Post-Transplant Follow-Up

What to expect after your kidney transplant surgery.

At Dallas Nephrology Associates (DNA), we offer the full range of post-transplant services, guidance and ongoing medical management. In addition, we are dedicated to making sure you are fully informed every step of the way, including during your regular post-transplant doctor visits and through our robust patient education program. This also includes the answers (below) to the most common questions related to post-kidney-transplant care.

After I am discharged, when will I be seen at DTI?

After you are discharged from the transplant center, you will be seen an average of three times per week at Dallas Transplant Institute for the first several weeks. You may need to come to the clinic between visits for blood tests to check your medication levels. When your kidney function has stabilized, you will be seen less frequently, but still followed closely. The physician will determine your next appointment date after examining you and reviewing your laboratory tests. As long as you have your transplanted kidney, you will continue to need regular physician visits.

Will I have any special tests after I leave the hospital?

Some diagnostic tests, such as EKG’s, X-rays, etc., may be ordered as necessary.

Who takes care of me at the DTI clinic?

You will be examined by a transplant team composed of transplant nephrologists and advanced practice providers. A different team member may evaluate you during each of your clinic visits. Also assisting in your post-transplantation care are dedicated nurses, social workers, dietitians, and laboratory and clinic personnel trained in the area of transplantation.

How can the social worker assist me after kidney transplant?

Kidney disease can change your life. The social worker will help you return to your normal activities. Areas where the social worker may help you include:

  • Concerns about your job
  • Your marriage and family life
  • Information about healthcare decisions
  • Changes in your role in your family
  • Finding outside help when needed
  • Dealing with all of the changes in your life
  • Return to employment
  • Making the best use of your medication coverage
  • Assisting you in wellness and exercise

With kidney transplant, there may be difficult social, personal and financial issues. Working as part of a team, with you as an active member, the transplant social worker can help you live life to the fullest!

When can I return to my primary care physician?

Once your medication blood levels and blood chemistries have stabilized, you will be encouraged to return to your referring physician for continued follow-up. We will send your physician information regarding your transplant surgery, current medications and lab results. Additional tests may be asked of your referring physician to be sent to DTI. You will still need to return to DTI periodically.

Who will take care of me when I return to my home if I am an out-of-town patient?

The physician who referred you for transplant will be responsible for your medical care when you return home. Initially, you will alternate visits with your physician and DTI physicians. As your kidney function stabilizes, the visits to Dallas Transplant Institute will become less frequent. You will be asked to return to DTI should certain problems arise. (We recommend that you be seen at DTI twice yearly or a minimum of once yearly so that your medications can be refilled.)

Will I be allowed to drink alcoholic beverages?

Alcoholic beverages in small quantities will do no harm, unless liver problems have been diagnosed. Ask your physician or nurse before drinking any alcohol after transplant.

When can I go back to work? Are there any restrictions?

One of the goals of transplantation is to help patients return to a productive lifestyle.  You should be able to return to work soon after your transplant.  Consult with your physician for a “Return to Work” statement.

Should I tell the dentist I have had a kidney transplant?

Yes, you should. Also, please notify the DTI nurses if you have an appointment with the dentist. Dental procedures (even cleanings) place you at higher risk for infection. Antibiotics may be prescribed depending on your cardiac status.

What happens if I go out of town and have an emergency?

We recommend that you request a copy of your clinical summary and a medication list to take with you. If you have an emergency, go to an emergency room. Tell them you are a transplant patient and give them the phone number of DTI (214-358-2300) or your transplant center. You should always tell the doctor what medicines you are taking. Do not let anyone change your medications until they have spoken with someone at DTI or the transplant center.

Can I be around large groups of people?

Avoid large crowds for the first few weeks after your discharge from the transplant hospital and any time you are treated for rejection. (DTI Clinic will be the exception.) Avoid contact with persons who have a communicable disease, such as cold or flu. The high doses of immunosuppressant medications make you more susceptible to infection.

Will I be on medications after the transplant?

You will take a combination of medicines after surgery to help your body accept the new kidney. It is important that you take your medications as prescribed.  Every patient is on a customized medication schedule. All immunosuppressive drugs increase the risk of infection and cancer. Research to better the outcome of transplants is ongoing.

The medications can be costly. You will meet with the transplant social workers during your evaluation and after the transplant to discuss your plan for paying for the medications.

Listed below are the most common medications currently being used:

  • Prograf/Astagraf XL (tacrolimus) – Acts to suppress the body’s immune system. This drug comes in a small capsule.
  • CellCept/Myfortic (mycophenolate) – Acts to suppress your body’s ability to fight the new kidney. This drug is available in both tablet and capsule. Side effects of this medication may include decreased white cell count (WBC), increased risk for infection, and increased stomach upset and diarrhea.
  • Rapamune (sirolimus) – Acts to depress the body’s immune system. This drug comes in both liquid and tablet form. Side effects may include increased cholesterol level and decreased platelet count.
  • Zortress (everolimus) – Acts to suppress the body’s immune system. This drug is used in the prevention of kidney transplant rejection in patients at a low to moderate immunologic risk.
  • Prednisone or prednisolone – Reduces your body’s chance of attacking your transplanted kidney. This drug is a tablet. The dose is high at the time of transplant but is tapered quickly to a lower maintenance dose. Some of the more common side effects are: fluid retention, weight gain, night sweats, joint pain, mood swings, increased risk of bleeding ulcer, changes in eyesight, weakness of bones, and increases in blood sugar.
  • Sandimmune/Neoral (cyclosporine) – Acts to suppress the body’s immune system. This drug is a gel capsule or liquid. Side effects may include excessive hair growth, increase in gum tissue, tremors, possible toxicity to your kidney or liver, and high blood pressure.
  • Imuran (azathioprine) – Acts to suppress your body’s ability to fight the new kidney. This drug is a tablet. Side effects may include decreased white cell count (WBC) and increased risk of liver abnormalities and hair loss.

You may receive additional medications to prevent complications or to treat a current problem. These include:

  • Insulin – Increased blood sugar seen with steroid medication may require insulin treatment.
  • Antacids – Coat the stomach to prevent stomach ulcers while you are on higher doses of steroids. Antacids can cause either constipation or diarrhea.
  • Mycostatin mouthwash (nystatin) or Mycelex Troches (clotrimazole) – Helps prevent a fungal infection called thrush. Side effects may include nausea.
  • Valcyte – Helps to prevent or treat cytomegalovirus (CMV) infections.

Additional medications:

  • Blood pressure medicine
  • Medicine to increase your urine output
  • Antibiotics – May be prescribed as a preventive measure while taking immunosuppressant medications

Please check with your insurance to findout which of your medications are covered.

PLEASE REMEMBER – IT WILL BE NECESSARY FOR YOU TO TAKE YOUR IMMUNOSUPPRESSIVE MEDICINES AS LONG AS YOU HAVE YOUR TRANSPLANTED KIDNEY. If you stop taking your immunosuppressive medicines, you will more than likely lose your transplanted kidney.

What is rejection?

Rejection is the body’s natural tendency to fight off your new kidney because it is foreign tissue. Rejection can prevent your kidney from working and even damage it permanently. Almost every kidney transplant patients has a rejection episode. Biopsy of the transplanted kidney may be needed to diagnose the type of rejection.

The two types of rejection usually seen are:

  • Acute – Occurs most often during the first 3 months of transplantation but may occur after many months or years. Acute rejection is often associated with failure to take immunosuppressant medications as prescribed.
  • Chronic – A continuous tendency to reject the kidney. Very often there are no signs or symptoms of rejection. This rejection is usually diagnosed by repeated laboratory tests. With careful medical treatment, this type of rejection process is often slow. The transplanted kidney may continue to function for several years.

To help prevent rejection episodes:

  • Take your medicines exactly as your physician tells you, and keep a daily record. Never stop taking or change your medicines unless instructed to do so by your physician or nurse.
  • Do not take any prescription or non-prescription drugs (such as cold medicine, ibuprofen or aspirin) unless ordered by or approved by your transplant team.
  • If any physician outside of DTI (or the transplant center where you receive your post-transplant follow-up care) wants to put you on any additional medications for any reason, call DTI or your transplant center before you have the prescription filled.

Acute rejection often causes no symptoms. Occasionally, some of the following signs and symptoms of rejection will occur:

  • Pain and swelling over the kidney
  • Decrease in urine output
  • Fever higher than 100 degrees
  • Sudden swelling, especially in the face, hands and feet
  • Rapid weight gain
  • Increase in blood pressure
  • Cough or shortness of breath
  • General malaise – “just not feeling well” or “flu-like” symptoms

How is rejection diagnosed?

Rejection is usually diagnosed through a combination of signs and symptoms of rejection, laboratory studies, and often a kidney biopsy.

What is a kidney biopsy?

A kidney biopsy is the microscopic examination of kidney tissue. The traditional type of kidney biopsy is done with a biopsy needle, and a small piece of kidney tissue is removed. This procedure is done in the hospital.

How is rejection treated?

There are several medications available to treat rejection episodes. These medicines are given intravenously. These are very potent immunosuppressive drugs that target the cells causing the rejection. The medicines you have been taking by mouth may be increased, decreased or discontinued during this therapy.

What happens if the transplant kidney fails completely?

If the kidney fails completely, the anti-rejection medications will be discontinued. In some cases, the transplanted kidney will be removed surgically because of possible complications. You will be placed on dialysis, and following a full recovery, you may be considered for another transplant.

If I lose my kidney, may I receive another?

You can be evaluated to determine the risks involved in giving you a second or even third transplant. It will be necessary to repeat a complete medical evaluation just as you did before your first kidney transplant.

Have additional questions? Call Dallas Nephrology Associates at 877-654-3639.