Key points: About Kidney Transplantation

What is a Kidney Transplant?

A kidney transplant is an operation that places a healthy kidney into your body. The kidney can come from someone who has died or from a living donor. A kidney transplant is a treatment for kidney failure, not a cure. A new kidney will usually function immediately. But, it's important to remember that kidney transplant recipients still have kidney disease. You still need to be careful about your health. You will also need special medicines to prevent your body from rejecting the new kidney. (If rejection happens, dialysis is needed and you can consider a second transplant.) And you may still need some of the other medicines you took before the transplant.

Take Your Immunosuppressant Medications

As a transplant recipient, you will need to take a lot of medications. Most likely, you will be taking a combination of drugs. You will need close monitoring to make sure you are getting the right doses to prevent rejection, but not too much to cause problems. How does your transplant team decide which medication is right for you? This will depend on many factors, including your age, your general health, your risk of developing cancer, and other risk factors.

The goal of each transplant center is to help you stay healthy and achieve good kidney function. The medications you take are very important, but they are not without serious side effects. Working with your doctor will help you achieve the outcome you want - returning to a long, healthy life. Talk to your doctor about the side effects and the choices that may be available to you.

Staying Healthy After Your Transplant

Getting a new transplant is a joyous thing, but you still need to be careful about your health. Kidney transplant recipients are more likely than someone without a transplant to develop:

• Heart and blood vessel disease
• Diabetes
• Cancer
• Infections

You will need to take action to reduce your risk of these conditions.

Reduce Your Risk for Heart and Blood Vessel Disease

Even with a transplant, your risk for heart and blood disease is higher than it is in a healthy person. What puts you at risk for heart and blood vessel disease?

• High blood pressure
• High blood cholesterol
• Being overweight
• Smoking
• Enlarged heart
• Anemia (low blood count)
• Acute rejection of your transplanted kidney
• Reduced kidney function
• Diabetes

As a transplant recipient, know what your risk factors are for developing heart and blood vessel disease. Do what you can to adopt healthy behaviors to modify your risk factors. Work with your health care and transplant teams to work out a plan of care that will improve your outcomes.

Manage High Blood Pressure

Having high blood pressure puts you at risk for heart and blood vessel disease. So maintaining a healthy blood pressure is important. Ask your doctor what blood pressure range is right for you. If you have high blood pressure, your treatment will be based on many factors including:

• Whether you are overweight
• Whether you have other diseases like heart disease
• Which medications you are taking for your kidney transplant

Medications that help you maintain healthy blood pressure are called anti-hypertensive medications. Your doctor will choose the right one for you. One important factor that your doctor will consider is whether a drug will have any long-term affect on your new kidney. You may need more than one medication from your doctor to maintain healthy blood pressure.

To help control blood pressure:

• Lose weight if needed.
• Limit sodium (salt) in your diet as recommended by your doctor and dietitian.
• Work with you doctor to balance medications with kidney function
• Work with your doctor to follow a daily exercise program that is right for you

Reduce High Cholesterol

As a transplant recipient, you have a higher risk for developing high cholesterol because some immunosuppressants can increase your cholesterol levels. If there is too much cholesterol in your blood, it can build up inside your blood vessels, causing heart and blood vessel disease. Your transplant team will give you routine blood tests to monitor your cholesterol. If your cholesterol is not in the right range, you may need to take medications. The recommended medicine for treating high cholesterol in people with a kidney transplant are drugs called "statins." Along with lowering cholesterol in the blood, these drugs help lower inflammation and scarring in the transplanted kidney.

To help keep cholesterol in the right range:

• Work with your transplant doctor to find a balance between medications and good cholesterol control
• Ask if you need to see a doctor who specializes in treating high blood lipids.
• Take your medications as ordered by your doctor
• Follow your diet. Pay special attention for your calorie and fat intake. If you need help with your diet, ask your doctor to refer you to a registered dietitian.
• Lose weight if needed.
• Ask your doctor about a daily exercise program that is right for you.
• Learn all you can about cholesterol and heart and blood vessel disease.

Maintain a Healthy Weight

Being overweight can lead to high blood pressure, diabetes and high cholesterol. All three of these conditions can increase your risk for heart and blood vessel disease. Being overweight can also make health problems like high blood pressure and diabetes harder to control.

Many people with new kidneys gain weight after their transplant. A weight gain of 20 percent or more in the first year is common. While it is hard to lose weight, it can help lower your risk for heart and blood vessel disease.

To help manage your weight:

• Work with a registered dietitian to develop a safe weight-loss program.
• Eat the amount of calories and fats recommended by your doctor and dietitian.
• Follow a program of daily exercise.

Manage Other Risk Factors for Heart and Blood Vessel Disease

You've learned that controlling high blood pressure, high blood cholesterol and weight gain helps lower your risk for heart and blood vessel disease. But you can also lower your risk by:

• Quitting smoking
  
  Smoking increases your risk for serious heart problems or fatal heart attacks.
• Controlling anemia (low red blood cell count)
  
  Most patients with kidney failure have anemia. Getting a kidney transplant may help control anemia. If you still have anemia after your transplant, you should work with your transplant team to find the cause and treat it.
• Lowering a high hemoglobin level
  
  Transplant recipients sometimes have a problem with a high level of hemoglobin—the very opposite of anemia. This may be a side effect of immunosuppressant medications. A high hemoglobin level can cause high blood pressure. It can also increase your risk for blood clots and stroke. Work with your transplant doctor and your general doctor to monitor hemoglobin levels.

Control Diabetes

Transplant patients have a higher risk for diabetes than people without a transplant. In fact, you may already have diabetes. One fourth of all kidney recipients have diabetes before transplantation and another 15 percent develop diabetes after their transplant. One reason for this is that the immunosuppressant medications that you take to prevent your body from rejecting your new kidney add greatly to this problem.

Having diabetes also adds to your risk for heart and blood vessel disease. So it is important that your blood sugar is under control. Strict control of blood sugar has been shown to lower the risk of heart and blood vessel disease. Without good control, other health problems may result from diabetes. These include:

• Heart disease
• High blood pressure
• Stroke
• Eye damage
• Foot problems that can lead to amputation

If you have diabetes, the following actions can help keep it under control:

• Work with a diabetes specialist to achieve good control of your blood sugar.
• Check your blood sugar as often as your diabetes doctor recommends.
• Work to control your blood sugar daily. Ask your diabetes doctor to help you with your home management plan.
• Learn what you need to do to keep your blood sugar in the normal range.
• Lose weight if needed
• Follow your recommended diet carefully
• Work with your doctors to develop a daily exercise program
• Learn all you can about diabetes.

Reduce Your Risk for Cancer

Transplant patients have a higher risk for cancer, including skin, lip, and lymphoid cancers.

• Skin and lip cancers
  
  Cancers of the skin and lips are are the most common types of cancers seen in transplant patients. Factors that increase your risk for skin cancer include:
  • Age
  • History of skin cancers
  • Exposure to sun over time
  • Fair skin
  • Long-term use of medications that prevent kidney rejection
• Viruses and Cancer
  
  Being exposed to certain viruses can also increase your risk for certain cancers after transplant. Most people don't know if they've been exposed unless they are tested. You will be tested before your transplant and at regular times afterwards for any of the viruses that could increase your risk for cancer. Your transplant center may also give you anti-virus medications to help prevent these virus infections.
• Lymphoid Cancers
  
  Cancers of the lymph glands (called lymphomas) can also occur. They are less common, but more serious. What puts you at risk for lymphoid cancers? The drugs you must take to prevent kidney rejection are one factor. Virus germs are another. — Treatment may include chemotherapy and stopping or lowering the immunosuppressant drugs. If untreated, lymphoid cancers can quickly lead to loss of your transplant and possible death.

To help prevent cancer after a transplant:

• Know the signs and symptoms for each type of cancer
• See your doctor when you have any signs and symptoms of cancer
• Avoid sun exposure; use sun screen year round
• Stop smoking
• Follow the American Cancer Society recommendation for cancer screening
• Know your family history of cancers. If other family members have had cancer, you are more likely to get cancer yourself.
• Ask your general doctor and transplant doctor for diet, exercise and screening recommendations.
• Take all antiviral medications as ordered by your doctor.

Reduce Your Risk for Infections

As a transplant recipient, you will be at risk for getting infections. Your immunosuppressant medications make your body's immune system less active. This helps to prevent rejection of your new kidney, but makes it harder for your body to fight off infections. Fifty percent of transplant recipients get an infection during the first year. Infections can be mild to life-threatening. Your risk for infection will lessen over time. Understanding when you are most at risk - and why - can help.

• Early Risk Period
  
  The first 30 days after your transplant is your highest risk period for infection. You are in the hospital and getting large doses of immunosuppressant medications. Being in the hospital exposes you to possible infection. The most common types are urinary tract infections, wound infections, and upper respiratory infections. Bacterial and yeast infections (a type of fungus) are less common. You will be closely supervised for infection during this time. You will probably be given medications to help prevent infections.
• Middle Risk Period
  
  From two to six months after transplantation, your immunosuppressant medications are being decreased, and the risk for rejection is high. Opportunistic infections are common.
• Late Risk Period
  
  The period after six months is fairly stable for most transplant recipients. You will be on your regular dose of immunosuppressant medications. You will be getting back to some normal activities. If you have not had all the vaccinations you need, this is the time to think about getting them up to date. You are at risk for opportunistic infections. Screening for cancers is very important. Early detection with early treatment is important.

To help reduce your risk of infection:

• Work with your doctors to improve your overall health
• Work with a registered dietitian if needed to help get back on track with healthy eating
• Keep a list of your vaccinations
• Ask your transplant team what to do when children in the household have recently been vaccinated.
• Wash hands often with ordinary soap. Lather well and use plenty of running water. Wash hands before and after going to the bathroom, eating, scratching and working in the yard. Long nails are okay but make sure to keep them clean, especially under the nails.
• In the early period, take your temperature daily and anytime that you don't feel well.
• You do not need to wear a face mask unless instructed by your transplant center
• Follow your transplant center's instructions for reporting possible signs of infection such as fevers, nausea and vomiting or just not feeling well.
• Avoid people who have an active infection.
• Report any of the following symptoms without delay:
  • redness, oozing or tenderness of a sore;
  • any changes in moles or areas on your skin;
  • any vaginal discharge;
  • changes in secretion from the lungs, congestion or odd coughing;
  • any diarrhea that cannot be explained or won't go away;
• See your doctor right away anytime you have any new symptoms;
• Take all antibiotics or anti-viral medications as ordered by your doctor.

Maintain Good Nutrition

Good nutrition helps lower your risk for diabetes and heart and blood vessel disease. It is the key to future good health. Studies show that diet may also be a factor in some cancers.

The amount of calories you should eat depends on your age, sex, activity level and health concerns. In general, you should:

• Make smart choices from every food group
• Find a balance between food and being active
• Get the most nutrition from the calories you eat

You may find it very helpful to speak with a registered dietitian, especially if you have several health problems. Make a list of all your medical conditions and any diet recommendations from your health care team before you speak with the dietitian. Your diet may change over time, so you may need more than one visit with the dietitian.

Your personal diet may need to be changed to:

• Prevent interactions between your medications and certain foods
• Help improve heart and blood vessel health
• Help control diabetes
• Help treat poor kidney function
• Prevent excess weight loss or weight gain
• Prevent poor nutrition

The dietitian will do the following to help you and your family:

• Create a meal plan based on your special health needs
• Give tips to family members about buying and preparing meals
• Suggest cookbooks or Web sites to find recipes
• Find your ideal weight and create a plan to help you reach your goal.

If you are overweight, it will be harder for you to control high blood pressure, diabetes, and heart and blood vessel disease. Maintaining a healthy weight can help you live a long, healthy life.

Tools to Help

• Are You Caring for Yourself...
• Communicating With Your Healthcare Team
• Track Your GFR and Albuminuria Numbers
• Know Your Numbers

To Learn More

You can learn more about kidney failure in the A-to-Z guide. Search for any of the topics listed below, or click on the links:

• What You Need to Know About Anemia and Chronic Kidney Disease
• Diabetes and Kidney Disease
• High Blood Pressure and Chronic Kidney Disease
• Kidney-Pancreas Transplant
• Kidney Transplant
• Metabolic Syndrome after Kidney Transplantation—Are You at Risk?
• Nutrition and Transplantation
• Your Transplant Care Team