The long term success of a kidney transplant depends on many things. You should
Be seen by your transplant team on a regular basis and follow their advice
Take your anti-rejection medications daily in the proper dose and at the right times, as directed by the transplant team, to keep your body from rejecting your new kidney.
Follow the recommended schedule for lab tests and clinic visits to make sure that your kidney is working properly.
Follow a healthy lifestyle including proper diet, exercise, and weight loss if needed
Rejection and Transplant Medicine
What is rejection?
Rejection is the most common and important complication that may occur after receiving a transplant. Since you were not born with your transplanted kidney, your body will think this new tissue is “foreign” and will try to protect you by “attacking” it. Rejection is a normal response from your body after any transplant surgery. You must take anti-rejection medicine exactly as prescribed to prevent rejection.
Are there different types of rejection?
There are two common types of rejection
Acute Rejection – Usually occurs anytime during the first year after transplant and can usually be treated successfully.
Chronic Rejection – Usually occurs slowly over a long period of time. The causes are not well understood and treatment is often not successful.
What are anti-rejection medications?
Anti–rejection (immunosuppressant) medications decrease the body’s natural immune response to a “foreign” substance (your transplanted kidney). They lower (suppress) your immune system and prevent your body from rejecting your new kidney.
Why do I need to take anti-rejection medication?
Kidney rejection is hard to diagnose in its early stages. Rejection is often not reversible once it starts. You should never stop taking your anti-rejection medication no matter how good you feel and even if you think your transplanted kidney is working well. Stopping or missing them may cause a rejection to occur.
How should I take anti-rejection medication?
Here are some tips to help you take your anti-rejection (immunosuppressant) medication as directed:
Make taking your medicine part of your daily routine
Use digital alarms and alerts to remember when to take your medication. Be creative because it is easy to forget, especially once you are feeling wellKnow all of your medications by name and dose. Know the reason for taking each medication. Click here for form.
Ask for and review all written instructions for any change in medication dose or frequency
Tell your transplant team of problems and concerns about medications during every clinic visit
If a doctor other than a member or your transplant team gives you a prescription, notify the transplant team before taking. Certain medications can interfere with your anti-rejection medications and keep them from working.
Continue to take your anti-rejection medication no matter how great you feel, even if you think your transplanted kidney is working well. Stopping them may cause rejection to occur.
Do anti-rejection medications have side-effects?
Anti-rejection (immunosuppressant) medications have a number of possible side-effects which are usually manageable for most patients. Blood levels of anti-rejection medications will be checked regularly to prevent rejection and lessen side-effects. If side-effects do occur, your doctor may change the dose or type of medications.
What are the side-effects of anti-rejection medications?
Some of the most common side-effects of anti-rejection (immunosuppressant) medications include high blood pressure, and weight gain, an increased chance of having infections, and increased risk of some forms of cancer.
What are the types of anti-rejection medications?
There are 3 groups of anti-rejection (immunosuppressant) medications
Induction agent – Powerful anti-rejection medication used before the transplant in the operating room, or immediately after the transplant surgery
Maintenance agents – Anti-rejection medications you will take daily for as long as you have your transplanted kidney
Rejection agents: Medications which are used for the treatment for rejection episodes
Infection
Why is infection a concern after kidney transplant?
The anti-rejection medicines that help keep your body from rejecting your transplanted kidney also lower your immune system. Because your immune system is lowered, viral and other infections can be a problem.
What is the best way to stay healthy?
Finding and treating infections as early as possible is the best way to keep you and your transplanted kidney healthy. Exposure to diseases such as the flu or pneumonia can make you very sick. Receiving vaccines as determined by your transplant team can help you stay healthy. It is also important to frequently wash your hands or use an antimicrobial gel during cold and flu season.
What problems should I report to my doctor?
You should report any of the following problems to your doctor as soon as possible
Sores, wounds, or injuries especially those that don’t heal
Urinary tract infection symptoms such as frequent urge to urinate, pain or burning feeling when urinating, cloudy or reddish urine, or bad smelling urine
Respiratory infection symptoms such as cough, nasal congestion, runny nose, sore or scratchy throat, or fever
How can I avoid getting infections?
To avoid getting infections you should
Wash your hands regularly
Maintain good hygiene habits especially around pets
Avoid close contact with people who have contagious illnesses
Avoid close contact with children recently vaccinated with live vaccines (see section on Vaccines). Also, no one in the household should get the nasal influenza vaccine
Practice safe food handling. For more information on safe food handling go to USDA: Basics for Handling Food Safely
Inform your doctor well in advance of any travel plans
Vaccines
Can a vaccine be harmful after kidney transplant?
Vaccines help your body protect you from infection. Some vaccines are not good for you when you have a transplant. For example, you should avoid all “live vaccines.” Check with your transplant team before receiving any vaccines or boosters.
What are some general rules for getting vaccines such as Hepatitis B, live vaccines, or a flu shot?
You should
Get Hepatitis B vaccine before transplant
Avoid all live vaccines
Avoid the nasal influenza vaccine
Wait at least 3-6 months after transplant before getting a flu shot then get a yearly booster (injection only)
What if someone I know receives a live vaccine?
You should avoid direct contact with anyone who has received a live vaccine. Examples include:
Children who have received oral polio vaccine for 3 weeks
Children who have received measles or mumps vaccines
Adults who have received attenuated (a-TEN-yoo-ated) varicella vaccine to prevent zoster (attenuated means weaker strength)
Children or adults who have received the nasal influenza vaccine
What if I travel to another country?
Contact your transplant physician if you plan to travel to another country. You may need to receive certain vaccines to prevent diseases that are common to the area.
Which vaccines are safe to get?
Always talk to your transplant coordinator before getting any vaccines or boosters. The following vaccines are recommended:
Diphtheria-pertussis-tetanus
Haemophilus influenzea B
Hepatitis A (for travel or other risk)
Hepatitis B (receive before transplant)
Pneumovax (single booster at 5 years)
Inactivated polio
Influenza types A and B (booster every year)
Meningococcus (if at high risk)
Typhoid Vi
Which vaccines should I avoid?
You should NOT receive the following “live” vaccines
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
Live Japanese B encephalitis vaccine
Yellow fever
New-Onset Diabetes After Transplant
What is new-onset diabetes after transplant or NODAT?
Even if you did not have diabetes before, you may develop diabetes after transplant. This type of diabetes is called new-onset diabetes after transplant or NODAT. This can occur as a side effect of the medications that you need to prevent rejection of your new kidney.
What are my chances of having new-onset diabetes after transplant?
Your chances of having new-onset diabetes after transplant will be higher if you are obese. Your chances are also increased if others in your family have diabetes.
Why should I worry about diabetes?
Having a high blood sugar level due to diabetes or due to NODAT can cause serious damage to your heart, blood vessels, eyes, feet, and nerves.
How can I find out about my blood sugar?
Blood sugar levels will be closely watched while you are in the hospital after the transplant and in the outpatient clinic. If needed, your doctors will help you develop a plan to keep your blood sugar under control. If you are on corticosteroid medication (such as prednisone), your blood sugar levels will improve as the dose of this medication is decreased in the first 2 months after transplant.
If I have diabetes, how can I control my blood sugar?
Your transplant team will help you manage your blood sugar. High blood sugar is usually done with:
A carbohydrate-controlled diet
Exercise, as allowed by your doctor
Diabetes medications
Heart Disease
What are my chances of getting heart disease after a kidney transplant?
People with kidney transplants are at greater risk for heart disease. There are many causes for heart disease including: smoking, diabetes, overweight, hypertension, high cholesterol and blood lipids, and number of years on dialysis.
How can I lower my chances of getting heart disease?
Here are some important things for you to do now to lower your chances for getting heart disease later (see information on each topic):
Control high blood pressure
Manage cholesterol and blood lipids
Stop smoking
Exercise, as allowed by your doctor
Maintain a healthy weight by following a healthy diet
If you have diabetes, work to keep it well controlled
High Blood Pressure
What are my chances of having high blood pressure after a kidney transplant?
If you had high blood pressure before getting your new kidney, it may continue after your transplant. High blood pressure might also occur as a side-effect of anti-rejection medications, organ rejection and/or obesity (from weight gain after transplant).
Should I check my blood pressure?
You should check your blood pressure as directed by your transplant team. The target blood pressure for people with a kidney transplant is less than 130/80.
How can I control my blood pressure?
Your doctor will help you manage your blood pressure. High blood pressure is usually controlled with:
Weight control including regular exercise
A low salt diet
Blood pressure medication
High Cholesterol and Blood Lipids
What are my chances of having high cholesterol and blood lipids after kidney transplant?
Many people may have higher cholesterol and lipid levels in the blood after transplant due to medication side-effects , weight gain, poor diet, family history, or lack of exercise. Kidney-related issues that cause protein in the urine (proteinuria) can also increase blood lipids.
Why should I worry about high cholesterol and blood lipids?
High blood lipids can lead to clogged blood vessels. When this occurs it increases risk of heart disease and stroke.
How can I control my cholesterol and blood lipids?
Your doctor will help you manage your cholesterol and blood lipids. Controlling high cholesterol and blood lipids is usually done with:
A heart healthy diet
More exercise as allowed by your doctor
Lipid lowering medication
Stop Smoking
Why should I stop smoking?
Smoking cigarettes significantly increases your r
