Post Transplant Care

After a kidney transplant, you will take immunosuppressive (anti-rejection) medications. These medications make you slightly more prone to infection. Infections are caused by germs such as bacteria and viruses. It is very important to recognize when you have an infection. Infections must be treated promptly! You may become ill and need to be admitted to the hospital. The signs of infection vary with the type of infection.

Signs and Symptoms of Infection:

• Sweating
• Pain
• Fever
• Chills
• Flu-like symptoms
• Nausea
• Vomiting
• Diarrhea
• Congestion or “stuffed up” feeling
• Productive cough
• Burning or pain when urinating
• Increased frequency or pressure when urinating
• Redness, pus, or drainage from your surgical wound
• Any sores or lesions on your skin

You must report symptoms of an infection to the transplant team promptly, so it can be treated. Call the transplant team or Nephrology fellow immediately if your temperature is 101°F or higher. Also, notify the transplant team if you have a low-grade temperature of more than 100°F for over 24 hours.

After receiving a kidney transplant, you should avoid LIVE vaccines including:

• Varicella zoster
• Bacillus Calmette-Guerin (BCG)
• Smallpox
• Intranasal influenza
• Live oral typhoid Ty21a and other newer vaccines
• Measles (except during an outbreak)
• Mumps
• Rubella
• Oral polio

Avoid direct contact with anyone who has received a live vaccine:

• Children who have received oral polio vaccine for 3 weeks
• Children who have received measles or mumps vaccines
• Adults who have received attenuated varicella vaccine to prevent zoster (shingles)
• Children or adults who have received the nasal influenza vaccine

You may receive a flu shot, a diphtheria-tetanus booster, or a Mantoux (TB) test.

If you have been exposed to viruses such as chicken pox, herpes, or HIV, please notify the transplant team so that appropriate measures can be taken.

Following transplant, the diet prescribed for you will depend upon how quickly and effectively your new kidney begins to work. If your new kidney is functioning well, a no-added salt, low cholesterol diet is ordered. Usually, you may drink as much fluid as you like. Your anti-rejection medications may cause changes in the way your body works. You may experience the following:

• A change in the way your body uses sugar and starches
• A breakdown of muscle tissue
• Increased appetite, often causing weight gain
• Increased sodium (salt) retention, which may cause high blood pressure
• Altered lipid (fat) metabolism, which may cause high cholesterol and triglyceride levels

Decreasing your sodium and cholesterol will help you maintain a good nutritional status and decrease the side effects of the immunosuppressive medications. If you have diabetes, your diabetic nutritional guidelines should also be followed. The clinical nutritionist will visit you during your hospitalization to discuss and explain your new diet. Please feel free to discuss any of your nutritional concerns.

Receiving a new kidney transplant can be a very emotional time for both you and your loved ones. While many of these emotions can be very positive, having a kidney transplant can also be a stressful and confusing time. Stress may arise from any number of areas such as financial problems, lifestyle changes, sexual concerns, medical problems, relationships, or self-image. It is also difficult to learn how to “be healthy” again. Our transplant social workers are available to you and your family to help you with stresses, problems, and/or concerns you may be experiencing.

Sexual Activity
Sex drive and fertility may return after a kidney transplant. If you choose to be sexually active, you may begin having intercourse three to six weeks after the surgery. If you have pain or discomfort during sex, wait and discuss it with the transplant team. For women, it is very important to use birth control if you are of childbearing age. Your gynecologist and transplant team should be consulted about the method that is best for you. Condoms and foam are highly recommended both as a birth control method and to prevent infection.

Pregnancy
Women of childbearing age should wait a minimum of one year after transplant before considering conceiving a child. Your kidney function and blood pressure must be stable. The transplant team and obstetrician must agree that your current health is adequate to safely complete a pregnancy. If you are planning a pregnancy, consult with your trasplant team to discuss changing your medication to avoid harm to your unborn fetus. If you become pregnant, you will require very careful monitoring. This includes having Tacrolimus levels drawn every week, and will require you to stop taking certain medications such as Myfortic. A substitute medication will be ordered. 

Returning to Work
Depending upon the type of job you have and how well things go, you may return to work 4 to 6 weeks after your operation. Some individuals who have been out of the workforce for an extended period of time may need additional emotional support or physical therapy as they prepare to return to work or school. Keep in mind that we are here to help. The reason why we work very hard at making your transplant a success is so you can resume a normal life. This includes going back to work.

Good dental care is essential after a kidney transplant. Infected teeth or gums could develop into a serious illness. After a kidney transplant you should:

• Brush your teeth, tongue, and gums twice a day with a soft toothbrush
• Floss your teeth twice a day to control gum swelling
• See your dentist every 3 to 12 months depending upon your needs
• For the first 6 months following your transplant, inform the transplant team of any dental work that needs attention
• DO NOT have your teeth cleaned by the dentist for the first four months following your transplant
• Always inform your dentist that you received a kidney transplant

You will need antibiotics before any invasive dental work that may cause your gums to bleed. Please call the transplant team prior to your dental visit so an appropriate antibiotic can be prescribed for you. Your dentist may also prescribe these antibiotics. We suggest Amoxicillin 2 g or Levaquin 500 mg taken one hour before the dental work is begun.

• Acne - If you have been prescribed Prednisone, be aware that it can cause acne. To help control acne, wash your face and other affected areas frequently with soap and water. You may try 10% Benzyl Peroxide, a non-prescription solution available from any pharmacy. You can be referred to a dermatologist (skin specialist) if acne remains troublesome.
• Cold sores or fever blisters - If you develop cold sores or fever blisters on your face, please notify the transplant team promptly. The ointment form of Acyclovir can help. It may decrease the discomfort you feel and speed the healing process.
• Growth of facial hair - Especially for women, can be a concern after transplant. You may use half-strength hydrogen peroxide to bleach your hair, or hair removal cream (depilatory), which is available at most pharmacies. Please follow the directions on the bottle if you choose to use a hair removal or bleaching product. Some can be irritating to the skin. Hair waxing or wax removal is another option and should be done by a professional at a full service salon.
• Bruising and hair loss - Please report bruising and hair loss, which are other side effects of your immunosuppressive medication.
• Nails - If your nails become ingrown or infected or you develop warts or growths on your skin, please notify the transplant team. You will need to take antibiotics if you have any procedures done, including having an ingrown toenail removed. If you cut yourself, wash the cut well with soap and water and watch it carefully for signs of infection. Go to the emergency room for treatment if the cut is deep. Don’t forget to inform the transplant team
• Skin Cancer - Patients who take anti-rejection drugs are at a slightly increased risk for developing skin cancer. Whenever you will be in the sun for more than 20 minutes, you should use a sun block product rated 30 or greater. You may buy any brand you choose. Consider wearing a hat outdoors during the summer, especially when in the sun.

A kidney transplant is major surgery. It takes approximately 6 weeks for your abdominal muscles to heal. You may notice discomfort as the nerves and muscles heal. Itching around the incision is also normal. Some patients notice the leg on the same side of the body as the kidney transplant swells a little. This is normal. Call us if the leg becomes tender or painful. Your activity should be limited while you heal.

• Driving - You should not drive until you are off of your pain medicine and your surgeon clears you to drive. Expect to refrain from driving for two to four weeks after discharge from the hospital.
• Heavy Lifting - Do not lift anything over 10 lbs. for six weeks after you are discharged from the hospital.
• Exercise - You can exercise your arms and legs after surgery. Walking is an excellent form of exercise. You can climb stairs. Bike riding is allowed six weeks after transplant. You may want to participate in more passive sexual activity to avoid added stress on your wound for two months after surgery. After your incision is healed and you are cleared by your surgeon, you can do abdominal exercises such as sit-ups. Swimming is an excellent exercise because it does not put pressure on bones and joints. You can play golf, roller skate, ice skate, fish, garden (using gloves) and do similar things as often as you like. Please notify us before engaging in any rigorous physical activities. Renal disease and the immunosuppressive medications can make your bones weak. We may refer you to a bone specialist, who can tell you how much stress you can safely place on your bones and joints.

• Alcohol - You may drink alcohol in small amounts. If you are taking blood pressure medicine however, alcohol may make you ill, and therefore you should not drink. Never drink and drive.
• Drugs - Do not take any mind-altering or mood-altering drugs such as cocaine, marijuana, or PCP, as they can affect your blood pressure and heart and will damage your new kidney.
• Tobacco - You should not smoke or chew tobacco for the same reasons. In addition, smoking leads to other serious and life-threatening consequences. It can significantly increase your risk for cancer, infections, high blood pressure, and coronary artery disease. Smoking constricts blood flow to your kidney and reduces its oxygen supply and nourishment. We strongly encourage you not to smoke and to avoid exposure to second-hand smoke as well. The social worker can refer you to programs to help you quit smoking.

If drinking or drug abuse becomes a problem after transplant, please notify any transplant team member. This is a dangerous situation and you could lose your kidney transplant and become seriously ill.

After discharge from the hospital, you will be followed very closely in the transplant clinic. Typically, after six months, we will refer you back to your primary nephrologist for routine follow up care. We will continue to see you at the transplant clinic once or twice a year. Together, your transplant team and nephrologist will follow your kidney transplant progress indefinitely.