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Abstract
Introduction: Renal transplantation requires immuno-suppressive treatment to prevent graft-host rejection, with an increased risk of opportunistic infections. This risk is higher in the late post-transplant phase and in patients with a past medical history of rejection, potentially leading to severe complications requiring hospitalisation.
Case Report Description: The case of a renal transplant patient admitted for fever and lymphadenopathy is presented, diagnosed with pulmonary tuberculosis and disseminated aspergillosis. During her hospitalisation, she suffered complications requiring an ostomy and temporary haemodialysis due to her critical condition.
Care Plan Description: Care plan was designed through an initial assessment and weekly re-evaluations according to Marjory Gordon's functional patterns. Fifteen days after admission, the diagnoses of readiness for enhanced knowledge, potential complication: infection, and risk for electrolyte imbalance were established as priorities. Nursing intervention focused on infection control, treatment management, and patient and family education.
Care Plan Evaluation: The care plan was evaluated weekly, with adjustments made according to clinical evolution. After a length of stay of 42 days, the established objectives were achieved, with subsequent follow-up at the post-transplant nursing consultation.
Conclusions: This case highlights the importance of comprehensive assessment from admission and the intervention of a multidisciplinary team to optimise care, prevent complications, and provide health education. Furthermore, it emphasises the role of nursing in emotional support and adapting the transplant patient to the physical and social changes resulting from their illness.
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Copyright (c) 2025 Brenda Sarai Ascencio-Hernández, Juan Oziel Romero-Tafoya, Paola Karim-Fernández
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References
- Vidanapathirana M, Minuvanpitiya G, Karunaratne R, Fernando A. Triple infection with disseminated tuberculosis, invasive aspergillosis and COVID-19 in an organ transplant recipient with iatrogenic immunosuppression. BMJ Case Rep. 2021;14(8):e245131. https://doi.org/10.1136/bcr-2021-245131 DOI: https://doi.org/10.1136/bcr-2021-245131
- Sigera LSM, Denning DW. Invasive Aspergillosis after Renal Transplantation. J Fungi (Basel). 2023;9(2):255. https://doi.org/10.3390/jof9020255 DOI: https://doi.org/10.3390/jof9020255
- Cikova A, Vavrincova-Yaghi D, Vavrinec P, Dobisova A, Gebhardtova A, Flassikova Z, Seelen MA, Henning RH, Yaghi A. Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation. BMC Gastroenterol. 2017;17(1):131. https://doi.org/10.1186/s12876-017-0695-5 DOI: https://doi.org/10.1186/s12876-017-0695-5
- Agrawal A, Ison MG, Danziger-Isakov L. Long-Term Infectious Complications of Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17(2):286-95. https://doi.org/10.2215/CJN.15971020 DOI: https://doi.org/10.2215/CJN.15971020
- Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-14. https://doi.org/10.1056/NEJMra064928 DOI: https://doi.org/10.1056/NEJMra064928
- Wagner CM, Butcher HK, Clarke MF, editors. Intervenciones de enfermería y resultados de enfermería vinculados a condiciones clínicas, Clasificación de Intervenciones de Enfermería (NIC). 8ª ed. Barcelona: Elsevier; 2024. p. 540-52.
- Johnson M, editor. NOC y NIC vinculados a diagnósticos de enfermería de riesgo, Vínculos de NOC y NIC a NANDA-I y diagnósticos médicos. 3ª ed. Barcelona: Elsevier; 2012. p. 249-94.
- González Quirarte NH, Castañeda-Hidalgo H, editores. Guía práctica para la elaboración del plan de cuidados de enfermería. Proceso de enfermería. 1ª ed. Barcelona: Elsevier; 2024. p. 139-44.
- Espejo-Rodríguez R, Morales-Cuenca C, Martín-Hurtado A J, Crespo-Montero R. Educación sanitaria en el paciente trasplantado renal: una revisión integrativa. Enferm Nefrol. 2024;27(3):190-200. https://doi.org/10.37551/S2254-28842024020 DOI: https://doi.org/10.37551/S2254-28842024020
- Pelayo-Alonso R, Cobo-Sánchez JL, Palacio-Cornejo CM, Escalante-Lanza S, Cabeza-Guerra MV, Martín Tapia O. Factores de riesgo para el desarrollo de complicaciones de la herida quirúrgica en el trasplante renal. Enferm Nefrol. 2022;25(3):249-56. https://doi.org/10.37551/52254-28842022025 DOI: https://doi.org/10.37551/52254-28842022025
- Perry AG, Potter PA, Desmarais PL, editors. Cuidados de la ostomía (bolsa). Guía Mosby de habilidades y procedimientos en enfermería. 9ª ed. Barcelona: Elsevier; 2019. p. 169-75.
- Álvarez Ruiz M. Análisis de la calidad de vida y adherencia terapéutica en pacientes tras trasplante renal en el Hospital Universitario Virgen del Rocío: un estudio descriptivo. Enferm Nefrol. 2024;27(1):63-70. https://doi.org/10.37551/S2254-28842024008 DOI: https://doi.org/10.37551/S2254-28842024008
- Argüeso-Gómez L, Rodrigo-Calabia E, Pelayo-Alonso R, de Cos-Cossío MA. Adherencia al tratamiento en pacientes con trasplante renal y su relación con los niveles plasmáticos de inmunosupresores. Enferm Nefrol. 2023;26(4):344-50. https://doi.org/10.37551/S2254-28842023033 DOI: https://doi.org/10.37551/S2254-28842023033
- Rosado-Alcocer LM, Medina-Escobedo CE, Salcedo-Parra MA, Madera-Poot GJ, Gil-Contreras JA, Aguilar-Castillejos LF. Supervivencia del injerto y pacientes postrasplante renal de un hospital de Yucatán, México. Enferm Nefrol. 2022;25(2):162-7. https://doi.org/10.37551/52254-28842022018 DOI: https://doi.org/10.37551/52254-28842022018
- Cancino-López JD, Hernández-Aguilar U, Oribe-Aguilar DI, Rojas-Montiel D, Escobar-Nieto JÁ, Pineda-Morales M, Espinoza-Pérez R, Rodríguez-Gómez R, Salazar-Mendoza M, Hernández-Rivera JCH. Supervivencia del paciente trasplantado y del injerto renal en una cohorte retrospectiva en México. Rev Med Inst Mex Seguro Soc. 2022;60(1):52-5.
References
Vidanapathirana M, Minuvanpitiya G, Karunaratne R, Fernando A. Triple infection with disseminated tuberculosis, invasive aspergillosis and COVID-19 in an organ transplant recipient with iatrogenic immunosuppression. BMJ Case Rep. 2021;14(8):e245131. https://doi.org/10.1136/bcr-2021-245131 DOI: https://doi.org/10.1136/bcr-2021-245131
Sigera LSM, Denning DW. Invasive Aspergillosis after Renal Transplantation. J Fungi (Basel). 2023;9(2):255. https://doi.org/10.3390/jof9020255 DOI: https://doi.org/10.3390/jof9020255
Cikova A, Vavrincova-Yaghi D, Vavrinec P, Dobisova A, Gebhardtova A, Flassikova Z, Seelen MA, Henning RH, Yaghi A. Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation. BMC Gastroenterol. 2017;17(1):131. https://doi.org/10.1186/s12876-017-0695-5 DOI: https://doi.org/10.1186/s12876-017-0695-5
Agrawal A, Ison MG, Danziger-Isakov L. Long-Term Infectious Complications of Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17(2):286-95. https://doi.org/10.2215/CJN.15971020 DOI: https://doi.org/10.2215/CJN.15971020
Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-14. https://doi.org/10.1056/NEJMra064928 DOI: https://doi.org/10.1056/NEJMra064928
Wagner CM, Butcher HK, Clarke MF, editors. Intervenciones de enfermería y resultados de enfermería vinculados a condiciones clínicas, Clasificación de Intervenciones de Enfermería (NIC). 8ª ed. Barcelona: Elsevier; 2024. p. 540-52.
Johnson M, editor. NOC y NIC vinculados a diagnósticos de enfermería de riesgo, Vínculos de NOC y NIC a NANDA-I y diagnósticos médicos. 3ª ed. Barcelona: Elsevier; 2012. p. 249-94.
González Quirarte NH, Castañeda-Hidalgo H, editores. Guía práctica para la elaboración del plan de cuidados de enfermería. Proceso de enfermería. 1ª ed. Barcelona: Elsevier; 2024. p. 139-44.
Espejo-Rodríguez R, Morales-Cuenca C, Martín-Hurtado A J, Crespo-Montero R. Educación sanitaria en el paciente trasplantado renal: una revisión integrativa. Enferm Nefrol. 2024;27(3):190-200. https://doi.org/10.37551/S2254-28842024020 DOI: https://doi.org/10.37551/S2254-28842024020
Pelayo-Alonso R, Cobo-Sánchez JL, Palacio-Cornejo CM, Escalante-Lanza S, Cabeza-Guerra MV, Martín Tapia O. Factores de riesgo para el desarrollo de complicaciones de la herida quirúrgica en el trasplante renal. Enferm Nefrol. 2022;25(3):249-56. https://doi.org/10.37551/52254-28842022025 DOI: https://doi.org/10.37551/52254-28842022025
Perry AG, Potter PA, Desmarais PL, editors. Cuidados de la ostomía (bolsa). Guía Mosby de habilidades y procedimientos en enfermería. 9ª ed. Barcelona: Elsevier; 2019. p. 169-75.
Álvarez Ruiz M. Análisis de la calidad de vida y adherencia terapéutica en pacientes tras trasplante renal en el Hospital Universitario Virgen del Rocío: un estudio descriptivo. Enferm Nefrol. 2024;27(1):63-70. https://doi.org/10.37551/S2254-28842024008 DOI: https://doi.org/10.37551/S2254-28842024008
Argüeso-Gómez L, Rodrigo-Calabia E, Pelayo-Alonso R, de Cos-Cossío MA. Adherencia al tratamiento en pacientes con trasplante renal y su relación con los niveles plasmáticos de inmunosupresores. Enferm Nefrol. 2023;26(4):344-50. https://doi.org/10.37551/S2254-28842023033 DOI: https://doi.org/10.37551/S2254-28842023033
Rosado-Alcocer LM, Medina-Escobedo CE, Salcedo-Parra MA, Madera-Poot GJ, Gil-Contreras JA, Aguilar-Castillejos LF. Supervivencia del injerto y pacientes postrasplante renal de un hospital de Yucatán, México. Enferm Nefrol. 2022;25(2):162-7. https://doi.org/10.37551/52254-28842022018 DOI: https://doi.org/10.37551/52254-28842022018
Cancino-López JD, Hernández-Aguilar U, Oribe-Aguilar DI, Rojas-Montiel D, Escobar-Nieto JÁ, Pineda-Morales M, Espinoza-Pérez R, Rodríguez-Gómez R, Salazar-Mendoza M, Hernández-Rivera JCH. Supervivencia del paciente trasplantado y del injerto renal en una cohorte retrospectiva en México. Rev Med Inst Mex Seguro Soc. 2022;60(1):52-5.