Immunocompromised surgical patients

• Sirolimus slows down wound healing.  Consider switching transplant patients to a different immunosupressive drug to limit wound healing problems.
• Patients on Sirolimus also exhibit higher post operative complications of seromas, hernias, and wound dehiscence.
• We have gotten away from the practice of administering stress dose steroids on most general surgery patients on maintenance steroids
• Avoid placing hemodialysis catheters if possible because of the short-term and long-term complications.
• Most likely wouldn’t remove a catheter just for a febrile episode on hemodialysis.  But if the patient is septic – still try to maintain the catheter if possible.
• UNOS = united network of organ sharing.  When an organ donor is identified, the info is sent to UNOS who then generate a list of possible recipients.
• Travel outside of the US.  Big question is who is the donor?
• Organ trafficking is illegal in the US.  But not illegal to take care of the patient postop in the US after the patient had gone overseas.
• AV fistulas are considered to be better than AV grafts – short-term and long term.
• Peritoneal Dialysis use is expanding – many people who weren’t considered eligible in the past are now eligible.
• Immunosuppression increases the risk for cancer.
• Typhlitis, non-surgical protocol is used whenever possible when the patient is not toxic.  Typhlon = cecum (Greek).  Necrotizing enterocolitis, neutropenic enterocolitis., caecitis.  Typhlitis affects immunocompromized patients such as those undergoing chemotherapy, patients with AIDS, transplant patients, or the elderly.