Introduction: Porcine xenografts can expand the organ pool for patients seeking transplants with end stage renal disease. This is especially true for those with difficulty finding suitable donors due to high panel reactive antibody (PRA). Our center successfully transplanted a human with a porcine kidney xenotransplant. Here, we detail our bedside care delivery experience for this patient with an interprofessional, collaborative approach ensuring safety, continuity of care, and favorable outcomes at an academic health system.
Methods: Following an approved study by the IRB and the FDA in collaboration with the Xenotransplant Research Group, registered nurses (RNs) and nurse practitioners (NPs) were educated about the care of the xenotransplant recipients, nurses' responsibilities, and potential known and unknown risks associated with participating with these recipients’ care. To prepare the nursing team, education occurred in advance with live meetings, video conferencing, and institutional learning modules which included review from clinical protocols to ethical considerations. Infection prevention precautions consisted of strict hand hygiene before and after patient care. The RN’s and NP’s assignments excluded other patients with infections requiring isolation precautions. RNs and NPs participated in daily hybrid (virtual and in person) interprofessional rounds detailing the patient’s prior 24-hour events, including all clinical data and interventions, culminating in a comprehensive plan for the day. This team also included transplant specific surgery, nephrology, infectious disease, pharmacy, xenotransplant researchers, and immunogenetics experts. Plans included immunosuppression management, diagnostics, and management of comorbid conditions. RNs and NPs assessed the patient throughout each shift. RNs performed bedside handover to ensure patient- family centered continuity of care. Post transplant education was provided by both NPs, RNs and pharmacists throughout the hospitalization. Discharge planning encompassed the entire team’s input and was executed by NPs, RNs, and care management RNs to arrange follow up visits, home health nursing, and home infusions.
Results: RNs and NPs were vital to data gathering, assessment of new findings, timely and accurate documentation, medication administration, teaching, and communication to the multidisciplinary team. Nurses were responsible for care coordination to ensure a smooth transition to the outpatient setting. The patient maintained the porcine xenograft for 130 days prior to xenograft nephrectomy. After surgical recovery, the patient was discharged and transitioned back to her primary care givers.
Conclusions: Nursing care with exquisite attention to detail was at the forefront of the success of our xenotransplant recipient. Our center and others can continue to use this protocol as a model for the care of future xenotransplant recipients.