Transplant in Elderly

  1. 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.
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    About Pam RN

    Joined: Feb '01; Posts: 62; Likes: 1
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  3. by   Hoozdo
    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
  4. by   fultzymom
    She is lucky that she got the transplant. Most hospitals will not do them on people who are over either 65 or 69 I forget which it is for sure. If you are not compliant with the treatment regimine, you will have a LONG and horrible road ahead. My father had a liver transplant about 8 years ago and he did really well. He did exactly what was told of him et required of et got out in only nine days post-op. You need to be very supportive et encourage her all along the way. Like the previous poster said, "No negativity allowed in!" Dad did really well. Had the transplant in December et was back to work in April. So only a five month recovery. Unfortunately, he got cancer et we lost him back in November. But he never once had to go back to the hospital after he was released because he was very compliant with everything that the doctors told him to do.
  5. by   km5v6r
    Your MIL probably developed a heptaorenal syndrome pre-op and it is continueing post-op. When the kidney's are "shocked" or stressed they may quit function for a time and take a while to recover. Even though urine is present it may not be "quality" urine just yet. That should come in time. Right now just getting the excess fluid off will be a help. Dialysis will probably be decided on a day-day basis.

    It is still early days for your MIL. I have seen transplant done at this age. They sometimes take a little longer to recover but most do well.
  6. by   Pam RN
    Thank you all for your very good replys. Yes, she did have hepatorenal syndrome and was hospitalized for two weeks a month or so prior to her transplant. So, yes that makes sense about the dialysis now post op. I have to get my brain back in ICU mode.

    Hoozdo, congratulations on your transplant and thank you for your insight. Boy, you sailed through the hospitalization part. I have heard through others that had family members transplanted that the road is hard and long for even the most youngest and healthy persons.

    I am surprised they went ahead and transplanted her quite frankly. She was rejected for the list but went in to appeal and they took her. This is a very aggressive program so she is not unusual apparently. But, since I'm an inlaw and not part of the direct info from doctors and not consulted on my opinion I'm not sure if they re-evaluated her psych-wise and if she was on anti-depressants. I know the nurses were on the transplant floor were very direct with her and had to do the "tough love" thing but I don't know if the doctors considered that information or if they even read the nursing notes. Gee, what a surprise.

    We'll see if the brochial lavage helped with pneumonia and if the dialysis helped with the edema and kidney function and getting urine of better quality. Fultzymom I'm glad to hear your dad did so well so he must have been motivated.

    Everyone has been positive but my MIL is a negative person and does not have much faith in anything. She does things mostly out of duty and guilt so I hope she didn't go through this to satisfy her family members. I hope she did it because she wanted to for herself and for her life.
  7. by   Pam RN
    Actually, I do make my opinions known and my husband always talks to me and wants to know what I think. He says he's so happy that I'm around and suppportive. But, with other family members I have to be careful because they don't want my opinion so I weigh my comments carefully because in the end it's not my decision and she's not my mother. I'm sure others have been in the same position being a healthcare provider and being on the outside. Tricky.
  8. by   Hoozdo
    Hi Pam,
    I am wondering how the MIL is doing now? I hope she has navigated over her "bumps in the road".
    :kiss

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