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What to Do After Transplant

When To Call the Transplant Institute

  1. At the earliest sign of infection. A list of symptoms is located on the following page.
  2. At the earliest sign of rejection. A list of symptoms is located on the following pages.
  3. Before you make any change in your anti-rejection medication routine. This includes stopping a current medication or starting a new medication no matter if it is you or your physician who decided to make this change.
  4. Any time you or your local physician has questions.
  5. Any other time outlined in this educational booklet.

Remember, the transplant coordinators and physicians are on call 24 hours a day, seven days a week. You can reach them at:

  • 605-322-7350
  • 888-909-1112

Transplant Complications

Infection

The medications taken to prevent rejection lower your immune system and you are more susceptible to infection. This risk is greatest early after transplant and decreases with time. You, however, will always be at a greater risk for infection. You should always avoid close contact with people who have obvious infections such as the flu, colds or active childhood diseases. You should monitor yourself for the signs and symptoms of infection and report any signs and symptoms to the transplant center. Early detection and treatment of a post transplant infection will reduce the risk of major complications and illness.

The Signs of Infection Include:

  • Fever: a temperature greater than 100 degrees Fahrenheit.
  • Shortness of breath
  • A productive or persistent cough
  • Persistent pain such as an earache, stomachache or headache
  • Chills
  • Nausea, vomiting or diarrhea
  • Swelling, redness or tenderness in an area of skin
  • Skin blisters or sores
  • Wound drainage
  • Neck or joint stiffness
  • Confusion, lethargy or altered mental state
  • Progressive weakness
  • Sore throat

Any of these signs should be promptly reported to the transplant center. Also report any exposure to chicken pox or herpes zoster as well as any dog bites, deep cuts or injuries.

Reducing the Risk of Infection

Immunosuppressant medications used to fight rejection after a transplant also reduce your ability to fight infection. There are some simple precautions you can take to reduce your risk of getting an infection. They include:

  • Maintain general health through proper nutrition, rest, exercise, and stress reduction.
  • Avoid people who have infections or diseases, especially people with active viral infections, such as chicken pox, mumps, measles, mononucleosis, tuberculosis, colds, or the flu.
  • Take medications to prevent infection, as prescribed.
  • Contact the transplant team with any sign of infection.
  • Take recommended antibiotics before dental work or other invasive procedures. Call the transplant coordinator before these procedures are performed.
  • Follow recommended food safety guidelines.
  • Practice proper hand washing, especially before eating, after touching objects that carry microorganisms (money, doorknobs, and public telephones), and after using the bathroom.
  • When in public facilities, turn off the water with a paper towel after drying your hands; use care not to touch the faucet or handles with clean hands. If paper towels are not available use your elbows or backs of your hands if possible. Use a paper towel to open the door when leaving the facility.
  • Scrub hands with soap for at least 10 seconds and be sure to rub between your fingers.
  • Avoid compost piles, construction sites, damp hay and decaying plants, fruits, and vegetables.
  • Wear gloves during activities such as gardening, which may allow dangerous microorganisms to breach the skin through small cuts in your hands.
  • Wear shoes when walking outside to prevent exposure to soil microorganisms through cuts in your feet.
  • Cover your body, including your arms and legs, when hiking.
  • Avoid touching your eyes, nose, and mouth when your hands are not clean.
  • Do not receive any live vaccinations. Avoid contact for 8 weeks with persons who have received an oral polio vaccine.
  • Get Tetanus shots as needed.
  • Get an annual flu shot in the fall. DO NOT take the flu vaccine in your nose. This is a LIVE virus.
  • Do not share razors, toothbrushes or eating and drinking utensils.
  • Practice safe sex.
  • Avoid drinking water that comes from a well. Use bottled water or boil water for 19 minutes if there is a question of contamination (travel outside the country).
  • Avoid contact with animal urine, feces or vomit.
  • Avoid live vaccines or exposure to the body fluids of a person who has recently received a live vaccine. Because transplant recipients are immunocompromised, use of a live vaccine or exposure to a virus shed in the body fluids of other individuals can cause active disease. The following vaccines are LIVE:
    • Measles,mumps and rubella (MMR)
    • Varicella/chickenpox vaccine
    • Typhoid,TY21a
    • Yellow fever
    • Bacille Calmette-Guerin (BCG)
    • Smallpox (Vaccinia)
    • Flumist (nasal vaccine)
  • If you are in close contact to anyone who has received a live vaccine, do not handle the body fluids (urine, stool, vomitus) of that person for at lease 8 weeks after the vaccination to prevent exposure to the shed virus in the fluids.

Rejection

The body recognizes the transplanted organ as a foreign body and tries to destroy it through a process called rejection. Rejection can be broken into 3 types:

  • Hyperacute - this occurs within 24 hours of the transplant. This is rarely seen with today’s blood tests done before transplant (crossmatches).
  • Acute Rejection - usually occurs after the fist week. The greatest risk occurs during the first 3 months after transplant.
  • Chronic Rejection - can occur months to years after transplant.

The anti-rejection medications will help to prevent and control this process. The transplant team carefully monitors you for the signs and symptoms of rejection. Early diagnosis is important because rejection episodes can be treated and reversed.

Generally, you will be admitted to the hospital for part or all of the treatment. Medications such as prednisone or thymoglobulin are given in your vein. You may be able to finish your treatment as an outpatient.

Signs and Symptoms of Rejection:

  • Abnormal laboratory test; an elevated serum creatinine and BUN.
  • Fatigue, lethargy
  • Pain over the transplant
  • Decreasing urine output
  • Fever
  • Weight Gain

If any of these signs or symptoms develop, you should immediately contact the transplant center. Rejections may be mild or sever. An ultrasound or biopsy of the transplanted kidney is often needed to diagnose and treat rejection. The transplant team is your best health care choice to make this diagnosis and treat your rejection.

Delayed Graft Function

The kidney transplant may not function immediately. Dialysis may be required after transplant. This delay in function is called delayed graft function. The reasons for delayed graft function are many. It is often difficult to predict before transplant which kidneys will not work immediately and if dialysis is required, for how long it will be needed. Fortunately the majority of kidneys do start to function. You are monitored very closely during this period. An ultrasound and biopsy of the transplanted kidney may be required. Other x-rays and tests may also be needed. Your anti-rejection medications may be changed.

Primary Non Function

Occasionally a kidney will never work and will need to be removed. Ultrasound and biopsy of the transplant kidney will be done to assist the transplant team in determining whether or not your kidney can be saved.

Psychosocial Changes Post Transplant

You may feel a wide range of emotions following transplant. Transplantation can be a dramatic, life-changing experience. Common feelings you may experience are unexpected problems recovering from surgery, fear of rejection, fear of returning to dialysis, role expectations in your family now that you are no longer "sick", financial concerns and depression. The transplant team can help with these issues and should be notified immediately if there are concerns.

Post-Op Visits

You are now ready to follow-up with the transplant team as an outpatient. Before you leave the hospital, you will get an appointment to be seen in the transplant clinic (located at the Avera Doctors Plaza 1, 3rd. Floor). The clinic is open Monday through Friday 8:00 A.M. – 5:00 P.M. Transplant coordinators and physicians are available seven days a week, 24 hours a day by calling 605-322-7350. An answering service will page the on-call professional after hours.

Post-transplant clinic days are generally Monday and Thursday. On the day of your clinic visit, arrive at the lab (located on the 3rd floor of Avera Doctors Plaza 1 no later than 8:00 A.M. for blood testing. The results will be available at the clinic later that morning at your appointment time.

The Morning Blood Work

The Morning Blood Work will include monitoring of drug levels for Prograf, Neoral and/or Sirolimus depending on what medications you are taking. These are important immunosuppressants and monitoring is an important aspect of medication management. Drug levels that are too low can cause rejection and drug levels that are too high can become toxic in your system (harmful to you).

On the day of the clinic visit, do not take these medications until after your blood has been taken. Be prepared to spend 2-4 hours in the clinic. After the blood has been drawn there will be time for breakfast before the clinic visit. This is also a good time to visit with other transplant patients and share experiences.

The Post-Op Visit

The Post-Op Visit involves a brief physical exam by the transplant physicians and staff. Lab tests will be reviewed. Medication schedules will be rechecked. This is a good time to ask questions regarding your recovery from the surgery or possible medication side effects. Please make sure you bring your Patient Handbook, all medication bottles and pillbox to your clinic visit.

Frequency of clinic visits: will vary, but generally are:

  • 2-3 times a week for 2-4 weeks
  • 1 time a week for 3-4 weeks
  • Every other week for 3-4 weeks
  • 1-2 times during the 3rd month after surgery
  • Once a year on the anniversary of the transplant

These are general guidelines. Your progress may require more or less frequent visits. After approximately three months your primary physician or nephrologist resumes your care.

Working with your local doctor

If you are doing well after the transplant, your general health care needs will be turned over to your primary care doctor. The team will send updates and records to your local doctor. When you return home, a packet of information describing the transplant and your post transplant course will be sent to your local doctor. The information includes a list of your current medications and the lab work you will need to continue.Once you return home, you should schedule an appointment with your local doctor (primary care physician).

The transplant team will manage all the anti-rejection (immunosuppressant) medications for the rest of the life of your new kidney and will work closely with your local doctor in monitoring your labs and health. The transplant team will notify you and the local doctor of all changes made in immunosuppressive medications. Your local doctor should keep the transplant team informed of ongoing health issues. You and your local doctor should notify the transplant team of changes in medications. The transplant team is always available to assist your local doctor in caring for your needs after transplant.

Routine Blood Tests

The following information explains the most frequently ordered blood tests for transplant patients. The transplant coordinator will inform you which laboratory tests you will need to record. The normal values quoted here are those from Avera McKennan Hospital and University Health Center. These may differ from the values used by the laboratory in which your blood tests are done. Individuals may have range variations for these tests.

Creatinine (Cr)

This test helps to determine how well the transplanted kidney is functioning. An increased level may indicate side effects from your immunosuppressant medications. In kidney transplant patients, an increased level may also indicate rejection, obstruction or recurrent disease.

  • Normal range: 0.5 – 1.2 mg/dL
  • Note: In kidney transplant patients, the normal range may be slightly higher.

Prograf (also known as: F.K. & tacrolimus)

This test measures the blood level of Prograf at its lowest level (trough). It is important to have it checked regularly. The test must be done one hour before your next scheduled dose.

Potassium (K+)

This test measures the amount of potassium in the blood. An abnormal potassium level may indicate a change in kidney function or loss of body fluids.

  • Normal range: 3.3 – 5.1 mEq/L

Blood Glucose

This test measures the amount of glucose (sugar) in the blood.

  • Normal range for people without diabetes: 70 – 110 mg/dL
  • Goal range for people with diabetes: 80 – 140 mg/dL
  • Note: may need to be individualized.

Hemoglobin(Hgb)

This test is done to measure the ability of your blood to carry oxygen. A low level could indicate anemia or blood loss.

  • Normal range: Women = 12.0 – 16.0 g/dL Men = 14.0-18.0 g/dL
  • Note: The values for this test may be slightly lower depending on age or kidney function.

White Blood Count (WBC)

This test measures the number of white blood cells in the blood. A level below normal may increase your risk for infection. It may also indicate a need to change your dose of Cellcept. An altered level may suggest that you have an infection, or it may be related to some medications you are taking.

  • Normal range: 4.8 – 10.8 K/CMM

Calcium (Ca)

Measures the amount of calcium in your blood needed for blood clotting, building bones and also muscle, heart and nerve function. An increased level could mean you’ve overused antacid, you have a bone disorder, there is too much vitamin D or there may be problems with your thyroid or parathyroid glands. A decreased value could mean you have an inflamed pancreas, kidney failure, too little vitamin D or there is too much water in your body.

  • Normal range: 8.2 – 10.2 MG/DL

Phosphorous (PO4)

This measures the amount of phosphorous in your blood that is valuable in creating energy. An increased level could indicate kidney failure or too much phosphorous in your diet. A decreased level could indicate a bone disorder, too little vitamin D, a complication of diabetes or excessive use of some antacid.

  • Normal range: 2.7 – 4.5 MG/DL

Magnesium (Mg)

This measures the amount of magnesium in your blood that is needed by every cell in your body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady and bones strong. Having a low magnesium level occurs more often than a level that is too high.

  • Normal range: 1.6-2.6 MG/DL

Additional Blood Tests

As part of your post kidney transplant blood test, the transplant team may recommend any of the following tests:

Cholesterol

This test measures the fat-like material carried in your blood that helps make hormones and build cell walls. An increased in level could indicate that you’ve eaten fatty foods within 12 hours of the test, you have narrowing or blockage of blood vessels or it could be a side effect of some antirejection medication.

  • Normal range: 50 – 200 MG/DL

Triglycerides

This test measures a fat that, along with cholesterol, helps determine the risk of coronary artery disease. An increased level could indicate poorly controlled diabetes, high blood pressure, and that you have an increased risk of coronary artery disease (if your cholesterol levels are also high). A decreased level could mean malnutrition or that you have an overactive thyroid.

  • Normal range: 25-150 MG/DL

Urinalysis

This test measures the white blood cells, red blood cells, bacteria and protein levels in your urine. An increased level could indicate kidney disease, urinary tract infection or poorly controlled diabetes.

Immunosuppressant Medications

You need to be familiar with the name, dosage and side effects of the medications you are taking. These medications must be taken every day as prescribed.

Pre-Op Medications

You may be given immunosuppressant (anti-rejection) medications through your I.V. immediately before you go to surgery or during surgery. They may include Campath, Zenepax, Simulect and/or Thymoglobulin. IV Anti-rejection medications may need to be given after surgery as a preventative measure or to treat a rejection episode.

Prograf® (FK 506/tacrolimus)

Purpose

Prograf decreases the activity of your immune system and helps to prevent your body from rejecting the transplanted organ.

Route (how it is taken)

  • Oral (tablet) taken twice a day
  • IV

Blood Tests

You will have a blood test to determine the correct dose. It is referred to as your Prograf Level.

Possible Side Effects

Frequently Experienced:

  • Decrease in body’s ability to fight off infection
  • Tremors
  • Headache
  • Mood changes
  • Numbness and tingling in hands and feet

Infrequently Experienced:

  • High blood sugar
  • Hair loss

Deltasone® (prednisone)

Purpose

  • Prednisone (Deltasone) is a steroid that is used to prevent your body from rejecting your transplanted organ.

Route (how it is taken)

  • Oral (tablet or liquid) taken once a day. You will start with a higher dose. This dose will slowly be lowered (tapered) over time.

Blood Tests

  • There is no blood test specific to this medication.

Possible Side Effects

Frequently Experienced:

  • Acne
  • Cataracts
  • Changes in mood, sleeplessness
  • Easy bruising
  • Increased appetite
  • Increased fat in the face, abdomen and upper back
  • Thinning of bone (osteoporosis)
  • Weight gain
  • Slow wound healing
  • Stomach upset

Infrequently Experienced:

Elevated blood sugar which may lead to steroid induced diabetes

  • Tendency toward stomach ulcers
  • Aseptic Necrosis of the hip

Note: Prednisone should always be taken with food.

Cellcept® (mycophenolate mofetil /MMF)

Purpose

  • Cellcept is used to help prevent your body from rejecting your transplanted organ.

Route (how it is taken)

  • Oral (tablet) taken twice a day
  • IV

Possible Side Effects

Frequently Experienced:

  • Nausea
  • Diarrhea

Infrequently Experienced:

  • Decreased white blood cell count
  • Respiratory infections
  • Mouth sores
  • Insomnia

Rapamycin® or (sirolimus)

Purpose

  • Rapamune is used to help prevent your body from rejecting your transplanted organ. This medication may be substituted for Cellcept or Prograf or may be added to your Cellcept and Prograf.

Blood Tests

  • You will have a blood test, called a Rapamycin level to determine your dose.

Route (how it is taken)

  • Oral (tablet) taken once a day

Possible Side Effects

Frequently Experienced:

  • Swelling in legs and arms
  • High blood pressure
  • Increased production of cholesterol &/or Triglycerides
  • Elevated BUN, Creatinine
  • Diarrhea
  • Nausea/vomiting
  • Acne
  • Tremor
  • Fever
  • Abdominal pain
  • Constipation
  • Anemia
  • Headache

Infrequently Experienced:

  • Risk of infection
  • Increased risk of certain cancers
  • Decreased blood counts

Additional Transplant Medications

You will have other medications to take after your transplant. The purpose of the additional medications is to help prevent your from getting sick while your immune system is at its lowest. Other medications are to help protect your new kidney.

The following medications are prophylaxes or preventative medications that you will take anywhere from 3-6 months after your transplant. You should follow the dosage prescribed by your doctor.

Valcyte (valgancyclovir)

Purpose: an anti-viral medication you will take for 6 months to help prevent cytomeglovirus (CMV). Take as directed.

Mycelex Troche

Purpose: an anti-fungal medication you will take 4 times a day for 3 months to help prevent mouth sores caused by yeast.

Bactrim (sulfa)

Purpose: an antibiotic medication you will take for 6 months to help prevent you from getting a urinary tract infection and pneumocystic pneumonia.

Calcium with Vitamin D

Magnesium

Phosphorus

Blood Pressure Medications

Medications you were on before your transplant for other illness/disease may need to be changed after your transplant. The pharmacist will work with the transplant physicians to ensure there are no drug interactions with your new transplant medications.

Important Points to Remember for Immunosuppressant Medications

  1. Never stop taking your medications or change your dose without consulting your transplant team even if it is recommended by another physician.
  2. Take your medications at the same time each day.
  3. If you are unable to take your medications by mouth due to an illness, contact your transplant team right away.
  4. Inform all your physicians, dentists and pharmacists of the medications you are taking.
  5. Use of immunosuppressant medications may increase your susceptibility to infections and cancer.
  6. Never let your pharmacist make substitutions unless it has been OK’d by your transplant team.

Your New Daily Routine

To help you identify infections and rejection at the earliest signs, you will be asked to monitor your blood pressure, temperature and weight on a daily basis. If you have a change in any of these areas, contact your transplant team right away.

Blood Pressure

Blood Pressure is the force of blood against the walls of your arteries. Your blood pressure is recorded as:

Systolic Pressure
_______________

Diastolic Pressure

  • Systolic Pressure is the highest pressure produced when the heart is contracting. This is the first pulsation you hear as you deflate the blood pressure cuff.
  • The lowest pressure reached when the heart is relaxing is the Diastolic Pressure. This is the point at which you stop hearing pulsation.

Your blood pressure can vary with your age and physical condition. Physical activity and anxiety can temporarily elevate the blood pressure.

It is important that you check your blood pressure as directed.

You should take your blood pressure _____________ times a day.

Notify the transplant team if your blood pressure is:

  • Above _______________
  • Below _______________

Daily Weights

Daily weights are necessary to help determine your fluid balance and nutritional status. It also helps regulate your medication dosages.

  • Weigh yourself at the same time each day.
  • It is helpful to weigh with the same amount of clothing on.
  • Weigh yourself on the same balanced scale. This helps to avoid inaccuracies in your weight.

Kilograms to Pounds Kilograms x 2.2

Pounds to Kilograms Pounds divided by 2.2

Temperature

Take your temperature twice a day in the morning and evening. An elevated temperature may indicate an infection. If your temperature is elevated to 100º F or higher, notify your transplant team immediately.

Do not take Tylenol or any other medications for an elevated temperature unless you are instructed to do so.

Diabetes Management

Blood sugar control is very important in keeping yourself and your new kidney healthy. If you have diabetes, you should check your blood sugar level several times a day to make sure that you have a proper balance between diet, exercise, and medications (insulin or oral medication). Talk to your doctor or diabetes educator about the ideal range for your blood sugars and ask them if you have questions about diabetes management. You may be referred to an Endocrinologist (a doctor that specializes in diabetes) if you do not already have one.

Activity After Transplant

After your transplant, there is a period of recovery from the surgery and a period of adjustment to the transplant medications. Most transplant related complications will occur within the first six months transplant. After you have recovered from your surgery, you will want to resume many of your normal activities. Here are some guidelines for you to follow:

Exercise

There is a significant loss of strength and stamina after surgery and during recovery. Because of the newness of your incision, you will need to limit your physical activity to what you can safely tolerate. During the first 6 weeks after surgery, you should not lift anything heavier than 15-20 pounds. Avoid extreme exertion. You should start with progressive but mild exercise. Walking and swimming are excellent activities that will help you regain strength and stamina. Exercise will also decrease your risk of unwanted weight gain associated with your medications.

Diet

You may not need to follow the strict renal diet you had before your transplant. However, because some of your medications make it easy to gain weight, you will want to "get a grip" on how much you eat. Uncontrolled weight gain can impact how long your new kidney works. People with diabetes will need to continue their pre-transplant diet to help manage blood sugar levels.

Sleep

One of the most common complaints in the early post-transplant period is difficulty sleeping. Sometimes your sleep patterns will become confused and you will nap through the day and stay awake much of the night. Normal patterns will come gradually. The transplant team can help by prescribing medications to help you with difficulties sleeping.

Work

It is hoped that most transplant patients will return to work after transplant. Timing depends on the type of work you do and your recovery progress after surgery. The transplant team can help with decisions regarding when you return to work and provide you with a letter of medical clearance if necessary.

Driving

The transplant surgeon will clear you to drive after transplant. The decision is based primarily on the surgeons’ assessment of your ability to safely operate a car and your ability to respond to emergency situations while driving. The transplant team recommends that seat belts be worn at all times and that pain pills stronger than Tylenol not be taken before driving.

Smoking

The transplant team requests that no transplant patient smoke. Smoking is one of the most significant risk factors for post-transplant complications.

Sex

Sexual activity may be resumed when it is comfortable for you. Problems with sexual dysfunction should be discussed with your transplant team. Some of these problems can be associated with certain medications, and your transplant team can help. Female patients who were infertile prior to transplant can become fertile after transplant and may become pregnant. You may choose to discuss birth control options with your health care providers.

Pregnancy

Pregnancy is possible after transplant. It is recommended that you wait at least one year after your transplant before getting pregnant. Your transplant team and your OB/GYN should work together before you become pregnant to review your current health, the status of your kidney and the adjustments that must be made to your medications. You should fully understand the risks and complications and plan for your care before, during and after pregnancy before you make your decision to get pregnant.

Other Activities

Common sense can serve as a good guide to determine which activities are safe. Remember you are at increased risk of infections associated with the transplant and the normal recovery from a surgical procedure. Questions about certain activities can be discussed with the transplant team.

Tips for Taking Care of Your New Kidney

  • Call the transplant coordinator if you start any new medications. Call even if your doctor has ordered the medicine.
  • Don’t change the doses or times of your medications without checking with the transplant coordinator.
  • Keep your prescriptions filled and up to date. Don’t run out.
  • Keep your medication list up to date.
  • If you miss a dose or don’t remember taking a dose of medicine, call the transplant coordinator for advice and help. If your doctor changes your medication, notify your transplant team.
  • If you become ill or need surgery, notify your transplant team.
  • If you are admitted to the hospital, make sure the doctor notifies your transplant team.
  • Take antibiotics before any dental procedure. Your dentist can call the transplant team for recommendations about which antibiotics are recommended.
  • Avoid anyone who has been vaccinated with the oral polio vaccine within the eight weeks of your transplant.
  • Notify your transplant team if you are exposed to chickenpox.
  • All results of blood tests should be forwarded to your transplant team.
  • Schedule and keep regular appointments with your doctor.
  • Avoid excessive alcohol.
  • Practice safe sex.
  • Take pain medications with acetaminophen, like Tylenol. Avoid using products with ibuprofen.

Post-Transplant Health Maintenance

You are encouraged to have regular check ups after your transplant. Below are a few suggestions.

Ophthalmologist

Regular and annual eye exams are recommended. Prompt exams are needed for sudden visual changes. The transplant team should be informed of ophthalmologist findings.

Dentist

Regular dental exams are recommended after the first 6 months of your transplant. Before dental work is done, however, antibiotics need to be given to prevent infection. The transplant team can recommend specific antibiotic coverage. Oral exams should be done twice a year due to the increased risk of lip, gum and mouth cancers.

Blood Work

Blood work is ordered at regular intervals and needs to be forwarded to your transplant teams office for review. The transplant team will provide orders to local labs for the studies you used. The lab will also be given instructions on how to forward the results to the transplant clinic. Call the coordinator when the test is done so the office knows to expect the results. The coordinator will contact you with the results.

Vaccines

It is recommended that you get vaccinated for the flu once a year. Do not take the “live” nasal flu vaccine (flumist). You should get vaccinated for pneumonia once every two years.

Female Patients

Female patients should undergo annual Pap tests and Mammograms. Pelvic exams should be done twice a year if you have more than one sexual partner. Please keep the transplant team informed of all exam results.

Male Patients

Prostate and PSA testing is recommended based on the normal guidelines for your age and your history. Ask your doctor what is recommended in your case. Results should be shared with your transplant team.

Important Long-Term Issues For Transplant Patients

1. Take Your Medications

The second leading cause of losing transplant function and needing to go back on dialysis is failure to take the immunosuppressive medications as prescribed. If you are having side effects, call the Transplant Institute!

2. Know Your Blood Pressure

Your goal blood pressure is below 130/80. In many patients, this requires multiple medications. A low blood pressure will make your kidney last longer and will reduce your risk of heart disease and stroke. The rate of heart disease is substantially higher in transplant patients compared to other people. A mild short-term increase in blood pressure is not much of a problem. This is a long-term issue.

3. Know Your Cholesterol

Some of the transplant medications increase cholesterol, which can contribute to heart disease. You may need a medication to lower your cholesterol.

4. Bone Disease

Steroids (Prednisone) causes osteoporosis (weak bones), increasing your risk of fracture over time. A large amount of bone loss occurs early after transplantation. You should be taking calcium and vitamin D supplements. Both often come in 1 pill. Ideally, you want to take about 500-1000 mg of elemental calcium and 400 units of vitaminDper day. Ask your pharmacist for the generic form of “Oscal-D”. Take 2 per day. Take the calcium on an empty stomach. You do not want to take the calcium with meals as you did before your transplant because your phosphorus is no longer high and does not need to be reduced. Many times the phosphorus is actually low in kidney transplant patients.

At some time, we will order a “bone densitometry” test to determine your degree of osteoporosis, if any. You may need more powerful medications than just calcium and vitamin D to prevent bone loss.

5. Cancer Risk

There is an increased risk of skin cancer in transplant patients. Cover up when out in the sun: long sleeves, hats with protective brims. Use sunscreen. White is good; tan is bad; red is dangerous. You will need a full head to toe skin exam every year by your nephrologist or a dermatologist making sure there are no suspicious lesions.

There is an increased risk of cervical cancer in transplanted women so keep up to date with your PAP tests. You should be aware of the standard recommended cancer screening: annual stool testing for blood, annual mammograms, annual PSA, colonoscopy every 5 years.

6. Immunizations

You should receive the influenza vaccination each year. You should not take the nasal spray vaccine (flumist) as it is a live virus. You should receive the pneumococcal vaccine (pneumovax) every 3-5 years.

7. Obesity

Weight gain is common after transplantation due to the appetite stimulating effect of prednisone. Eat a low fat diet and start an exercise program as soon as you are feeling up to it. Walking is an outstanding exercise routine.

8. Vitamins

There is preliminary scientific evidence suggesting that folic acid, B6 and B12 vitamins will decrease hardening of he arteries and therefore heart disease in transplant recipients. The easiest way to get these vitamins in sufficient quantity is to take the vitamin called “Diatx”. It costs $17 per month and requires a prescription. It is recommended if you can afford it.

9. West Nile Virus

Transplant recipients are at a much higher risk of developing West Nile Virus. Use insect repellent containing DEET during the mosquito season. Minimize time outside at dawn and dusk, the times of peak mosquito activity.

Additional Information

View more information about long-term health for transplant patients on the Avera McKennan Hospital & University Health Center website.

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