Life after transplant: Rejection prevention and healthy tips

Getting a kidney transplant can feel like having another chance at life. There are many great things that come after a transplant, like having better health and more freedom to do the things you enjoy. However, it is important to remember a transplant is a treatment for kidney disease, not a cure, and you will need to take special care of yourself, and your transplanted kidney. Here are some guidelines on how to stay healthy with your new kidney.

What you should know about life after a transplant:

What can I expect after transplant surgery?

Recovery after kidney transplant surgery can be different for every person. In general, this is what to expect.

Recover in the hospital for 3-4 days after surgery

Your transplant team will closely watch your recovery while you are in the hospital. It is common to feel some discomfort in the first week after surgery. Your belly area and side may be sore, and you may also feel weak and tired while you are healing. Usually, it is best to get up and start slowly moving around one day after surgery.  Your new kidney may start working right away, and you will have more energy. If your new kidney takes a few days to start working, you will need dialysis for a short time until it starts working.

Go to follow-up visits with your doctor

Before, or soon after you leave the hospital, you will schedule follow-up visits with your doctor. Your transplant center will talk with you about your specific schedule. For example, during the first month after you leave the hospital, you may have doctor visits and lab work 1-2 times a week. Over time, you will have fewer visits and blood draws per week.   If you live far from the transplant center, you will need to make a plan to get to your follow-up visits. Talk to your transplant center about resources and programs to help you with travel and lodging.

Care for yourself during at-home recovery

You will need to closely watch your health when you go home from the hospital. Your transplant team will tell you how to care for yourself at home. It is very important to follow their directions for how to care for your body after surgery. This includes caring for your surgery site (incision) and keeping track of:

• The amounts of fluids you drink
• The amount of urine (pee) you produce
• Your temperature
• Your blood pressure
• Your weight

You will also need to limit your activity for several weeks and avoid being around people who you know are sick to prevent getting infections. You have a higher chance of getting infections because immunosuppressant medicines weaken your immune system.

How will I know if my new kidney is working?

Blood tests and urine output (how much urine you make) will help you know if your new kidney is working. At your follow-up visits, you will have lab work and blood tests to show how well your kidneys are removing waste from your blood.

You doctor may also do a kidney biopsy to check how well your new kidney is working, or to find out why it is not working. In a kidney biopsy, your doctor will take a small sample of kidney tissue and look at it under a microscope.

If the tests show that your kidney is not working as well as it should, you may need dialysis for a short time. It is also possible that your body may reject the transplanted kidney. Usually, doctors can treat kidney rejection so the transplanted kidney will start working.

How long does recovery take after transplant surgery?

Most people fully recover from the surgery after three months

Kidney rejection after transplant

What is kidney rejection?

Rejection is your body’s response to the transplanted kidney’s foreign proteins. Rejection happens when your immune system, which protects your body from germs and foreign proteins, tries to fight your new kidney. Immunosuppressant medicines help keep your body from fighting your new kidney and rejecting it. This is why you take immunosuppressant medicines every day exactly the way your doctor has prescribed.

There are two types of kidney rejection that can happen after transplant:

• Acute rejection usually happens soon in the months after a transplant. Out of 100 people who get a transplant, 5-20 people will have an acute rejection episode and less than five people will have an acute rejection episode that leads to complete failure of their new kidney.
• Chronic rejection happens slowly over the years after a transplant. It means your new kidney may stop working over time because your body’s immune system is constantly fighting it. Chronic rejection happens to kidney recipients more often than acute rejection.

What causes a kidney transplant to stop working?

There are many reasons why a kidney transplant could fail, such as:

• Rejection can damage your kidney and lower the number of years it works.
• Infection can cause permanent problems with the kidney if it is not found and treated early.
• Long-term side effects of medicines that can be harmful to kidneys.
• Not taking immunosuppressant medicines or following other treatments prescribed by your doctor. Without enough immunosuppressant medicine in your blood, your body’s immune system will attack and damage the kidney.

How will I know if my body is rejecting the transplanted kidney?

Many people have no signs or symptoms of kidney rejection. Every person is different. Signs and symptoms of kidney rejection may include:

• Feeling like you have the flu, such as body aches, chills, headache and feeling sick to your stomach
• Fever of 101° F or higher
• Urinating (peeing) less than usual
• Having very high blood pressure
• Suddenly gaining weight
• Swelling in your ankles
• Pain or tenderness in your side or belly area
• Feeling very tired

If you have any of these signs or symptoms, call your doctor right away.

To know if you are having kidney rejection, your doctor may do these tests:

• Blood tests, such as creatinine and blood urea nitrogen (BUN), which measure how well your kidneys filter waste from your blood. They may also do blood tests that show how likely it is you will have rejection.

• Kidney ultrasound, which is a safe and painless test that uses sound waves to make images of your kidneys
• Kidney biopsy, which means taking a small sample of kidney tissue and looking at it under a microscope

How is kidney rejection treated?

If your doctor tells you that you are having kidney rejection, it does not mean that your new kidney will fail. It could mean that your doctor may just need to adjust your medicines to keep your body from rejecting your kidney.

The usual treatment for kidney rejection is to change the amount of immunosuppressant medicine to a higher dose. Treatment depends on the severity of the rejection. Your doctor may have you stay in the hospital for 3-5 days for treatment.

What happens if my body rejects the new kidney and it fails?

If your new kidney fails, you will need to go back on dialysis to live. You can also get evaluated for another kidney transplant. If you are healthy enough, you can have more than one kidney transplant.

Living healthy after a transplant

Learn how to live healthy and resume normal activities after a transplant including which foods to eat, exercising, and preventing infection

How can I follow a healthy meal plan after a transplant?

If you were on dialysis before your transplant, you will notice a difference in what you can eat and drink after your transplant. You will have fewer limits with what you can eat but eating healthy still plays a big role. For example, it can help you keep a healthy weight and lower your chance of other health problems, such as high blood pressure. In general, you should:

• Follow a low-salt and low-fat meal plan
• Drink plenty of water and non-sugary fluids – this is usually about two liters (68 ounces) per day

• Limit alcohol and caffeine
• Avoid grapefruit or grapefruit juice, starfruit and pomegranate or pomegranate juice
• Avoid foods that are spoiled, moldy, or past their “use by” date to lower your chance of food poisoning and infections

Ask your dietitian to help you make a healthy eating plan that will work for you and your new kidney.

What types of exercise can I do?

Once you recover from transplant surgery, you should try to be active five or more days per week. Being active can help your overall health, help you keep a healthy weight and even boost your mood.

Talk to your transplant team about the types of exercise that are right for you, how often you should exercise and for how long. Try to choose activities that you enjoy so you are more likely to continue doing them. Examples include walking, riding a bike, swimming, playing sports, gardening and hiking.

How can I avoid getting infections?

The immunosuppressant medicines that prevent your body from rejecting your new kidney also lower your immune system. This can make infections a problem.

To avoid getting infections, you should:

• Wash your hands often:
  • Before you eat anything (even a snack!)
  • After every time you go to the bathroom
  • Every time you come home after leaving your house
• Avoid being around people who you know are sick.
• Avoid close contact with people who recently got a live vaccine, such as children who got measles or mumps vaccines or people who got the nasal flu vaccine. Live vaccines contain a weak form of the actual virus, and the virus could spread from the vaccinated person to others within two weeks after a person gets the vaccine.
• Use food safety practices, such as cooking meat to the correct temperature, avoiding eating from buffets or cafeteria settings and tossing food that is spoiled, moldy or past its “use by” date.
• Talk to your transplant team before you travel to another country. They will help you get medicines and vaccines to prevent diseases common in that country and share tips to lower your chance of getting infections based on where you are traveling to. For example, tap water in many countries may have bacteria, which means you should drink bottled water instead.
• Take steps to lower your chance of infection if you are getting a permanent tattoo, such as waiting six months after your transplant and using a licensed tattoo parlor and artist.

Are vaccines (shots) safe after a kidney transplant?

Vaccines can help your body protect you from infection, however some vaccines are not good for you when you have a transplant. Talk to your transplant team before getting any vaccines or booster shots.

You should:

• Avoid all live vaccines, such as for chickenpox (varicella zoster). Live vaccines contain a weak form of the actual virus and can make copies in your body that could lead to infection due your lowered immune system.
• Wait 3-6 months after your transplant before getting a flu shot, then get only a yearly shot, and avoid the nasal flu vaccine (which is a live vaccine).

In general, it is safe to get these vaccines:

• COVID-19
• Diphtheria-pertussis-tetanus
• Flu
• Hepatitis A
• Hepatitis B
• Inactivated polio
• Pneumovax
• Shingles

How do I take care of my surgery site (incision)?

A scar is the tissue that your body forms during the healing process. Your body begins to heal your incision right after surgery, but it can take up to two years to fully heal. To help your scar heal, you can:

• Do a scar massage every day for six months – use the pad of your thumb and rub your scar and skin around it in a circle motion
• Apply lotion to your scar so it does not get dry
• Apply sunscreen – your scar is thinner than the rest of your skin and will sunburn more easily

Other health issues after a transplant

Learn about some health problems that may occur after a transplant, including, diabetes, high blood pressure and gout

Most people feel better and live longer after a transplant. But, some unwanted health problems can still happen, such as those caused by the medicines you need to take or underlying medical issues you have. Some health problems are less likely to happen and others are more common. You may have a higher chance of getting the health conditions below.

Diabetes

After a transplant, you may develop diabetes (high blood sugar) because of the medicines that you need to take to prevent rejection. Certain immunosuppressant medicines and steroids prevent your body from using insulin normally, which leads to high blood sugar levels. Your chance of getting diabetes is higher if you are overweight or obese, or have a family history of diabetes.

Your health care team will do blood tests to closely watch your blood sugar levels after your transplant.

If you get diabetes or already have it, high blood sugar levels can cause serious damage to your heart, blood vessels, eyes, feet and nerves. It is important to take steps to prevent diabetes or control your blood sugar levels.

High blood pressure

High blood pressure means your heart is working too hard to pump your blood. Your chance of getting high blood pressure is higher after a transplant because of the medicines that you need to take to prevent rejection. Your chance of getting high blood pressure is higher if you are overweight or obese.

Your health care team will tell you how to check your blood pressure after your transplant. The goal after a transplant is a blood pressure reading of less than 130/80.

Your team will also help you control your blood pressure by:

• Keeping a healthy weight
• Eating less salt
• Taking blood pressure medicine, if your doctor prescribes it

If you get high blood pressure (or already have it), it can cause serious damage to your heart and blood vessels. So, it is important to take steps to prevent or control your high blood pressure.

Skin cancer

Skin cancer is the most common type of cancer people get after a kidney transplant. Your chances of getting skin cancer are higher after a transplant because the medicines you need to take to prevent rejection lower your immune system, which is your body’s defense against certain types of cancer. Your chance is higher if you have fair skin or have had skin cancer in the past.

Your transplant team may recommend that you see a dermatologist (skin doctor) every year to check your skin.

To prevent getting skin cancer, you should:

• Apply sunscreen before going outdoors
• Cover your skin, such as by wearing a lightweight long-sleeved shirt and a hat
• Check your skin for any new lumps, bumps or colored areas
• Stay in the shade to avoid direct sunlight

Gout

Gout is a type of arthritis that causes severe pain, redness and swelling in the joints. High blood levels of uric acid (a normal waste product in blood) cause crystals to build up in the joints, which causes gout.

After a transplant, you may have higher levels of uric acid in your blood because of the medicines you need to take. Your doctor can do blood tests to check your level of uric acid.

Lupus

Lupus is a long-term disease that can cause pain and inflammation (swelling) in any part of the body. When lupus affects and damages the kidneys, it is called lupus nephritis. It can keep the kidneys from working as well as they should or cause them to stop working.

If you have lupus and get a transplant, it is possible for your symptoms to come back and affect your new kidney. It is important to keep all your follow-up visits so your health care team can watch you closely.

Other chronic diseases

Smoking cigarettes and using smokeless tobacco raises your risk for heart disease, cancer and lung disease. It can also shorten how long your new kidney will work.

 

Reference:

1. American kidney fund: https://www.kidneyfund.org/kidney-donation-and-transplant/life-after-transplant

2. health line : https://www.healthline.com/health/kidney-failure