Nursing management of a renal transplant recipient with premature graft loss.

This case study does not illustrate the typical course for the majority of renal transplant recipients. In fact, 89.4% of recipients will still have a functioning cadaveric transplant after a year. Graft function is maintained in 76.3% of cadaveric recipients after 3 years and 64.7% after 5 years (Transplant Patient Data Source, 2000). C.N. had several predisposing factors that have been implicated in premature transplant loss, including donor age greater than 50 years old, delayed graft function, acute rejection episodes, elevated serum lipid levels, and cytomegalovirus infection (Mudge, Carlson, & Brennan, 1998). With the advent of recently approved immunosuppressant medications used in combination, improved outcomes for transplant recipients can be expected in the future. Yet, renal transplantation is not considered a cure for ESRD. Many of the pathophysiologic issues of renal disease are exchanged for the adverse effects of the immunosuppressant medications. However, for patients who have been appropriately screened both medically and psychosocially, renal transplantation generally increases patients' longevity as well as their quality of life (Wolfe et al., 1999).