Life after Transplant

Kidney Transplant as an option is the best possible solution for chronic renal failure. The quality of life is almost normal. However certain care and precautions as enumerated below will need to be observed by transplant recipient and supporting family members.

Medications: The nephrologist will closely monitor the transplanted patient in respect of various parameters such as Blood Urea, Creatinine, WBC, BP, etc., for first 2-3, months and thereafter he will give directions for monitoring the various parameters periodically. He would also prescribe immune suppressant and other drugs for managing the transplant kidney from time to time. Please ensure that these instructions are followed meticulously without fail. Any side effects noticed must be brought to his notice by the fastest means for further directions.

Diet and Nutrition

Eating properly is an important part of the recovery process & healthy life. A nutritionist can help in developing an eating plan that provides a balanced diet to meet patient's needs. The number of calories a patient requires will be based on whether he needs to gain, maintain, or lose weight and on his level of activity.

Health Food - Diet should include a variety of foods such as

• fruits
• vegetables
• whole-grain cereals and breads
• low-fat meal and dairy products or other sources of calcium
• lean meats, fish, and poultry or other sources of protein such as dal,legumes etc

Use of salt (sodium), sugar, and fat
Use of salt may be restricted to help limit fluid retention and to control blood pressure. Low fat, low-sugar diet will help control weight and blood sugar. Consult a nutritionist regarding the use of salt, sugar, and fat in a diet.

Food should be fresh, well cooked, hot, and hygienic. The fruits with the skin must be peeled before consuming. Drink always boiled water.

Exercise
After transplant surgery, exercise is critical to mental health and physical well being. Physical activity is also very important in helping decrease the effects of Prednisolone, which causes muscle weakness. A daily exercise routine is essential to avoid muscle and total-body weakness that often occurs after a long illness or period of confinement. The program should be a progressive one, in which the patient builds or increases his levels of exercise. In this way, he will obtain the full benefits of exercise without causing strain or serious injury to his body. Before starting on any exercise program, he should remember to check with his nephrologist. He will give him advice regarding an exercise routine that will best meet his needs.

WARNING: If a patient experiences any untoward symptoms or discomfort, he should stop exercise until he consults his doctor

Avoidance of infection, Skin / Hair Care

Patients will not need any special skin care unless he develops acne or dry skin. Generally, he should shower or bathe as often as necessary to keep his skin clean. Most soap is appropriate.

Acne

Prednisolone can cause acne on the face, chest, shoulders, or back. Cyclosporine can make the skin more oily. If acne develops, the patient should wash the area three times per day with a mild soap, scrubbing gently with a clean, wet washcloth. Rinse the soap completely from the skin to leave the pores open and clean.

Ways to control acne:

• Keep hands away from the face and avoid rubbing the affected area.To avoid infections, do not prick or touch the acne.
• Do not use cosmetics.
• Avoid the use of medicated hypoallergenic cosmetics intended to cover acne.Wearing makeup will prevent acne from going away.
• Do not rub or scrub the skin vigorously. This can irritate the skin.
• Avoid soaps that contain creams and oils, because they will aggravate acne.
• Do not use lotions for dry skin.
• If the skin becomes very dry, stop washing those areas temporarily so that the skin can recover its natural moistness.

WARNING: If acne remains a problem, the patient may contact his nephrologist for further directions.

Dry skin care - For problems with dry skin, use a mild soap and apply body lotion after bathing

Cuts and scratches - Wash minor cuts and scratches daily with soap and water. For treatment of large cuts, contact your nephrologist immediately.

Skin growths - The nephrologist should be notified if the patient discovers any unusual skin growths, rash, or discolouration.

Sun exposure - Transplant patients have an increased chance of developing skin and lip cancers. Since the risk increases with time, the patient must always protect his skin from the ultraviolet rays of the sun that cause skin cancers.

• Avoid direct midday sun, when ultraviolet rays are strongest.
• Wear a cap, long sleeves, and slacks when outdoors unless using a sunscreen.
• Wear sun glasses to prevent cataract
  

Dental Care

Precautions for dental care - Before the kidney transplant, the patient may have received a dental consultation to ensure that all dental work would be completed before surgery. If the patient has dental pain, he should consult his nephrologist who will direct him to an appropriate dentist immediately. Before he has dental work done (including cleaning and polishing), he should check with his nephrologist to see if he needs to take antibiotics.

Alcoholic Beverages

The liver breaks down Cyclosporine, Azathioprine, and Co-trimoxazole medications etc., and, if combined with alcohol, could harm the liver and eventually lead to abnormal blood levels of these medications. This can compromise the function of the kidney.

Pregnancy

There have been a number of successful pregnancies among women who have had kidney transplants, although pregnancy may have special risks for both the transplant recipient and the baby. Women should avoid pregnancy for two years following transplant surgery. Risks related to childbirth & control should be discussed with the nephrologist and gynecologists. Thereafter, the decision to have children must take a number of factors into account. This is a question that should be discussed with the nephrologist.

Smoking

Transplanted patients are advised not to smoke and avoid consuming tobacco/other narcotics products, as this will compromise the functioning of kidney.

Vacations and Travel

Travelling within the country can be undertaken after 2 months of transplant, however all precautions and medications including food should be followed as stated above. If planning a trip to a foreign country that requires immunization for smallpox, measles, or any other vaccine containing a live virus, the patient should request his Nephrologist to send a letter to concerned authorities stating that he cannot receive these vaccines. Travel to these countries may not be safe being not immunized.

General summary instructions for transplant patients and donor

Transplanted patient:

1. Take medications as per nephrologist's directions. Avoid self-medications.
2. Monitor various health and blood parameters as advised by nephrologist.
3. In case of any side problems, get in touch with your nephrologist by the fastest means.
4. Avoid getting infections from others.
5. Eat well cooked hot foods.
6. Drink boiled water.
7. Eat fruits after peeling the skin.
8. Wear sun glasses to prevent cataract.
   

Donor:

1. Rest for one month after transplant.
2. Not to lift weights, not to do strenuous work till three months.
3. To check blood pressure quarterly- life long.
4. To report to the Nephrologist once in a year.