ever. What can you gather from this? What are your expert opinions and I want you to be brutally honest. I really don't see her doing well with this. She certainly has the will to live but preop she refused to do what was ordered for her like PT, working on her IS and trying to gain strength. She was lectured by the medical staff (docs, RN's, etc) to comply with the treatments or she would have a long road ahead.
Well, you know the rules........no medical advice here. I can only speak from experience since I had a liver transplant 7 years ago, I was 42 though. That surgery is pretty brutal and difficult to recover from. I was pretty strong going into it also. A bili of 6 is not too bad 4 or 5 days post transplant. It takes awhile for that liver to start playing well with the other organs.
Why did she need dialysis - hepatorenal syndrome? Why did she not comply with treatments pretransplant? Organs are generally not allocated to non-compliant patients. Compliance is scrutinized very closely pretransplant because post-transplant you must be compliant with the immune suppression drugs the rest of your life.
I will be brutally honest, she has 3 organ systems in failure. Her age is against her and so is her physical condition. She was very lucky that she even got transplanted. Support her and rally her. Allow no negative talk in the room. You and the family must encourage her to get out of bed, (if she is extubated) and get moving. The longer she lays there, the weaker and sicker she will get.
It took me 6 months to feel in any way human again. My surgery went well and I only spent 24 hours in the ICU and 5 days total in the hospital. She does have a long road ahead of her. So do you and all of the family.
Best wishes for a recovery :kiss