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My Transplant Book
Monroe Carell Jr. Children’s Hospital
at Vanderbilt
Pediatric Nephrology
615-322-7416
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Vanderbilt Children’s Hospital
Kidney Transplant Program
Guidelines for Home Care and Follow Up
It’s time to go home from the hospital with your new kidney. Your kidney transplant
offers you a more normal lifestyle, and as time goes on, your day to day routine will
become standard operating procedure. No sweat! But right now you might be a little
scared about your future, about all of those medicines, about the risk of rejection,
about being different… that’s perfectly normal! The guidelines outlined here are
designed to help us to help you have the most successful outcome possible with your
new kidney transplant.
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Things you can do each day to take care of your kidney transplant:
1) Take Your Medicines as Prescribed: You will be on at least three medicines
to prevent rejection of your transplanted kidney. All of these medicines will be
absorbed from your stomach into your blood, and certain “blood levels” need to be
maintained for these anti-rejection medications to be most effective. Therefore it
is important to take these medications on a schedule. For example, every 12 hours
for medications given twice a day, or every 8 hours for medicines given 3 times a day.
Being a few minutes off every once in a while won’t be the end of the world, but
missing by more than an hour regularly will definitely shorten the life span of your
transplanted kidney. Also, be sure to call us ahead of time for refills so you never
run out!
Call 615-322-7416 for refills or questions about your medications.
(Detailed information about anti-rejections medications and other common medications can
be found in the section on Medications later in this booklet.)
2) Drink Plenty of Fluids: You only have one kidney working now. Transplanted
kidneys make lots of urine, whether you have had a lot to drink or not! So if you get
a cold or the flu, or you work or play outdoors in extreme heat, you are much more
prone to dehydration than someone who hasn’t had a transplant. Even a little
dehydration is not good for your kidney! The number one cause of acute kidney
failure is dehydration! Not drinking enough fluid increases your chances of long
term damage to your kidney from prograf toxicity too. Drinking
plenty of fluids also decreases your chances of getting kidney
stones and urinary tract infections. So it’s a great idea to get in
the habit of drinking plenty of fluid. Your doctor recommends
that you drink _______ oz of fluids per day.
The best fluid to drink is water, but anything that becomes liquid
at room temperature counts! So if you like ice, popsicles, jello or
soup, they count as fluid just like juices, milk and water.
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3) Daily Home Monitoring: The best way to take care of your kidney transplant is
to take care of you! Eat right, exercise, and get plenty of rest.
Weight: You should weigh yourself every day. You may find that you
have a steady weight gain over the next several months. This is most
likely because you are eating more because you feel so much better!
Also some of the medications may increase your appetite. This
type of weight gain will be slow. Fast weight gains, of say 1 to 3
pounds in 24 hours, are more likely fluid retention. It is
important for you to let us know about these fast weight gains
as it can affect your blood pressure.
Blood Pressure: Your kidney doctor will want you to check your
blood pressure at home twice a day. High blood pressure, left
uncontrolled, can damage your new kidney as well as your heart. If
you are on blood pressure medications, make sure to take them on
schedule.
Call if your BP is above: _______________________
Temperature: If everything is running smoothly, your temperature should
be around 98.6. Take your temperature every day and any time
you have the chills, which could mean your temperature is rising.
Fever can be a symptom of infection or even kidney rejection.
Report any fever you’ve had for more than a day. If you suddenly
develop a high temperature (above 101.5), call us right away.
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Daily Symptoms: Along with these vital signs, it is important that you take note
and record any unusual symptoms each day. For instance, please record any of the
following symptoms:
*flu-like feelings
*nausea or vomiting
*unusual weakness or tiredness
*headaches
*muscle cramps
*aches and pains
*swelling, warmth or tenderness over the transplant scar
*swelling in your ankles or legs
*less urine than usual, or a burning feeling during urination, or a change in urine color
or odor.
If these symptoms last more than a day, or if you have any concerns
about your symptoms, please call us.
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You can use these forms to keep track of your daily weights, temperatures, BP’s and
symptoms. Bring these forms to clinic with you.
Date
Weight
Temp am
Temp pm
BP am
BP pm
Symptoms
Call for temperature >101.5, or BP over: _________________________
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You can use these forms to keep track of your daily weights, temperatures, BP’s and
symptoms. Bring these forms to clinic with you.
Date
Weight
Temp am
Temp pm
BP am
BP pm
Symptoms
Call for temperature >101.5, or BP over: _________________________
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4) Regular Follow up Care with Your Pediatric Nephrologist (Kidney
Doctor):
For the first year following your transplant, you will see the pediatric nephrologist
A LOT! When you first go home, you should plan to see your kidney doctor 2 or 3
times a week. At your visits, your doctor will review your medications with you, so
please bring all of your medications and your medication schedule with you. Your
doctor will also examine you, get your height and weight, and take samples of your
blood and urine. It is very important that you keep all of your appointments!
Rejection is when your body doesn’t think the kidney transplant belongs there, and so
your body tries to destroy your new kidney. The likelihood of rejection is highest
right after the transplant, and the risk goes down with time. In early rejection, you
may not feel any different, so don’t be surprised if you come for a routine visit and
end up in the hospital for a day or two! During the first year after your transplant,
it is not uncommon to require hospitalization for rejection or infections.
Within a few months you’ll be coming to see your pediatric nephrologist only once a
week, then once every two weeks, etc, etc. After the first year, you’ll probably see
your pediatric nephrologist less frequently. But you will always need to have your
labs checked every month. That’s because the risk of rejection does go down over
time, but it never goes away completely. The good news is you don’t need to come to
Vanderbilt for lab work, if it’s not convenient. We will help you find a place where
you can have labs drawn near your home each month. Remember, early rejection may
have no symptoms, so monthly lab work is very important. The earlier we are able to
treat a rejection episode, the less damage it can cause.
(To find out more about rejection, see the section entitled “Rejection of Your
Transplanted Kidney” on page 30.)
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5) Regular Follow Up Care with Your Pediatrician (Local Doctor):
It’s very important that you have a pediatrician in or near your home that you can see
for check ups and in case you get sick. Your local pediatrician can work with your
pediatric nephrologist for your well care and if you become ill. If you see your local
doctor and they prescribe a new medicine for you, please be sure you check with your
pediatric nephrologist before starting it so we can be sure it doesn’t affect your antirejection medications. This goes for vitamins, herbal remedies, and over the counter
cold and pain medicines too. Be sure to call us before taking any meds on your own.
We recommend that you get the flu shot every year. However, if you need other
immunizations, please check with your pediatric nephrologist first! Some are not
recommended for kids who have had a transplant.
6) Regular Dental Care: Be sure to brush and floss daily. You should see your
dentist for a cleaning and check up every 6 months. You may notice that your gums are
swelling. This is a common side effect of your anti-rejection medication, although it is
much less of a problem if you are faithful about cleaning your teeth every day. If your
gums do become a problem for you, your dentist may be able to help you with this.
NOTE: From now on you will have to take a dose of antibiotics before all dental
procedures, including cleaning. Please call us for a prescription
before your dental visits.
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If you get sick:
Because of your anti-rejection medications, you may be sicker
with colds and viruses. Also, if you come down with seemingly
common illnesses such as chickenpox, or a stomach virus, or a
urinary tract infection, you will probably need to come into
Vanderbilt Children’s Hospital for a few days instead of staying
home in bed like you did before your transplant. In general, local
emergency rooms are not familiar with pediatric patients, or people with
kidney transplants, so if you are sick it is always best to call us before heading to the
ER. We can help you decide where you can receive the best treatment, be it at your
local pediatrician, at our clinic, or at Vanderbilt’s Children’s Emergency Room. There is a
pediatric nephrologist on call 24 hours a day 7 days a week. If you don’t feel
good, call us FIRST!
Your pediatric nephrologist is:
Dr. Kathy Jabs
Our phone number is:
(615) 322-7416
CALL US IF YOU NOTICE ANY OF THE FOLLOWING:
1.
2.
3.
4.
5.
Temperature over 101.5 degrees.
Any pain, tenderness, and/or swelling of the transplanted kidney.
A decrease in the amount of urine output.
A new rash (could be an infectious illness).
Your blood pressure is above : ______________________
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NOTES:
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Kidney Transplant
Directions for taking blood pressures at home:
You will need to check your blood pressure twice a day. You should check it in the
morning just before you take your blood pressure medications, and you should check it in
the evening before taking your medications.
Always wait 30 minutes after eating, drinking or exercising.
It is best to take your blood pressure when you are sitting down.
It is best to take your blood pressure after you have rested for 5 minutes.
It is best to use the same arm all the time to check your blood pressure.
You should make sure the middle of the blood pressure cuff covers the artery in your
upper arm. (The artery runs under the muscle that sits on the front of your arm.)
The blood pressure cuff should fit snugly around your arm before you blow it up.
If your blood pressure measures a lot higher or a lot lower than usual, wait a minute and
try again. Most of the time I take 3 blood pressures to be sure I’m accurate.
If your blood pressure reads above _______ on the top (systolic) or _______ on the
bottom (diastolic), call us. Our office number is (615) 322-7416.
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Medications
After a kidney transplant, it will be
necessary to take anti-rejection
medications (also called
immunosuppressants) for the rest of your life.
These medications prevent your body’s natural defense system from seeing your
new kidney as a foreign object. Without them, your own body would attack the
transplant and prevent it from working. (This is called rejection. We will talk about
that more later.)
Most people will be going home on 3 anti-rejection medicines. Like all medications, these
drugs have some side effects. You will need to be on other medications to treat these
side effects. For instance, you will likely have stomach upset as a side effect of
prednisone or Cellcept, so your doctor will also prescribe a stomach medicine to prevent
the stomach upset from bothering you. Also, the anti-rejection drugs affect your
immune system so you will need to take anti-viral and/or antibiotic medicines to help you
avoid infections. You may also need to take blood pressure medications.
You will be responsible for taking all these medications! It is very important that
you understand:
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The name and purpose of each medication.
How to take each medication.
When to take each medication.
The main side effects of each medication.
How long to continue taking each medication.
What to do if you forget a dose.
When and how to order your medication so you don’t run out.
NEVER STOP TAKING YOUR MEDICATIONS OR CHANGE THE
DOSAGE WITHOUT YOUR KIDNEY DOCTOR’S APPROVAL!!!
Please call your kidney doctor if:
1) You have prolonged vomiting and are unable to take your medicines.
2) You are unable to get your medicines (no way to pick them up, no money, pharmacy
says your insurance won’t pay, etc.)
3) You experience any unusual side effects or symptoms.
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Name: Prograf (tacrolimus or FK506)
Purpose: Prograf is used to prevent rejection of your kidney. It is used as long as you
have your transplanted kidney.
How to take it: It comes in liquid, or in 5 mg, 1 mg, or 0.5 mg capsules.
Avoid grapefruit/grapefruit juice while taking Prograf. Grapefruit can affect the
amount of prograf in your bloodstream. This includes the soft drink Fresca.
When to take it: Prograf needs to be taken on a schedule. For example, every 12
hours if you need to take it twice a day, every 8 hours if you need to take it 3 times a
day. When you take Prograf, the amount of medicine that reaches your blood stream is
very important. If you don’t get enough Prograf into your blood stream, it may not
prevent rejection. But if you get too much Prograf into your blood stream, it may cause
kidney damage. We need to check the blood levels just before a dose is due to make
sure your level is not too low or too high. For example, if you take your Prograf at 9 am
and 9 pm, you would need to have your blood drawn between 8:30 and 9 am BEFORE you
take your morning dose of Prograf. So, you would take your Prograf at 9 pm the night
before a scheduled blood draw, and bring your morning dose to clinic with you to take
right after you have your blood drawn. (Note: If you normally take your morning dose of
Prograf earlier than 8 am you will need to adjust this schedule on the days you come to
clinic because our lab doesn’t open until after 8 am. We can give you instructions on how
to adjust your dose for clinic visits.) Your doctor will use these lab test results to make
changes in your Prograf dose, so accuracy is very important!
Main side effects: As we said, all medicines have side effects. Prograf is no
exception! Some of the side effects of Prograf may include an increase in your blood
pressure, a slight shaking or tremor in your hands, tingling in your hands or feet, or
headache.
How long will you need to take: Prograf is an antirejection medicine. You will need to
take it as long as you have your kidney transplant.
What to do if you forget a dose: This medicine is critical to the
life of your kidney transplant, so missing a dose is no joke.
Every dose is important. Prograf needs to be taken within
an hour of when it is due. If it’s been 2 hours or more, please
call us for instructions. Never take a double dose to “catch
up”.
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Name: Cellcept (mycophenolate mofetil)
Purpose: Cellcept is an antirejection medicine that works with your Prograf to help
prevent rejection of your kidney.
How to take it: It comes in a 250 mg capsule, a 500 mg tablet or as a liquid.
When to take it: Most people take their Cellcept twice a day. It can be taken at the
same time as Prograf and your other twice a day medicines. When you come for blood
checks, it is OK to take your Cellcept before you come.
Main side effects: Its most common side effects are nausea, vomiting, and diarrhea.
Sometimes, if the stomach upset is prolonged or severe, we can lower the dose and work
up, or give smaller doses more frequently.
How long will you need to take: You will need to take it as long as you have your
transplanted kidney.
What to do if you forget a dose: Take it as soon as you remember, and get back on
your schedule. If you don’t realize until it’s time to take the next dose, don’t take two
doses at once.
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Name: Prednisone
Purpose: Prednisone works with your other 2 antirejection medicines to help prevent
and treat rejection of your transplanted kidney.
How to take it: Prednisone is available as a liquid or in several different pill strengths
(1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 25 mg, and 50 mg tablets).
Shortly after your transplant, your kidney doctor will start decreasing the prednisone
dose you are taking. Your dose will be tapered (lowered) over the next several months
until you are on a very low dose.
When to take it: At first you will be on prednisone twice a day. You can take your
prednisone at the same time you take your other twice a day medicines. When your
doctor starts to lower or taper your dose, you may go to once a day or sometimes even
once every other day doses of prednisone.
Main side effects: The side effects of prednisone are dose related. That means, the
more prednisone you take, the more side effects you have. Fortunately, many of these
side effects can be treated with medications and diet until your dose of prednisone can
be lowered. The common side effects of prednisone include mood swings, stomach
upset, fluid retention, acne of the face, neck, and back, increase in blood pressure and
increase in appetite. Many people gain weight as they eat more while on high doses of
prednisone. You won’t necessarily gain weight if you don’t eat a lot of fatty foods and
sweets. However you will notice a change in the way you look. Prednisone changes the
way your body deposits fat, and most people on high doses will have a rounder face, and
possible increased fat deposits around the waist and back of the neck. Usually, the
more weight you gain, the more pronounced this will be, but most everyone has a
noticeably rounder face. As your dose is tapered, this and all side effects of
prednisone will resolve. It is important to note that people on prednisone will develop an
increased sensitivity to the sun and should always use sun block.
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Name: Nystatin Suspension
Purpose: When you take antirejection medicines you are at higher risk for thrush.
Thrush is a fungal infection that looks like white ulcers in your mouth. You should check
your mouth and tongue each day. If you start to see little white spots, you should call
us. It is important to get these mouth sores treated early because they can get so bad
that you could have to come into the hospital for treatment.
How to take it: Nystatin is a sweet yellow liquid. You should take a mouthful of
Nystatin and swish it around in your mouth for a few seconds like a mouthwash, then
swallow it.
When to take it: It’s best to take Nystatin after you’ve taken your other medicines
and after you’ve eaten. Do not eat or drink for 15-20 minutes after taking it. You will
take this medicine four times a day.
Side effects: None!
How long will you need to take: You will need to take Nystatin for about 6 months, or
until your prednisone is weaned enough so that you are no longer at risk for thrush.
What to do if you forget a dose: Take it as soon as you can. Get back on your
schedule.
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Name: Bactrim* (sulfamethoxazole and trimethoprim)
Purpose: Bactrim is an antibiotic medicine. That means it kills bacteria. When your
immune system is suppressed to help prevent rejection of your transplant, it also may be
suppressed to help you fight off infection in your lungs or in your urine from bacteria!
Taking Bactrim will hopefully help your body to fight off these types of infection.
How to take it: Bactrim is available as a pill or a liquid. If you take pills, your pediatric
nephrologist may have you take a half or whole pill. The pills are scored, so they can be
easily broken in half if need be.
When to take it: Bactrim is only taken once a day in the evening. It’s ok to take with
your other evening medications.
Main side effects: The most common side effects are stomach upset, and diarrhea.
You may also get an allergic skin rash. If you get a rash, you should not take any more
Bactrim, and you should call your pediatric nephrologist.
How long will you need to take: You will have to stay on Bactrim for at least a year.
Frequently, patients take Bactrim for the life of the transplant, especially if they have
urologic problems.
What to do if you forget a dose: Take it as soon as you remember and get back on
schedule.
*People who are allergic to Bactrim (a sulfa drug) will be prescribed a different
antibiotic. The purpose, when to take, etc. will be the same.
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Name: Valcyte* (valganciclovir)
Purpose: Valcyte is used to prevent and treat CMV infection. CMV is a very common
virus. When you go to the doctor with a fever and the doctor says, “you have a virus,” it
is often CMV they are talking about. Once you get CMV, you will not get it again. But
you never totally get the virus out of your body either. Your doctor has checked your
blood and the donor’s blood to see whether either of you has had CMV. If you and your
donor have not had a CMV infection, you will not need Valcyte. But if your donor has had
a CMV infection, then Valcyte is given for about 6 months after your transplant. Often
times, this doesn’t prevent you from getting the CMV virus from the donor kidney, but it
can reduce the severity of the symptoms from the CMV virus.
How to take it: Valcyte is available in 450mg tablet or liquid (which needs to be
refrigerated).
When to take it: It is taken 3 times a day, and it is recommended that it be taken
with food.
Main side effects: Ganciclovir can affect your blood counts. Your doctor will be
monitoring your blood counts when you have your blood tests done.
If you do have problems with low counts, your doctor may change your dose or stop the
medication.
How long will you need to take: You will take ganciclovir for about 6 months after
your transplant.
What to do if you forget a dose: Take it as soon as you remember, and get back on
your schedule.
* If your donor hasn’t had CMV, you will not be put on Valcyte, but you may be placed on
another antiviral medication to help prevent other viral infections while you are on high
doses of immunosuppressants.
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Name: Blood Pressure Medications (Atenolol, Amlodipine, Doxazosin,
Carvedilol)
Purpose: Many kids have high blood pressure after getting a kidney transplant. There
are a lot of reasons for you to have high blood pressure right now. Several of the
medications you are taking cause the blood pressure to go up, changes in fluid balance
can make the blood pressure go up, and it may be that the kidney itself is putting out
hormones to make your blood pressure go up. Anyway, it’s pretty common to need a
blood pressure medicine to bring your blood pressure down to normal.
How to take it: Your pediatric nephrologist will decide which high blood pressure
medicine (or medicines) you will need. All are available as either a pill or liquid.
When to take it: Most blood pressure medicines are taken twice a day. It is ok to
take your blood pressure medicines with your other twice a day medicines.
Main side effects: Anyone taking blood pressure medication is at risk for having their
blood pressure go too low. The symptoms of this are a dizzy feeling, especially when you
go from standing to sitting, generalized weakness or tiredness.
How long will you need to take: Most of the time, as we lower the dose of prednisone
and your body adjusts to your new kidney, your blood pressure will come down on its own,
and you can lower and often times even stop having to take blood pressure medications.
You can expect this within the first 6 months after your transplant.
What to do if you miss a dose: Take it as soon as you can and get back on your
regular schedule.
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Name: Pepcid (famotidine) or Zantac (ranitidine)
Purpose: Some of the medications you are taking for your kidney transplant can cause
stomach upset, and these medicines are used to prevent that.
How to take it: These medicines are available in pill or liquid form. Your pediatric
nephrologist will decide which one of these medications is best for you.
When to take it: These medicines are usually given twice a day. It’s ok to take them
with your other twice a day medicines.
Main side effects: Rarely, kids on these medicines may have headaches, or
constipation, or diarrhea.
How long will you need to take: This is up to your pediatric nephrologist. If you
aren’t having any problems with stomach upset, you may be able to stop taking this
medicine during the first 6 months after your kidney transplant.
What to do if you miss a dose: Take it as soon as you can, and then get back on
schedule.
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Name: Colace (docusate)
Purpose: This medicine is a stool softener. Some of the medicines you are taking may
cause constipation. This medicine helps prevent that.
How to take it: Colace is available as a capsule or liquid.
When to take it: Colace is prescribed twice a day. If you aren’t having problems with
hard stools or constipation you can talk to your pediatric nephrologist about taking it
less often, or only when you feel like you need it.
Main side effect: There are no side effects from taking Colace.
How long will you need to take: As we said, you will need Colace as long as you have
problems with hard stool. Most kids will need a dose or two every day for awhile.
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Name: K-Phos Neutral
Purpose: Some kids with kidney transplants get rid of too much phosphorus in their
urine. (If you’ve been on dialysis and worried about having too much phosphorus in your
blood, isn’t it weird that now you don’t have enough!!) K-Phos Neutral is a phosphorus
replacement medicine.
How to take it: K-Phos is available as a tablet, or a powder that you can put in juice or
sprinkle on food. It should be taken with a large amount of water.
When to take it: Most kids need to take their K-Phos Neutral 3 times a day.
Main side effects: K-Phos Neutral can cause stomach upset.
How long will you need to take: After a while, your new kidney will start to regulate
the amount of phosphorus it’s spilling and you may not need to take a supplement any
longer. Most kids need to stay on K-Phos Neutral for several months after their kidney
transplant, but some kids will need to stay on K- Phos Neutral as long as they have their
transplant.
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Medication Planner
Name:
SAMPLE
Medication:
Name & Strength
Dose
Morning
AM
Midday
Afternoon
PM
Evening
PM
Special
Instructions
Prograf (tacrolimus) **
5 mg cap
1 mg cap
Immunosuppressant
Prednisone
Immunosuppressant
Varying
dose
Immunosuppressant
Cellcept
(MMF)
500 mg tablets
Nystatin Suspension
100,000 U / ml
Bactrim
(trimethoprim/
sulfamethoxazole)
DS tab
Valcyte
1000 mg tab
BP med
Pepcid or Zantac
Colace
100 mg
K Phos
250 mg
Anti-fungal
5 ml
Antibiotic
1 tab
Anti-viral
1000 mg
Anti-hypertensive
Anti-acid
1 tab
Stool softner
1 tab
1 tab
Phosphorus
replacement
** On clinic day, the goal is to draw your blood approximately 12 hours after your dose of Prograf the night
before. In other words, if you will get to clinic at 9:00 a.m., you should take your Prograf the night before at
9:00 p.m. and not take the morning dose until after your blood has been drawn.
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Resuming Normal Activities
Diet and Nutrition
Eating properly is an important part of your recovery process. Your diet should
include a variety of foods such as: fruits, vegetables, low-fat milk, dairy products,
lean meats, fish, and poultry. You should limit salt to avoid fluid retention and
control blood pressure. Eating less fat and sugar will help control your weight as
your appetite improves. Here are some general guidelines:





Limit most foods that come out of a vending machine (chips, candy, soda).
Don’t eat lots of salty foods (country ham, pizza, and fast food meals).
Stay away from lots of fried food.
Try not to use the salt shaker.
Use low fat dairy products to increase calcium and phosphorus.
You should avoid high fat, high salt, high sugar foods as a
general rule – But occasional treats are fine!
Activity
You need to avoid the following activities for a while, usually
for a month of two. Ask your doctor when you can resume:






No lifting heavy objects.
No strenuous activity.
If you drive, you should not drive a car, until approved by your physician.
You may perform light housework and chores.
Showers are permitted, but no baths, until approved by your transplant surgeon.
Be sure to get plenty of rest.
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Exercise
After kidney transplant, exercise is very important for your mental health and
physical well being. A daily exercise routine is important to having a healthy body
and a healthy heart.
Walking is a great daily exercise. Sports are fine too. If you plan on participating in
a contact sport, check with your kidney doctor first. We usually don’t recommend
full contact sports like football, hockey, boxing or lacrosse. But we’ll help you get a
“kidney protector” for playing other sports.
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Avoiding Infection
Because anti-rejection medications lower your natural immune system, you need to
protect yourself from infection after your surgery by taking the following
precautions:
 Wash your hands often, such as before & after eating, after being outdoors,
after using the restroom and after being with other people. Also, it’s a good idea
to keep alcohol based hand sanitizing gel available for when it’s difficult to wash
your hands.
 Avoid crowded places for at least the first 6 weeks (school, church, mall, movies).
 There are no restrictions on being outdoors.
 When possible, stay away from people with colds or other infections.
 Ask friends to visit only if they are well and have not been around anyone who is
sick.
 If someone in your family becomes ill with a cold or flu, have that person use
separate drinking glasses, cover their mouths when they cough, and wash their
hands often (or use alcohol based hand sanitizing gels).
 If you have pets, avoid handling animal waste. Do not clean birdcages, turtle
tanks or cat litter boxes.
 Avoid vaccines that consist of live viruses, such as oral polio, MMR or flu nasal
mist. If your doctor or school recommends any vaccinations, please call us first.
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Skin and Hair Care
You should not need any special skin care unless you develop acne or dry skin.
Generally, you should shower or bathe as often as necessary to keep your skin clean,
and of course, wash your hands frequently during the day. As we said, prednisone
could cause acne on your face, chest, shoulders or back. Your kidney doctor can
prescribe acne treatment if you need it.
Notify your kidney doctor if you discover any unusual skin growths, rash or
discoloration.
Transplant patients have an increased chance of developing skin and lip cancers.
Since the risk increases with time, you must always protect your skin from the
ultraviolet rays of the sun that cause skin cancers.
 Avoid midday sun (10 a.m. to 3 p.m.), when ultraviolet rays are the strongest.
 Wear a hat, long sleeves, and slacks when outdoors unless you are using sunscreen.
 Use a sun screen lotion with sun protective factors (SPF) rated at least 15.
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Again, Call Your Doctor at (615) 322-7416 if you
notice any of the following:
1) Temperature over 101.5.
2) Any pain, swelling, or tenderness of the
transplanted kidney.
3) Decrease in the amount of urine output.
4) Weight gain over 2 to 3 pounds from one day to
the next.
5) Top number of your blood pressure is higher
than _________, or lower than _________.
6) You are unable to get your medicines.
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Rejection of Your Transplanted Kidney
Rejection is when the body’s immune system sees your transplanted kidney
as something that doesn’t belong in your body and tries to destroy it. It is
the most common problem people with transplants have, and it can happen
at any time, even after you’ve had your transplant for many years.
We’re going to talk about 2 kinds of rejection: acute rejection and chronic
rejection.
Acute rejection is a sudden reaction of your body’s defense system
(immune system) against your kidney transplant. This rejection causes the
kidney function to get worse and if not treated, the kidney will be
destroyed. This type of rejection is mostly seen in the first year after
your transplant. If you have acute rejection, you will have to come back
into the hospital. If acute rejection is treated early, kidney function will
usually come back.
The treatment for acute rejection usually involves giving strong
immunosuppressant medicines IV. You may need to have a biopsy of your
transplanted kidney so your kidney doctor can decide which IV medicine will
be best for you. The goal of treatment is to stop your immune system’s
attack on the kidney, and to prevent further rejection.
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Signs of Rejection
1.
Pain, tenderness, or swelling over the transplanted kidney.
2.
Increase in BUN and creatinine (lab tests.)
3.
Increase in blood pressure.
4.
Increase in temperature.
5.
Decreased urine output.
6.
Sudden increase in weight.
Call your kidney doctor if you notice any of these signs. Your kidney doctor
is available 24 hours a day, 7 days a week. Remember, the earlier we treat
a rejection episode, the less damage that is done to your kidney transplant.
A prolonged rejection episode will cause permanent damage to your kidney
transplant, and may even lead to kidney transplant failure requiring dialysis.
One of the most common causes of acute rejection is NOT TAKING YOUR
MEDICATIONS!!!! That’s why we go over it so much.
Chronic rejection is a gradual loss of kidney transplant function. This type
of rejection usually occurs several months or years after the transplant.
The cause of chronic rejection is not well understood, and treatment with
medications is usually not helpful. Chronic rejection will eventually lead to
failure of your transplanted kidney, requiring dialysis.
If your body totally rejects the transplanted kidney, you will need dialysis.
The kidney may or may not need to be removed. You may choose to try for
another transplant.
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You will need to remember that a kidney transplant is a treatment for
kidney disease. The kidney may work for a short time, or for as long as you
live.
Remember this kidney is “borrowed”. It will never belong in your body, so
you will always need to take anti-rejection medicines. You will need to have
monthly lab draws, and regular doctor visits for the rest of your life.