Komplikationsdata SMaRT Id_________________________________ Datum _________________ □ Ingen komplikation att registrera Graftrelaterad □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ Anastomosblödning, reoperation (=1) Blödning i sår/urin, transfusion (=2) Blödning i sår/urin, reoperation (=3) Urinläckage, ej reoperation (=4) Urinläckage, reoperation (=5) (Avflödeshinder, ej reoperation) (=6) Avflödeshinder, nefrostomi (=7) Avflödeshinder, jj-kateter (=8) Avflödeshinder, reoperation (=9) (Sår- eller graftinfektion) (=10) Sårinfektion (=11) Djup graftinfektion (=12) Lymfocele, ej behandling (=13) (Lymfocele, punktion el reop) (=14) Lymfocele, dränbehandling (=15) Lymfocele, reoperation (=16) Trombos i graftet (=17) Sårruptur (=18) Annan graftkomplikation (=19) □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ Sepsis, bakteriell (=1) Svampsepsis (=2) Pyelonefrit i transplantat (=3) Urinvägsinfektion (=4) Pneumocystis (=5) Listeria (=6) Pneumoni (=7) Legionella pneumoni (=8) Hepatit A (=9) Hepatit B (=10) Hepatit C (=11) CMV (=12) Herpes (=13) HIV (=14) Viros UNS (=15) Tuberkulos (=16) Polyoma BK virus (=17) Annan infektion (=18) □ □ □ □ □ □ □ □ □ □ Hjärtinfarkt (=1) Perifer kärlsjd (behandlingskrävande) (=2) CVI (cerebrovaskulär insult) (=3) Diabetes (sekundär) (=4) Hyperparatyreoidism (op-krävande) (=5) Allvarlig benmärgsdepression (=6) Allvarlig gastrointestinal komplikation (=7) Fraktur pga benskörhet (=8) Allvarlig reaktion mot läkemedel (=9) Annan allvarlig komplikation (=10) Infektion Generell Malignitet □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ Acute leukaemia Anus Basal cell carcinoma Bone Bone – metastases Brain – metastases Brain – other primary tumour Brain – primary lymphoma Breast Bronchus Chronic leukaemia Colon Gall bladder and bile duct Histiocytic reticulosis Hodgkin´s disease Kaposi´s sarcoma Kidney – hypernephroma of kidney graft Kidney – hypernephroma of host kidney Kidney – Wilm´s tumour Larynx Lip Liver – metastases Liver – primary hepatoma Liver – primary lymphoma Lung – metastses Lung – primary tumour Lymphoreticular tumour Lymphosarcoma Malignant Lymphoma non-Hodgkin Malignant Lymphoma NUD Malignant melanoma Metastatic carcinoma, primary site unknown Muscle Myeloma Oesophagus Other tumour of central nervous system Ovary Pancreas Parotid Penis Perineum Plasma cell lymphoma Prostate Rectum Renal pelvis Reticulum cell sarcoma Scrotum Squamous and basal cell carcinoma Squamous cell carcinoma Stomach Testis Thyroid Tongue Ureter Urethra Urinary bladder Uterus – body Uterus – cervix Vagina Vulva Kommentarer____________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________