LIFE AFTER KIDNEY TRANSPLANTATION
- When will I be discharged from the hospital after transplantation?
You will be discharged on the seventh or eighth day.
- Will I have any tube at discharge?
All tubes and catheters are removed by day 6. Occasionally you may get discharged with urinary catheter (in case you have urinary retention or developed urine leak), drain tube (increased drain output) or central vein catheter (if you are dialysis dependent because of poor graft function and there is no other vascular access for hemodialysis). You may also have a ureteric stent, a small tube kept inside the transplant kidney ureter (not visible outside) for continuous urinary drainage. These tubes will be removed later once the clinical situation (for which they are retained) improves. Among these, ureteric stent requires removal in Operating Room; others can be removed in Procedure Room.
- Should I take medicines after transplantation?
You should take medicines after transplantation lifelong. Medicines will be needed for a) immunosuppression, b) control of hypertension and diabetes mellitus (DM), c) prevention of urinary tract infection (and cytomegalovirus infection in some) for the first six months and d) supplementation of iron and calcium stores. Dose and number of medicines will change during follow up depending on the clinical condition.
- What is immunosuppression?
Immunosuppression is suppression or reduction of the activity of body’s immune system (body defense mechanisms that fight against infections and other foreign substances).
- Do immunosuppression medicines have side effects?
Immunosuppression without supervision can result in serious infections, infections with unusual microorganisms and rarely cancers. These infections may have different symptoms in immunosuppressed individuals thereby delaying diagnosis and treatment and can result in life threatening illness and even death.
- Then why are they necessary?
The recipient’s immune system recognizes donor kidney as foreign and triggers defense reactions that can damage the graft (rejection). Immunosuppressive medications are given to reduce the risk of rejection. The risk of rejection is high in the first six months; the dose of immunosuppression will be high during this period and it will be reduced gradually thereafter.
- Is there no other way to reduce the risk of rejection?
To minimize rejection, blood group compatibility and negative cross match are essential. If tissue matching is less, the patient will require more powerful immunosuppressive medications; in the process of reducing immunity, these medications will predispose the patients to serious infections. Better tissue compatibility is possible and therefore results are better with living related donor transplantation.
- Will I be totally all right after transplantation?
If you have good graft function with few episodes of rejection, you are likely to be totally all right after transplantation. However you may develop DM, vascular disease (heart attack, stroke and gangrene), bone problems, urinary tract obstruction and recurrence of original kidney disease (which may or may not affect the graft seriously depending on the type of kidney disease) apart from side effects of the drugs anytime during follow up.
- What are the side effects related to immunosuppressive medications?
You may develop cosmetic side effects (puffy face, rough skin, excessive hair growth, stretch marks over abdomen and thighs, gum enlargement, obesity), acne, hand tremors, abdominal pain related to stomach ulcer, decreased blood cell count and weak bones apart from tendency for DM, increased blood pressure, infection, decline in kidney function and very rarely cancer. Most of these side effects are dose dependent; they may subside over a period of time with reduction in immunosuppression. Some of them are preventable and that is why regular follow up is essential.
- Will there be surgical complications post transplant?
Surgical complications, though rare can happen in the post transplant period. They may result in clot within the blood vessels, blood leak, blood vessel narrowing, urine leak, urinary tract obstruction etc. They may occur early (in the immediate postoperative period requiring immediate intervention – may require removal of the graft if there is rupture or clot of the blood vessel) or late.
- If I have to continue medicines and am not going to be completely all right, why should I undergo transplantation?
Among the various options of renal replacement therapy for patients having end stage renal disease, renal transplantation offers the best patient survival and quality of life.
- When should I come to the hospital?
Following discharge, you should visit the hospital once a week for the first 3 months, once a fortnight in the next 3 months and every third week until you complete one year post transplantation. Thereafter you will be visiting the hospital once in 1 -3 months depending on your clinical condition. However you will have to visit the hospital in between (or call the consultant over phone) if you have fever, chills, cough, sputum, reduced urine output, burning urination, loose stools, vomiting, pain over the graft or unusual symptoms at any point of time.
- Should I do tests during follow up?
You will be doing blood and urine tests periodically to monitor kidney function, liver function, blood cell count and blood glucose apart from drug level monitoring for immunosuppressive medicines and screening for infection with x ray and ultrasonogram.
- How should I take care of myself to minimize the risk of these complications?
Take your medications without fail; always keep adequate stock of medications; visit the hospital and get the tests done as advised; report any unusual symptom to the doctor at the earliest; if at risk for urinary tract infection, do not hold large volumes (more than 300 ml) of urine and for long periods (more than 3 hours); follow healthy life style (routine physical activity; avoidance of smoking, alcohol, high calorie food, unhygienic food, intravenous drug use and high risk sexual behaviour); avoid visiting crowded places without face masks; eat cooked freshly prepared food.
- When can I resume my work?
You can resume your work after 3 months of transplantation.
- When can a transplant female in the reproductive age group become pregnant?
A female transplant recipient can plan pregnancy two years after transplantation if renal function is good and stable and there is no recent acute rejection. Couples should follow contraception (preferably barrier method) until this period.
- Will immunosuppressive medications harm the fetus?
At the end of two years, she should be on maintenance dose of immunosuppression. With this dose the fetal risk is likely to be less if the immunosuppressive medication regime does not include Mycophenolate Mofetil and/or Sirolimus. It is recommended to discontinue Mycophenolate Mofetil and/or Sirolimus 6 weeks prior to planning pregnancy.
- Can a transplant mother breastfeed her child?
As these immunosuppressive medications are excreted in breast milk, breastfeeding is not recommended.
- Will I require procedures related to transplantation anytime later?
Lower urinary tract procedures (if you are detected to have lower urinary tract obstruction as the cause for urinary tract infection), graft kidney biopsy (if there is unexplained decline in renal function or there is new onset proteinuria) and occasionally angioplasty for narrowing of graft blood vessel are the procedures that may be required in the post transplant period.
- Will I require dialysis again if the transplant kidney does not function well?
You will require dialysis if decline in graft function is severe; the need may be temporary or permanent depending on the cause of the disease.
- Can I undergo transplantation again if the graft is irreversibly damaged?
Second transplantation is possible provided tissue cross match is negative.