Post Kidney

8/3/2019 Post Kidney

http://slidepdf.com/reader/full/post-kidney 1/20

After Your Kidney Transplant:Information for Patients



Intr

Following Surgery ...........................................................1

Infection and Rejection..................................................3

Medications.....................................................................5

Life After Transplant .......................................................9

Best Wishes ...................................................................14

Discharge Checklist.......................................................15

Piedmont Hospital’s Transplant Services offer superior medical and surgical care

for recipients and donors, delivered by an interdisciplinary team of experienced,

dedicated specialists with decades of collective experience in caring for transplant

patients. Our mission is to provide transplant services to enhance patients’ quality of life

save lives by reducing the wait times for patients to receive organs, and advance the science of transplantation through progressive research.

We offer an integrated approach to care in a caring, compassionate environment.



Your transplant team will continue your kidney care.

However, at this point, you are the most important

person on the transplant team. You must be responsible

for your own care and assist the transplant team in

keeping you and your new kidney healthy.

Your nurse, transplant coordinator, social worker,

transplant surgeon and nephrologists will give you all

the information you need to care for yourself at home.

This booklet contains:

I Discharge reminders

I Signs of rejection and infection

I Discharge checklist

Please read this manual and familiarize yourself with

the contents. Your family members should become

familiar with it, too. DO NOT send it home with them.

If you need additional copies, ask your nurse or

transplant coordinator.

It is normal to be anxious after transplant. Remember,

you are not alone. If you have any questions or concerns,

please call us at 1-888-605-5888 – the Piedmont

Hospital Transplant Services team is only a phone

call away.

Be proactive. Ask questions. Remember, there is no

such thing as a stupid question – you simply need more

information.

FOLLOWING SURGERY

When will I be able to eat?You will be “NPO” (which stands for nothing by mouth)

until your bowel function returns. The nurses and the

physicians will be listening to your abdomen for bowel

sounds. Once they return, you will be advanced slowly

to a regular diet.

Diet restrictions will be based on your kidney function.

If your kidney function is adequate, your physician will

not restrict your diet. If your kidney function needs to

be closely monitored, you may be asked to restrict your

sodium, potassium and protein intake; our dietitian wil

explain how.

What is the importance of turning, coughing and

deep breathing?One of the main complications after transplant surgery

pneumonia. This can occur from fluid building up in you

lungs. To move these secretions, it is important to turn

every two hours if you are unable to walk. Coughing and

deep breathing will also move these secretions out of

your lungs. The nurses and respiratory therapist will sho

you how to use an incentive spirometer or flutter valve,

which are deep breathing devices. We understand that

1

Congratulations! You have received a new kidney and are now on the road to a fu

recovery. However, surgery is only the first step. Keeping yourself and your new kidn

healthy requires a lifetime commitment from you. The Piedmont Hospital Transplan

Services team has prepared this booklet to provide you with information on a

aspects of your care after transplant, including medications, rejection, lifestyle issue

outpatient follow-up and other topics.

duction



pain from the incision may make it uncomfortable to take

deep breaths, which is why we encourage you to hold a

pillow against the incision while you take deep breaths.

The best thing you can do is to GET OUT OF BED!

What activities can I do immediately after surgery?After surgery, we expect our patients to begin

resuming normal activities relatively quickly. One of

the complications from lying in bed is developing blood

clots in the legs. Walking in the halls at least three times

a day can help minimize that risk. Your physician may

order a compression device to improve circulation. You

may progress to more activity as you feel stronger.

To allow your incision site time to heal, avoid lifting

anything greater than 10 pounds for the first six weeks

after surgery. When you go home, you may shower, but

don’t take tub baths until the incision site is closed.

Keep the incision clean. You will be able to drive in

about four weeks, but discuss this first with your

transplant coordinator.

Will I get something for pain?The physicians will order pain medications for you.

Immediately after surgery, you will be placed on a pain

pump. This allows you to control the amount of pain

medication necessary to keep you comfortable. Onpost-operative day two, you will be transitioned to pain

medication taken by mouth. This medication is ordered

“as needed.” This means you will need to ask your nurse

for the pain medication. The physicians will specify how

often you may take pain medications.

What is a Foley catheter and when is it removed? A Foley catheter has been inserted into your bladder to

monitor and drain your urine. The catheter is located in

your bladder and constantly drains urine. Some people’

bodies make urine immediately after the transplant and

others take longer. The urine may be clear or bloody an

may have clots. When the urine contains clots, the staff

may need to irrigate the bladder with fluids to remove

the clots. The nurses will measure your urine output.

The catheter is usually removed by post-operative day

three. After removal of the catheter, please tell the nurs

promptly if you have:

I Pain over the bladder.

I Any swelling in the scrotum (male) or labia area

(female).

I Inability to urinate.

What is delayed graft function and ATN?Even though you have a new kidney, you may find it is

not making much urine. You may hear your physician

or nurse tell you that your kidney is in ATN (Acute

Tubular Necrosis) or delayed graft function. Your kidney

is made up of millions of microscopic tubular cells calle

nephrons. These nephrons need time to heal. Until the

kidney “wakes up”, you may temporarily need dialysis fo

a few days to several weeks. The transplant team will

discuss your progress with you. Your doctor will order

daily blood tests to monitor your kidney function.

How long will I be in the hospital?

The average length of stay is three to seven days. After discharge from the hospital, you will return to

the transplant clinic for outpatient follow-up. It is

important that you make transportation arrangements

for follow-up visits until you can resume driving.

All of these steps, along with frequent walks, are a cruci

part of post-op care. By following these orders, you will

be less likely to develop complications, such as blood

clots in your legs, constipation and pneumonia. Also, y

will feel better much sooner. IT IS ESSENTIAL YOU ARE

INVOLVED IN YOUR OWN CARE.



SIGNS AND SYMPTOMS OF INFECTIONAND/OR REJECTION

I Fever of 100°F or greater.

I Increased wound pain or drainage from your wound.

I Fluid retention – weight gain of three pounds in a

24-hour period, swelling of the ankles or hands, or

puffiness around the eyes.

I Decreased urinary output.

I Change of color of urine.

I Foul smelling urine.I Pain or burning on urination.

I Increased frequency of urination.

I Nausea, vomiting or diarrhea for greater than

24 hours.

I Blood pressure changes.

I Blood present in stool or urine.

When should I call the Transplant Clinic or my

transplant coordinator?

Call the Transplant Clinic or your transplant coordinatorif you have any of the following signs and symptoms

of infection:

I Temperature above 100°F (38.0°C)

I Productive, persistent cough.

I Sore throat or mouth sores.

I Persistent nausea, vomiting, diarrhea for

more than 24 hours or if you cannot keep

your medications down.

I Pain or burning while urinating, cloudy urine

or urgency to urinate.

I

Redness or tenderness in your incision.

INFECTIONSAnti-rejection medications interfere with your natural

immunity by preventing rejection and interfering with

the action of your white blood cells. Since your white

blood cells are also responsible for fighting infection,

you will be more likely to get infections after your

transplant. The risk of infection becomes less as your

anti-rejection medications are decreased. Following

are the most common infections:

VIRAL INFECTIONSCall your transplant coordinator if you think you have an

infection.

Cytomegalovirus (CMV)CMV is one of the most common viral infections in the

transplant patient. The risk of CMV is highest in the first

months after transplantation. Signs can include fatigue,

fever, night sweats, aching joints, headaches, vision

problems and pneumonia. Treatment may include

hospitalization, and you may have to take medicine

intravenously or by mouth for several weeks or months.

Herpes simplex virus Type 1 and 2These viruses most often infect the skin but can also tu

up in other areas like the eyes and lungs. Type I causes

cold sores and blisters around the mouth; Type 2 cause

genital sores. Herpes infections in transplant patients a

not necessarily transmitted sexually.

Most herpes infections are mild and can be treated.

Depending on the severity of the outbreak, treatment is

either by mouth, topical or IV. Symptoms of herpes

include feeling weak and having painful, fluid-filled sore

in your mouth or genital area. Women should also watc

for unusual vaginal discharge.

Herpes zoster (shingles)Shingles appear as a rash of small water blisters, usuall

on the chest, back or hip. The rash is usually painful.

Varicella zoster (chicken pox)Chicken pox may appear as a rash or small blisters and

usually occurs in childhood. However, once you have

been immunosuppressed, you are at risk to have an out

break. Call your transplant coordinator if you have been

exposed to the chicken pox or think you have the chicke

pox. DO NOT wait to see if you are going to get sick.

FUNGAL INFECTIONSCandida (yeast)Candida is a fungus that can cause a wide range of

infections in the transplant patient. It usually starts in

the mouth and throat, but may also be in the surgical

wound, eyes, lungs, vaginal or urinary tract. Candida is

most severe when it gets into your blood stream. If the

infection is in your mouth, it is called thrush. Thrush

causes white, patchy lesions, pain, tenderness, a white

film on the tongue and difficulty swallowing. Vaginal

infections usually cause an abnormal discharge that ma

be yellow or white, and is often itchy. Treatment of sevefungal infections may include hospitalization and you

may receive IV medications.

BACTERIAL INFECTIONS

Wound InfectionsBacterial wound infections happen at the incision.

If you see redness, oozing, swelling or have a fever, call

your transplant coordinator. If you test positive for an

infection, your doctor will prescribe an antibiotic.

3



OTHER INFECTIONSPneumocystis carinii pneumonia is a lot like fungus and

is naturally found in the lungs, but can cause pneumonia

in transplant patients. Once a patient has a transplant

and becomes suppressed, it may cause a type of

pneumonia. Early in the illness, you might have a mild,

dry cough and a fever. If you think you have a cold or you

have flu-like symptoms that do not get better, contact

your transplant coordinator. Treatment will be provided to

you to prevent this infection immediately after transplant.

KIDNEY REJECTION

What is rejection?Kidney rejection occurs when your immune system

activates specific white blood cells to attack your new

kidney because it recognizes the transplanted kidney as

foreign tissue. To prevent this rejection, you must take

anti-rejection medications (as prescribed) for the rest of

your kidney’s life.

Kidney rejection does not necessarily mean kidney

failure. Most episodes of rejection can be reversed if

detected early enough.

In spite of all precautions, rejections can occur.

Rejection episodes occur most frequently during the

first six months after transplant. As many as half of all

kidney transplant patients will have at least one rejection

episode. A rejection episode can rarely be identified by

physical symptoms. It is identified by a change in your

lab values, such as increases in BUN and creatinine.Therefore, always keep your outpatient transplant office

and lab appointments, even if you are feeling well.

Rejection episodes are treated by changing the

dosages of your anti-rejection medications or by

temporarily adding a new one. You should look for the

signs of rejection and call your transplant coordinator

immediately if you have the following:

I Pain or tenderness over your kidney transplant

I Fatigue/weakness

I Fever

I Less urine output than usual

I Swelling of your hands or feetI Sudden weight gain

I Elevated blood pressure

KIDNEY BIOPSYThe most accurate way to diagnose kidney rejection is

through a kidney biopsy.

What is a kidney biopsy? A kidney biopsy is a minimally invasive procedure

performed to determine the cause of declining kidney

function. The biopsy will provide guidance to help the

physician determine the best route to take to correct

any problems with your new kidney.

Preparing for the biopsyIf your doctor orders a biopsy, don’t eat or drink

anything after midnight the night before the procedure.

You may take your usual medications. A family member

or friend should accompany you to the test. An ultra-

sound of the kidney will be done first to help the

physician find the best place to do the biopsy.

Test procedure While you are lying on your back, the area where the

biopsy will be done is cleaned with a disinfectant.

The area is then injected with an anesthetic that makes

the area numb. You might feel a slight burning sensatio

when the medication is administered. The physician the

makes a small incision and inserts a needle through

the incision into the kidney tissue. A very small piece o

tissue is taken. The procedure only lasts a few minutes.

Once the needle is withdrawn, hand pressure is appliedto the area for about 10 minutes. After the biopsy, you

will lie on your back for about four hours. The nurse wil

check your urine to assure that it is clear and monitor

your vital signs. Once you feel ready, you will be able to

eat and drink.



If you are being discharged home after the biopsy, make

sure a family member or friend accompanies you home

and that you follow these steps:

I Perform no strenuous activity for 24 hours.

I If your urine is pink, drink more fluids.

I If you see a blood clot or bright red urine,

call the Transplant Clinic immediately.

I If your urine output decreases, call the

Transplant Clinic immediately!

Your biopsy results should be available in the next day or

two. You will be notified by the physician or transplant

coordinator to discuss the results.

ULTRASOUND WITH DOPPLER

What is an ultrasound?Ultrasound is a procedure that uses high-frequency

sound waves to view internal organs and produce

images of the human body. An ultrasound Doppler

is an examination performed to determine if there is

a blockage in the artery or vein leading to and from

the transplanted kidney. An ultrasound may also be

done to check for extra fluid in or around the kidney,

a blockage in the ureter causing an obstruction, or to

localize the kidney for a biopsy.

Preparation for the ultrasoundThere is no preparation for the test. You may eat, drink

and take your medications with no changes.

Test procedureThe ultrasound is performed without needles or

injections, and causes no discomfort. While you are

lying on your back, a small ultrasound microphone

called a Doppler is placed on the skin over the area of

your transplanted kidney. With the Doppler in place,

the ultrasound technologist can listen to the flow of

blood to and from the kidney.

After the test, the physician will discuss the results with

you. Don’t hesitate to ask questions.

MEDICATIONSThe immune system is your body’s natural defense

against foreign invaders such as bacteria and viruses.

It is designed to recognize these invaders and will moun

a defense to kill them. Your body sees your new kidney

as a foreign invader. Without the special medications to

interfere with this defense mechanism, your body will

attack and kill your new kidney. These medications are

called immunosuppressives. They suppress your body’s

ability to recognize your new kidney as an invader.

Without these medications, your body will attack your

kidney and you could lose your new kidney.

Taking your medications is one of the most important

things you can do for your health and for the health of

your new organ. It is A LOT to keep track of – organizati

and commitment are the keys to your success!

These tips can make things easier. Try them and see wh

works for you.

I Use a medication scheduler, pick certain times

to take your medicine and stick to them.

I Wear a watch with an alarm or use your cell

phone alarm to remind you when it’s time to

take your medications.

I Use a pill dispenser to line up your medications

for a whole week.

I Coordinate your pill taking with other activities,

such as meals.

I When traveling, take extra days of pills in the

original container.

I Re-order your medications A WEEK IN ADVANCE

so you do not run out.

I Have a family member keep an eye on your pills to

make sure you take them.

Notify your transplant team if you:

I Cannot take your medicines by mouth because

of an illness.

I Have vomiting, diarrhea or nausea for 24 hours

or more.

I Think the directions on the label may be different

from what you were told.

I Feel you are having a reaction to your medication

I Receive a new prescription from your local doctor.

I Experience any unusual symptoms or side effects.



General guidelines for storing your medications

I Store in a cool, dry place.

I Do not store medications in the bathroom –

moisture and heat can cause them to lose

their strength.

I Do not allow liquid medications to freeze.

I Do not store your medications in the refrigerator

unless you are directed by your pharmacist.

Remember, you must take immunosuppressivemedication for the rest of the life of your new kidney.

NEVER stop taking your medications or change the

dosage without the transplant team’s approval. There is

always a risk of rejection and loss of your new kidney.

There are three immunosuppressive medications that

you will take to prevent rejection:

I Prograf (FK506 or Tacrolimus)

I Cellcept (Mycophenolate Mofetil)

I Prednisone

Occasionally, you may be switched to an alternative:

I Rapamune (Rapamycin or Sirolimus)

I Myfortic (Mycophenolic acid)

I Neoral (Cyclosporine)

ANTIREJECTION MEDICINESPROGRAF (FK506 or Tacrolimus)Prograf helps prevent rejection. It is usually dispensed in

0.5 mg, 1 mg, and 5 mg capsules. It is usually prescribed

twice a day and should be taken 12 hours apart. Prior to

your lab draws, do not take Prograf until after your blood

is drawn and plan to take your Prograf 12 hours the night

before your anticipated lab draw. Bring your medication

with you to your lab draw or clinic visit so you can take it

after your blood is drawn.

Possible side effects:

I Increased serum creatinine – This can usually be

reversed by lowering your dose.

I Tremors – Usually related to high doses of Prograf

I Thinning of hair –You may notice it.

I Diarrhea – Drink plenty of fluids to prevent

dehydration! Notify your transplant coordinator

if you are having diarrhea that lasts longer than

24 hours.

I Elevated blood sugar – Will be treated withmedications if necessary.

I Elevated potassium – If this happens, you will be

instructed to eat a low potassium diet.

Precautions:

I Frequent lab tests are conducted during the first

few months to keep a watch on the effectiveness

and side effects of Prograf.

I Prograf has several interactions with other

over-the-counter medications. Check with your

transplant pharmacist or transplant coordinator

before starting any new medications.

I DO NOT USE HERBAL PRODUCTS. This includes

green tea!

I Notify the Transplant Clinic immediately if you thi

you are pregnant or if you are breastfeeding. The

benefits of taking this medication must be weighe

against the possible danger to you, your unborn

child or your infant.

CELLCEPT (Mycophenolate Mofetil)Cellcept is given to you with other medications to help

prevent rejection. It is usually dispensed in 250 mg

capsules or 500 mg tablets. It is usually prescribed twic

a day and should be taken 12 hours apart. If you are

having severe side effects from this medication, it is

possible to spread out the medication throughout the

day. Talk to your transplant coordinator if you are

experiencing any side effects.


I

Diarrhea – Drink plenty of fluids to preventdehydration. Notify your transplant coordinator

if you are experiencing this side effect.

I Nausea/vomiting – If you are unable to keep

your medications down, notify your transplant

coordinator. You may need IV fluids to avoid

becoming dehydrated.

I Decreased white blood cell count – Your dose will

be adjusted to keep your white blood cell count

within the normal range.



I Anemia – Your lab values will be monitored closely.

Please notify your transplant coordinator if you

experience increasing fatigue.

Precautions:

I Notify your transplant coordinator if you are

experiencing any unusual bruising or bleeding.

I Cellcept should NOT be used by pregnant women.

Women of childbearing age should use two reliable

forms of contraception simultaneously, unlessabstinence is the chosen method before beginning

Cellcept, during the time you are taking Cellcept, or

for 12 weeks after you stop taking Cellcept. Call the

Transplant Clinic if you think you are pregnant.

PREDNISONEPrednisone is a steroid that helps prevent and treat

rejection of your transplanted kidneys. You will have to

take this medication for the rest of your kidney’s life.

Do not let anyone other than your transplant team stop

this medication. It is usually dispensed in 5 mg tablets.

It is usually prescribed once a day and should be taken

in the morning.


I Increased appetite – Appetite due to Prednisone

cannot be satisfied by eating. Try to eat five to six

small, well-balanced meals a day. The dietitian is

available to help in your meal planning.

I Stomach ulcers – May cause increased stomach

acidity which can lead to ulcers. You will take

medications such as Prevacid, Prilosec, Protonix,

Nexium or Pepcid to block acid production. Notify

your transplant coordinator if you have stomach

discomfort or burning.

I Osteoporosis – Regular exercise can help counteract

muscle wasting or weakness in your legs and arms.

You should not feel any joint pain while doing

exercises. You may be told to get yearly bone

density scans to monitor your bones.

I

Elevated blood sugars – If you have diabetes,you will require an increased amount of insulin.

Patients who are overweight and who have a family

history of diabetes may also require insulin. As the

Prednisone doses decrease, your blood sugars

should also decrease.

I Mood swings – Be aware of mood changes and

inform your family members that this is a possible

side effect. As the Prednisone doses decrease, you

mood swings will lessen. If you are hearing voices

having hallucinations or feel like things are crawli

on you, please notify your nurse immediately!

I Vision changes – May cause blurred vision. It can

also cause permanent changes such as glaucoma

and cataracts. Do not have your vision checked fo

the first month after transplant because the resultcan be inaccurate.

I Skin changes – You may experience skin thinning,

acne and sun-sensitivity, and your skin may bruise

easily. Cuts and scratches may heal more slowly.

Make sure you are wearing gloves when you do ya

work or go fishing (if you handle the fish). Protect

yourself from the sun by applying sunscreen daily.

RAPAMUNE (Sirolimus, Rapamycin)Rapamune helps prevent rejection. It is usually

dispensed in 1 mg or 2 mg tablets. It is usually

prescribed once a day and should be taken in the

morning. If you are scheduled for lab work, take your

Rapamune 24 hours prior to your anticipated blood dra

On lab days, bring your Rapamune with you so you can

take it after your labs are drawn.


I Increased cholesterol/triglycerides – Your

cholesterol levels may become elevated requiring

additional medications. Your cholesterol levels

will be checked in the clinic. Your transplant

coordinator will notify you when your level is goin

to be checked. This is a fasting blood test, so do

not eat or drink anything for 12 hours prior to the

lab draw.



I Anemia – Your lab values will be monitored closely

for a decrease in your red blood cell count. Notify

your transplant coordinator if you are experiencing

increased fatigue.

I Low platelet count – This may result in unusual

bleeding or bruising. However, dose reduction does

reverse this effect.

I Delayed wound healing.

I Mouth ulcers.

MYFORTIC (Mycophenolic acid)Myfortic helps prevent rejection. It is usually used

in patients who cannot tolerate Cellcept due to the

side effects. It is usually dispensed in 180 mg or

360 mg tablets. It is usually prescribed twice a day,

12 hours apart.


I Constipation – You may take a stool softener to

help with the constipation. Remember to drink

plenty of fluids. Avoid taking antacids two hours

before and after the dose.

I Nausea – If you are unable to keep your medica-

tions down, notify your transplant coordinator.

Precautions:

I For better absorption, Myfortic should be taken on

an empty stomach.

I Myfortic should NOT be used by pregnant women.

Women of childbearing age should use two reliable

forms of contraception simultaneously unless

abstinence is the chosen method before beginning

Myfortic, during the time you are taking Myfortic, or

for six weeks after you stop taking Myfortic. Call the

Transplant Clinic if you think you are pregnant.

NEORAL (Cyclosporine)Neoral, commonly referred to as Cyclosporine, helps

prevent rejection. It is usually dispensed in 25 mg or

100 mg capsules. It is usually prescribed twice a day,

12 hours apart. Prior to your lab draws, take your

Cyclosporine 12 hours before your anticipatedblood draw.


I Increased creatinine – May cause your creatinine to

stay higher than the normal range. Your labs will be

monitored closely. Remember, your kidney function

is stable when the creatinine is not rising.

I Increased blood pressure – Notify your

transplant coordinator if your blood pressure

is higher than normal.

I Excessive hair growth – You may remove excess

hair on your face and body by using a depilatory

cream or wax.

I Overgrowth of the gums – Maintain good oral

hygiene and see your dentist.

I Increased potassium – If this happens, you will be

placed on a low potassium diet.

I Increased cholesterol – Your cholesterol levels ma

become elevated requiring additional medications

Your cholesterol levels will be checked in the cliniYour transplant coordinator will notify you when

your level is going to be checked. This is a fasting

blood test so you cannot eat or drink anything for

12 hours prior to the lab draw.

I Tremors – Usually temporary and related to high

doses of Cyclosporine.

Precautions:

I Cyclosporine interacts with many commonly

used drugs including over-the-counter medication

Check with your transplant pharmacist or your

transplant coordinator before starting any new

medication.

I Frequent lab tests will be conducted during the

first few months to keep a watch on the effective-

ness and side effects of Cyclosporine

I NO HERBAL PRODUCTS. This includes green tea!

I Notify the Transplant Clinic immediately if you thi

you are pregnant or are breastfeeding. The benefit

of taking this medication must be weighed agains

the possible danger to you, your unborn child or

your infant.

ANTIBACTERIAL MEDICATIONS

BACTRIM (Trimethoprim/sulfamethoxazole

or TMP/SMX)Bactrim is used to treat and prevent pneumocystis

carinii pneumonia and other bacterial infections. Once yo

have had a transplant, you have an increased risk of getti

this type of pneumonia because of the drugs taken to

avoid rejection. It is usually dispensed in single strength

(400/80 mg) tablets. It is usually prescribed once a day fothe first three months after transplant. If you are allergic

sulfa drugs, an alternative drug will be prescribed.


I Increase risk of sunburn – Bactrim will make

you sun-sensitive. Do not forget to protect

yourself by applying sunscreen daily!

I Nausea – If you are unable to keep your medica-

tions down, notify your transplant coordinator.



Precautions:

I Do not take Bactrim if you are allergic to sulfa.

I Call the Transplant Clinic immediately if you think

you are pregnant. The benefits of taking Bactrim if

you are pregnant or breastfeeding must be weighed

against the possible danger to you, your unborn

baby, or your infant.

ANTIVIRAL MEDICATIONS

VALCYTE (Valganciclovir) or ACYCLOVIRValcyte or Acyclovir are given to help prevent or

treat infections that are caused by a virus called

Cytomegalovirus (CMV). The CMV virus is present in

about 50 percent of the population. The virus is generally

experienced in the form of a common cold or flu and

most people are unaware that they have had this virus.

However, when a donor kidney with CMV is transplanted

into a recipient who has not had CMV, the recipient is

at risk for becoming infected with the virus. If you have

previously been exposed to the CMV virus, you are at risk

after the transplant of having a reactivation. By taking

Valcyte, you are protecting yourself against the CMV virus

and thus protecting yourself from infection. Your dosage

is determined by your physician and the CMV status of

the recipient and donor.

Acyclovir is used primarily when neither you nor your

donor kidney have been exposed to the CMV virus. In this

case, the Acyclovir protects you against the virus during

the first few months after transplant. Acyclovir is usually

prescribed twice a day, 12 hours apart. It is dispensed in

200 mg or 400 mg tablets. If you have questions about

medications, do not hesitate to ask.


I Decreased platelet count – This may result in

unusual bleeding or bruising.

I Decreased red blood cell count – Your lab values

will be monitored closely for a decrease in your red

blood cell count. Notify your transplant coordinator

if you are experiencing increased fatigue.I Decreased white blood cell count – Your lab values

will be monitored closely for a decrease in your

white blood cell count.

Precautions:

I Can cause birth defects. Use two reliable forms

of birth control.

I Swallow the tablet whole. Do not break, crush

or chew the tablet before swallowing.

ANTI-FUNGAL MEDICATIONS Various medications are used to treat or prevent fungal

infections. Some of the medications include Diflucan,

Nystatin, and Clotrimazole. Anti-fungal drugs interact

with most anti-rejection medications, so your medicatio

dosage will change when you start or stop the medicati

ANTI-ULCER MEDICATIONS

PROTONIX, PREVACID, NEXIUM, PRILOSECThese medications are used to prevent and sometimes

treat stomach ulcers. Depending on your insurance, you

may be prescribed any of these medications. It is okay!

We are not particular about which medication you use,

just that you take the medication as directed for the nex

few months. During your follow-up clinic visits, your

physician will discuss the length of treatment that is

needed for you. Medications will vary from person to

person.

LIFE AFTER TRANSPLANTDietHealthy eating is an important part of healing after

transplant. Your transplant dietitian can help you devel

an eating plan that provides a balanced diet to meet

your nutritional needs. During the first few weeks after

your transplant, your body will require extra calories an

protein. By meeting your nutritional needs, you will hel

your body heal, fight infection and gain back any weight

you might have lost. Even if your appetite is not hearty

after surgery, it is still important to eat. Think of food as

medicine – it helps you get well.



Below are some tips to help you increase calories and

protein in your diet:

I Try eating five to six small meals a day.

I Ask about adding supplements with or between

your meals, such as Boost.

I Eat a wide variety of healthy foods.

I Choose a diet low in saturated fat and cholesterol.

I Increase the amount of vegetables, fruits and grains

in your diet.

May I use salt?Yes, in moderation. One of the differences about a

transplanted kidney is that it doesn’t conserve fluid as

well as an original kidney. Therefore, you will need some

salt in your diet in order to prevent dehydration. Salt

needs will differ from person to person, but there are a

couple of guidelines. If you are losing weight, experiencing

dizziness or having drops in your blood pressure, you willneed to increase your salt intake. If you begin swelling

or your blood pressure starts rising, you will need to

decrease your salt intake.

What are good fats and bad fats?Good fats are polyunsaturated fats that include Omega-

and Omega-6 “fatty acids.” They are found in liquid

vegetable oils, sesame and sunflower seeds, corn,

soybeans, nuts, and fish. By eating these types of fats,

you can help lower your bad cholesterol for healthy

blood vessels. Remember, good fats are extremely high

in calories, so a little goes a long way! Bad fats include

saturated and hydrogentated fats also known as trans

fats. Saturated fats can be found in animal products.

Any fats that are solid at room temperature, such as

the fat found on a steak or a stick of butter, are probably

saturated fats. Other sources include dairy products like

cream, milk and cheese. Minimize your intake of these

by trimming meat, removing the skin from poultry, and

grilling, boiling or steaming foods instead of frying.

What kind of citrus fruits may I have?NO GRAPEFRUIT or GRAPEFRUIT JUICE! Grapefruit

inhibits your liver’s ability to break down some drugs an

can make the effects of your medications unpredictable

You can have any other types of fruit. Watch the labels f

juices that contain grapefruit juice, such as Sunny D.

10

Note: The above list is ONLY a guideline. It is not a complete list. If unsure about a medication, please contact your transplant pharmacist or transp

coordinator. Also, look at the active ingredients to make sure the medication DOES NOT contain ibuprofen, naproxen or psuedophedrine. YOU SHOULD ALWACONTACT YOUR TRANSPLANT TEAM BEFORE TAKING OVER-THE-COUNTER MEDICATION OR MEDICATIONS PRESCRIBED BY A NON-TRANSPLANT PHYSICI

PAIN RELIEVERS

Safe after transplantation

Acetamenophen (325 mg tablets)

Regular strength Tylenol

PAIN RELIEVERS

Not safe after transplantation

Advil

Aleve

AnaproxExcedrin IB

Ibuprofen

Midol

Nuprin

Motrin IB

COUGH AND COLD MEDICINES

Safe after transplantation

Afrin nasal spray and drops

Allegra

BenadrylChlor-Trimeton

Claritin

Dristan

Duration nasal spray

Nyquil

Robitussin

Thera-Flu

Vicks Formula 44E

COUGH AND COLD MEDICINES

Not safe after transplantation

Afrin Tablets

Alka Selzer Plus

Benadryl allergy and cold or sinusChlor-Trimeton Allergy

Decongestant

Claritin D

Comtrex products

Dayquil products

Dimetapp products

Drixoral products

Neo-synephrine products

Pamprin IB

Sudafed products

DRUG INTERACTIONSThere are several over-the-counter medications that may interfere with the absorption or breakdown of your immuno

suppressive medications. Others may cause your blood pressure to rise. Below is a list of pain relievers and cold and

cough medications that are safe and unsafe to use after you receive your transplant.



Should I eat super-sized portions?Even if the calories are from healthy foods, the calories

add up! You need only as many calories as your body

uses – less if you are trying to lose weight. If you are

finished eating your meal but still feel hungry, wait

20 minutes before eating again. Sometimes it may take

your stomach a while to signal that it is full.

Do my medications affect my potassium, phosphorus

and magnesium levels?Yes! You may need to restrict or supplement your intake

of these things to keep them in a desirable range. The

following list includes some examples of foods that are

high in each category:

Potassium Phosphorous Magnesium

Bananas Diet Coke Shrimp

Cantaloupe 2% Milk Peanuts

Orange/orange juice Cheese Beets

Broccoli Yogurt SpinachPotatoes Whole Grains Tomatoes

Raisins Tofu

May I have raw sushi, raw oysters or have my steak

cooked medium rare?No, no and no! Your food should be cooked completely.

You should not eat any rare or medium-rare foods.

You can have your sushi cooked and your oysters

steamed or baked. You must get your steak cooked

to at least medium.

May I use herbal products?No! Herbal products are not regulated by any government

agency. This means they are not tested for safety, side

effects or drug interactions. Since there is little information

about drug interactions between herbals and anti-

rejection drugs, it is not recommended that transplant

patients take herbal products – this includes green tea!

For example, St. John’s Wort is known to increase the risk

of rejection by decreasing the amount of anti-rejection

drugs in your blood.

Below are some tips to change the way you eat and keep

you healthy:

I Ensure that your fruits and vegetables have been

thoroughly washed and peeled when appropriate.

I Never skip a meal because you want to save your

calories for later. Skipping a meal will make it more

likely that you will overeat at the next meal.

I A “low fat” or “low calorie” label does NOT

mean you can eat as much as you want. Watch

your portions!

I Limit beverages and foods that contain added

sugars. Some examples include soda, jam, honey,

candy, Jello, cookies, cakes and pies.

I Add color to your plate by adding fruits and

vegetables.

I Choose lean cuts of meat.

I Microwave, broil, grill or steam foods instead

of frying.

REMEMBER, your transplant dietitian can help you worout a meal plan that is appropriate for you.

EXERCISEExercise is important for your health and wellbeing.

Initially, you may find it hard to get started because of

your medical conditions or because it is hard to change

your behavior. You have overcome obstacles that few

people have had to endure. You have a new appreciatio

for life and a new motivation to create better habits, so

you owe it to yourself!

Below are a few things you should be able to do:

Immediately after transplantI Start walking as soon as you can. Ask the nurse to

assist you while in the hospital. When you are at

home, get a family member or friend to go with yo

I Avoid sit-ups, push-ups or anything involving the

muscles around your transplant site.

I Once out of the hospital, slowly add a new activity

I It is okay to have the occasional “bad days.”

It is okay to do less exercise on those days.

As you feel better, build up to your normal

exercise program again.

I Increase the duration of your activity by one

minute every two days. Your goal should be

30 minutes of consistent aerobic activity at

least three days a week.



Two to Six months after transplant (and beyond!)I Stay disciplined!

I If you take a trip by car, don’t forget to get

out of the car every 90 minutes and walk around.

I Put more movement into your everyday activity.

Get involved with a neighborhood walking group.

Do not exercise if you have any of the following:I Pain in the joints that is made worse by activity.

I Chest pain.

I Fever greater than 100°F

I Are diabetic and your glucose level is above

300 or less than 70.

Call the transplant clinic or 911 promptly if any of the

above symptoms occur!

RETURNING TO WORKIf you were working before the transplant, you should

be able to return to your job once your transplant

physician has cleared you. You will have regular visits to

the transplant clinic, especially in the first three months.

If you were not working prior to the transplant and your

transplant physician tells you it is okay to go to work,

Georgia Transplant Foundation has a program called

JumpStart (www.gatransplant.org) that will help train

you or assist you in finding a job. All you have to do is

call and speak with your social worker regarding this

unique program.

SEXUAL ACTIVITYYou may resume sexual activity as soon as you feel well

enough. Always make sure that you urinate immediately

after intercourse to minimize the risk of a urinary tract

or bladder infection. Your sexual functioning may be

affected by your surgery. Certain medications can also

interfere with sexual functioning. Some people avoid

sexual activity because they are afraid of kidney rejection,

hurting the kidney or of infection. If you experience any

of these fears, talk to your transplant coordinator. How

quickly you feel ready will depend on your recovery

progress. You must use contraception to preventunplanned pregnancy. Always use condoms with any

form of birth control. Condoms help prevent disease.

PREGNANCYThere are many women who have had kidney transplant

that have had successful pregnancies. Becoming pregna

after a transplant has special risks for both the transpla

patient and the baby. You should avoid pregnancy for at

least two years after transplant.

You should always use two forms of birth control. Your

gynecologist can discuss the various methods of birth

control with you – just be sure you clear your choice wi

your transplant physician.

Once you decide you would like to become pregnant,

discuss this with your transplant physician, as your

pregnancy will be considered high-risk. You will also be

referred to an obstetrician experienced in dealing with

transplant patients. This will be a planned pregnancy.

You will need to have medication changes at least three

months in advance of trying to conceive. This will ensur

a safe pregnancy for both the mother and the baby.

Men with kidney transplants have also fathered children

Because of the medications, it is important to discuss t

possible risks to the baby with your transplant physicia

SMOKINGDO NOT SMOKE AFTER YOUR TRANSPLANT. It is well

known that smoking is harmful to your health and can

cause diseases such as cancer and emphysema. If you

smoke after your transplant, you are increasing your ris

of developing lung cancer. You are more susceptible to

lung infections. These can be life-threatening in a

transplant patient. You may want to join a stop-smoking

group. Don’t be afraid to talk with your transplant

coordinator or your physician to get help.

ALCOHOLIf you have a history of alcohol abuse, you should avoid

alcohol. Otherwise, you may have alcohol in moderatio

not exceeding one drink per day. Medications such as

Prograf, Cyclosporine and Bactrim are broken down by yo

liver and, if combined with alcohol, could potentially har

your liver. If you have any questions, call your transplant

coordinator or speak with your transplant physician.

PETSKeep your pets well groomed and clean. Keep litter box

away from the kitchen and eating areas. Have someone

else clean the litter box outside. Some pets – such as

wild animals, monkeys and exotic animals – can carry

diseases that can spread to humans. Please try to stay

away from them. You can have cats, birds, fish, turtles,



dogs, cows, horses, etc. Do not clean the bird cages,

turtle tanks or fish tanks. They can carry diseases that

could hurt you after the transplant.

TRAVELYou should not plan to travel for at least three months

after transplant or until the transplant team has cleared

you medically. Complications are most common during

the first three months and you may require hospitalization

to treat them. You must discuss travel plans with thetransplant team.

If you plan to travel to a foreign country, always drink

bottled water and avoid ice in your drink. You must also

brush your teeth and rinse your mouth with bottled water.

Prior to traveling to a foreign country, you may or may not

need vaccines. Talk with your transplant team to assure

you are appropriately vaccinated. If you should need a

live vaccine such as smallpox, measles, German measles

or yellow fever, you will need a letter sent to your local

passport bureau indicating you cannot receive these

vaccines. Travel to these countries may not be safe for you!

Whenever you travel by air, do not use a pill box.

Have all of your medicines in their original containers

in your carry-on luggage. You may take a pill box with

you for use when not traveling. You will also need a

letter stating that you are a transplant patient and need

these listed medications.

HEALTH MAINTENANCE

When can I return to my primary care doctor or

my nephrologist?Approximately six months after transplantation, most of

your care should be provided by your local doctors. It is

important that you identify and re-establish contact with

them after you receive your transplant. As specialists, we

will be providing care for your transplant. Your lab values

will always be sent to us and we will always manage your

immunosuppressive medications. You will need to have

labwork performed at least monthly for the life of your

transplant.

When can I go to the dentist?Avoid going to the dentist for six months after transplant.

If an emergency arises, please call your transplant

coordinator or the Transplant Clinic. We recommend

that you have routine dental checks every six months

and practice good dental hygiene to minimize the risk

of developing an infection in your mouth. In some

patients, Cyclosporine has been known to cause an

overgrowth of your gums called hyperplasia. You will

need antibiotic therapy before going to the dentist.

The American Heart Association has published guidelin

for the use of antibiotics in the transplant patient. Your

dentist will prescribe the medication for you. Remembe

to always check with your transplant coordinator before

taking any new medications.

Should I see my gynecologist? We recommend yearly Pap smears and pelvic exams for

all women ages 18 years and over. You should do a brea

self-exam every month to check for changes. Women ov

the age of 40 should have a yearly mammogram.

When should I have a colonoscopy?You should have a colonoscopy at age 50, or earlier if

there is a family history.

When may I go see the eye doctor?

You should have your eyes examined every year, or if yonotice any changes in your vision. Prednisone can cause

blurred vision or cataracts. If this develops, it needs to b

treated promptly. You should wait to go to the eye doct

until your Prednisone dose has been tapered down to a

maintenance dose.

When may I have my vaccinations? Which vaccines

are safe for me to take?Transplant patients are at risk of severe infections due

to their life long immunosuppression. The timing of

vaccinations appears to be critical because responseto vaccinations is decreased in the first six months

after transplantation. For these reasons, the primary

immunizations should be given before transplant.

Recommended vaccines include pneumovax, Hep A

and B, influenza, and tetanus-diphtheria. A transplant

recipient may never have a live vaccine such as yellow

fever, oral polio vaccine, bacillus Calmette-Guerin,

vaccinia, and the chicken pox vaccine. We highly

recommend that you receive a flu shot on a yearly

basis. If your child needs a chicken pox vaccine, please

notify your transplant coordinator before your childis vaccinated.

13



SKIN CAREBecause of your immunosuppressive medications,

you are at an increased risk for skin cancer. You must

use sunscreen with an SPF greater than 30 daily. If you

are outside, reapply these sunscreens frequently. Since

most skin cancers occur on the head and neck, wear a

wide-brimmed hat when outside. You also need annual

skin checkups with a dermatologist.

The most common types of skin cancers are squamous

cell carcinoma (SCC), basal cell carcinoma (BCC) and

melanoma.

I Squamous cell carcinoma is 65 times more

common among transplant recipients than the

general population. It often appears on areas

exposed to the sun. It is slow-growing and develops

over months. It can spread to other parts of the

body if not treated. Even with treatment, this form

of skin cancer can be fatal.

I Basal cell carcinoma is 10 times more common

among transplant recipients than the general

population. It often appears on the head, neck and

upper torso. This is the least dangerous type and it

rarely spreads to other parts of the body.

I Melanoma is the most dangerous type of skin

cancer. Transplant patients are three times more

likely to get melanoma than the general population.

It is aggressive in growth and able to spread to

healthy tissue. It usually appears as a new spot or

an existing spot, freckle, or mole that changes color,

size or shape. This can be successfully treated if

caught early.

What you can do…See a dermatologist within the first six months after your

transplant. The sooner you have an examination of all

your skin surfaces, the better! Your dermatologist will

recommend how often you should return based on your

personal level of risk.I Stay alert for skin changes….the earlier a

skin cancer is found, the better chance of

successful treatment.

I WEAR SUNSCREEN EVERY DAY!

I Stay out of the sun between the hours of 10 a.m.

and 2 p.m. The more skin you cover, the better.

You play the most important role in prevention and

treatment of skin cancer. BE AWARE of your skin and

always wear sunscreen!

WRITING TO YOUR DONOR FAMILYYou may write a letter to the donor’s family thanking

them for the gift of life you have received. We will provi

you with a copy of guidelines to follow for writing this

letter. You can give the letter to a member of the transpla

team or you can send it directly to Lifelink yourself.

Many donor families are very pleased to hear from you

and are grateful for the opportunity to tell you about th

loved one. Other donor families are so grief-stricken tha

they need more time to respond, and some may never b

able to respond. Over time, you may wish to write them

again. You may have an opportunity to speak to them

on the phone or even meet them, but building this

relationship takes time. For now, just focus on your first

letter. Do not worry about saying the “right thing” or

bringing back difficult memories for your donor family.

The words “Thank You” really do say it all.

BEST WISHESCongratulations and best wishes on your transplant!

We hope that in appreciation of the gift of life given by

your donor, you will do all you can to care for your new

kidney and maintain good health. Remember to be awa

of any changes that you experience in your body. Know

the warning signs of rejection, infection and side effects

of your medication.

Call your transplant team if you see any changes at any

time. The earlier you detect and report a change, the

greater the chance of survival of your new kidney.

Receiving a transplant can be a frightening, yet satisfyin

experience. We hope this booklet explains what you nee

to know about kidney transplantation and addresses an

concerns that you have about receiving a new kidney. If

you have more questions, please call our office at any

time at 404-605-4600 or 1-888-605-5888.

14



CONTACT INFORMATIONPIEDMONT HOSPITAL TRANSPLANT SERVICES

Office: 404-605-4600

Toll Free 24-hour line: 1-888-605-5888

Helpful Information OnlinePlease visit www.piedmonttransplant.org.

www.transweb.org - a site dedicated to transplant

patients and recipients that presents detailed information

about transplantation in simple to understand language

and includes real stories from patients and their families.

www.unos.org - United Network for Organ Sharing

(UNOS)

SIGNS AND SYMPTOMS OF REJECTIONAND/OR INFECTION

I Fever of 100°F (38.0°C) or greater.

I Increased wound pain or drainage from your wound.

I Fluid retention – weight gain of three pounds in a

24-hour period, swelling of the ankles or hands, or

puffiness around the eyes.

I Decreased urinary output.

I Change of color of urine.

I Foul smelling urine.

I Pain or burning on urination.

I Increased frequency of urination.

I Nausea, vomiting or diarrhea for greater than

24 hours.

I

Blood pressure changes.I Blood present in stool or urine.

If any of these signs and symptoms occurs, call the

Transplant Clinic immediately.

POST-TRANSPLANT DISCHARGE CHECKLIST What you should know before you go home:

I Have I attended the discharge education class?

___________________

I Do I have a stent?

_______________________________________

I If on Prednisone, do I have my taper schedule?

__________________

I If my medications were delivered to the hospital,

they were inspected by:

_________________________________________

I My medication action plan was reviewed and

finalized by my discharge nurse.

I The 24 hour emergency line phone number

is 1-888-605-5888

I My post-transplant coordinator is:

___________________________________

I My next appointment is:

________________________________________

DISCHARGE REMINDERS: Upon discharge, you should

be able to…

I Correctly identify the purpose of your medications

I Correctly identify the schedule of each medication

I Correctly administer your Prednisone dosage.

I Be able to record your blood pressure, temperatur

and pulse at home.

I Be able to describe the signs and symptoms for

which you will need to call the Transplant Clinic.

I Identify activity and diet restrictions.

15



NOTES

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

16



Helpful Information OnlinePlease visit www.piedmonttransplant.org.

www.transweb.org – a site dedicated to transplant patients and recipients that presents detailed information

about transplantation in simple to understand language and includes real stories from patients and their families

www.unos.org – United Network for Organ Sharing (UNOS).

PIEDMONT HOSPITAL TRANSPLANT SERVICES1968 Peachtree Road, N.W. | 77 Building, Fifth Floor | Atlanta, Georgia 30309

Tel 404-605-4600 or 1-888-605-5888 | Fax 404-609-6620 | www.piedmonttransplant.org



1968 Peachtree Road, N.W. | 77 Building, Fifth Floor | Atlanta, Georgia 30309

l | | d l

Documents

Post Kidney