DATE OF ADMISSION: MM/DD/YYYY
DATE OF DISCHARGE: MM/DD/YYYY
ADMISSION DIAGNOSES:
1. Chronic renal failure secondary to lupus, status post renal transplantation in the past.
2. Hypertension.
3. Hyperlipidemia.
4. History of deep venous thrombosis.
DISCHARGE DIAGNOSES:
1. Chronic renal failure secondary to lupus, status post renal transplantation in the past.
2. Hypertension.
3. Hyperlipidemia.
4. History of deep venous thrombosis.
PROCEDURES: Deceased donor renal transplantation on date of admission.
CONSULTANTS:
1. Urology.
2. Nephrology.
BRIEF HISTORY AND HOSPITAL COURSE: This is a (XX)-year-old female with a history of end-stage renal disease secondary to chronic lupus nephritis, who had previously had a transplant six years ago that failed two years later. She was placed back on the waiting list and had a deceased donor organ offered. The final crossmatch was compatible. After checking a CT of the abdomen to be sure that a retroperitoneal hematoma found two months ago was resolved, the patient was taken to the operating room for transplantation.
On the day of admission, the patient was noted to have a transplant that was relatively uneventful. It was a right kidney with an IVC extension graft. It was placed on the left side, which was the same side as a left AV graft. In the OR, the patient was noted to have venous hypertension in the external iliac vein. The kidney was relatively dark. Therefore, a ligation of the AV graft was performed.
At this point, there was good venous outflow for the kidney and the kidney became pink. Total cold ischemic time was 12 hours. The kidney was initially slow to recover function. She remained in the ICU postoperatively until postoperative day #2, at which time she was transferred to the floor with increasing urine output. She had mild ATN but never required dialysis during this hospital stay.
Her creatinine on admission was 7.7 and postoperatively it peaked to 8 and this was on postoperative day #4. Thereafter, it began to decrease as the kidney recovered and it was 5.3 on the date of discharge, which was 7 days postoperative. Again, the patient did not require dialysis during this admission.
Immunosuppression consisted of daily Thymoglobulin for a total of 5 days. As urine output picked up on the 6th day, the patient was started on Prograf and Myfortic. She was given a standard 5-day prednisone taper. She was tapered down to 10 mg daily. Since the patient was on prednisone preoperatively, she was maintained on prednisone on discharge as part of her maintenance drugs.
Foley catheter was removed on day 5 postoperatively. Her JP drain remained in place when she was discharged since it was putting out 100 mL per day. Urology was consulted for outpatient stent removal. She was given dietary counseling by nutritional services. She was given teaching by the transplant nurse practitioner as well as transplant pharmacist. Followup appointment was given.
ACTIVITY RESTRICTIONS: To avoid lifting greater than 10 pounds for 2 months and she was given diet order of 2-gram sodium diet.
DISCHARGE MEDICATIONS: Myfortic 720 b.i.d., Prograf 1 mg b.i.d., aspirin daily, Septra 1 daily, Valcyte 450 daily, Mycelex Troches 2 times a day, prednisone 10 mg daily, Senokot 1 b.i.d., Pepcid 20 b.i.d., Norvasc 10 daily, labetalol 400 mg b.i.d., Lasix 40 mg daily, and Darvocet as needed for pain.
