Living with a Transplant
Congratulations on your kidney transplant! You may be concerned about what the next few weeks and months hold in store as you recover. Remember to call your doctor or the Northwest Kidney Centers with any concerns or questions you have. You are on your way to better health!
(Check out Transplant Connection, a new Northwest Kidney Centers newsletter for transplant recipients.)
Recovery from transplant surgery can be quite fast. Depending on which hospital you were at for your surgery, you might be taken to the Intensive Care Unit (ICU) for a day or two after surgery. Staff can then monitor your progress closely and move you to a regular room when you are ready. You will probably stay in the hospital for two or three weeks because of the risk of infection, and because your new kidney might not work right away. Transplant patients often return to work within eight weeks of their surgery.
Medical Follow-up
After you leave the hospital, your doctor will pay very close attention to your lab test results. At first, you will need to go to the doctor's office as often as three times a week. Later visits will be less frequent.
Rejection Problems after a Kidney Transplant
The body naturally tries to reject (get rid of) things that are foreign to it. This function is called the body's immune response. Antibodies and white blood cells called lymphocytes attack viruses, fungi, bacteria, and other foreign substances (such as a transplanted organ).
Immunosuppressive drugs suppress the immune system of the body. You will take these drugs as long as you have your transplant. This is done to try to fool your body into accepting the new kidney and not rejecting it. Doctors need to carefully plan the amount of each drug so your body is still able to fight infections and illnesses. Modern versions of these drugs have greatly reduced the number of rejections, but rejections do still occur.
There are three types of rejection:
Acute rejection most often takes place after recovery from surgery and is quite common. Acute rejection happens at least one or more times to half of all cadaver transplant patients.
Quick treatment almost always controls or reverses the rejection. It is common during the first three months after surgery, but acute rejection can happen many months or years after surgery. This is why ongoing medicines and regular medical follow-ups are essential. Lab tests often show that rejection is taking place before symptoms even show up.
When acute rejection is more sudden or severe you might have the following symptoms:
• Fever
• General body aches like with the flu
• Sudden weight gain, with or without swelling, from fluid retention
• Less urine produced for unknown reasons
• Tenderness or soreness over the transplant area
If you are a transplant patient with any of these signs, call your doctor right away.
Treatment of acute rejection depends on a number of things. You will not need a hospital stay for mild rejections. More serious rejections need hospital care and must be watched closely. The treatment may include a change in the amount or types of drugs that suppress the immune system.
Chronic rejection is the body's slow, ongoing effort to reject the new kidney. It is more common in patients who have had acute rejection several times. Usually the only signs of chronic rejection are a tendency towards edema (swelling) and weight gain. Chronic rejection is another reason why you will need tests over the years to show how well your transplanted kidney is working.
Careful drug treatment can control, but not stop, this type of rejection. Your transplanted kidney can keep working for months or even years. If you have active chronic rejection, you can lead a fairly normal life but you will need to see your doctor more often than other patients. As your kidney function gets lower, medication doses and your diet may need to change. In time, the changes in the transplanted kidney become the same as when your own kidneys were failing.
Hyperacute rejection is quite rare. It happens fast and there is no treatment to stop the kidney from being destroyed. This type of rejection takes place within minutes or within the first few hours after receiving a kidney transplant. When treatment does not stop rejection, the patient no longer takes immunosuppressive and antirejection drugs. In some cases surgery may be needed to remove the transplanted kidney. The patient then returns to dialysis, and may be considered for a second transplant at a later time.
Drugs Used to Control and Treat Rejection
The human body never fully accepts a transplanted kidney except in the case of identical twins. Even so, the risk of your body rejecting your transplanted kidney goes down over time. This means that your doctor usually lowers the dose of immunosuppressive drugs. Your doctor's advice about the dose you need must be followed exactly. Most kidney transplant failures result from patients not taking their drugs as ordered by their doctors.
After a transplant it is very important to learn about your drugs and their doses. It is your job to take these drugs under the close direction of your doctor. Always carry with you information about the drugs you are taking, including the name and dose of each drug. This helps in an emergency or if there is any reason to see a doctor you don't know. Make sure you have this information in writing.
• Cyclosporine is an immunosuppressive drug that came into general use in 1983. It greatly improved the success rate for all types of organ transplants.
• Cellcept® is another immunosuppressive drug used with cyclosporine.
• Prednisone is an anti-inflammatory steroid medication, usually given with other drugs.
• Azathioprine or Imuran® is the other immunosuppressive drug often used.
• OKT3 is a drug used to fight acute rejection.
• Antilymphocyte globulin is often given in the first two or three weeks after a transplant to help prevent acute rejection.
All immunosuppressive drugs have side effects. The most common ones include a greater risk of infection and illness. This is because your body’s suppressed (lowered) immune system is less able to fight these health problems.
Some of the other possible side effects of these drugs include more facial hair; changes in body fat that cause fullness in the cheeks, stomach, and back; mood swings; short term memory loss; increase in appetite; liver damage; and bone disease. These effects vary from person to person and depend on the amount of each drug being taken. Over time, your doctor lowers the amount of drugs needed, which reduces the side effects. Diet and exercise often help. Your doctor has more detailed information to give you.
The drugs you need can cause other health problems to develop such as diabetes, cataracts, peptic ulcers, and bone and joint problems. It is not known ahead of time if a person will develop any of these problems or how serious they might be.
Serious problems are possible when a rejection happens at the same time as a life-threatening infection. In order to fight the infection, you may need to stop taking immunosuppressive drugs which causes your transplanted kidney to stop functioning.
It is most important to tell your doctor at once about any fever, cough, or other signs of illness. Prompt treatment may be needed. Always keep appointments with your doctor for follow up visits so he or she can find any serious infections as early as possible.
Limits to Your Diet
People with a transplant usually eat a normal diet. You may still need to be careful of the amount of sodium (salt) and potassium in your diet. You also need to watch the amount of calories you eat to avoid gaining too much weight.
Important Things to Consider
Transplantation has its own set of advantages and problems that each individual patient must carefully think about. Most people have a transplant that works well with few problems, but this is not always the case.
There are certain risks with any surgery. Possible risks include a reaction to anesthetic, an infection, or physical problems that arise during or after surgery. Also, in some cases kidney rejection can cause serious long-term or permanent health problems. Discuss all these issues with your doctor and carefully think about them.
Payment
Most patients who are able to have a kidney transplant have their hospital costs paid by Medicare and private insurance companies. These sources also pay 80 percent of the doctor's fees and most lab fees. After discharge from the hospital, Medicare pays 80 percent of the costs of outpatient follow-up medical visits for three years. It also pays for 80 percent of your immunosuppressive drug charges for one year. For low-income people, Washington State Medicaid or the state’s Kidney Disease Program may help pay transplant and/or drug costs.
The funding sources above also pay the costs of the medical work-up before surgery for living donors. Medicare (if the person getting the kidney is eligible for Medicare) pays 100 percent of the allowable charge of the hospital and surgeon costs for removing the donor’s kidney.
Northwest Kidney Centers financial coordinators can answer your questions about funding for transplant costs.
Commonly Asked Questions
Does the success of a transplant depend directly on the tissue typing match?
Yes, especially with a living donor transplant. Tissue matching is less important with a cadaver transplant. Some poorly matched cadaver kidneys have worked for more than 20 years, and some good matches have rejected early. Even so, perfectly matched transplants generally do better than other cadaver kidney transplants.
Is there an age limit for people who can have a transplant?
Doctors base medical decisions about having a transplant on overall health — mainly the condition of the blood vessels and heart. People older than 60 to 65 years of age often have more problems with transplant drugs, blood vessels, and have more risk of infection. Each patient needs a personal evaluation.
Can a diabetic dialysis patient receive a kidney transplant?
Yes, but problems from the surgery and risk of infection may be more likely.
• Diabetic patients usually have blood vessel disease.
• The average life span for both diabetic dialysis patients and diabetic transplant patients is shorter than for those who do not have diabetes.
• Controlling diabetes may be harder in transplanted patients since steroids can raise the blood sugar level. A combined kidney and pancreas transplant may solve some of these problems.
If diabetes, high blood pressure, or glomerulonephritis destroy my kidneys, could the same disease destroy my transplanted kidney?
Certain forms of glomerulonephritis may happen again. Over many years, diabetes damages the blood vessels and causes kidney failure in the transplanted kidney. Since the progress of these diseases is slow, a transplant is still a very good idea.
Can a kidney from a person of one race or sex be transplanted into a person of another race or sex?
Yes, if the blood type is compatible and there are no problems with the tissue matching.
What is happening while I am on the "waiting list"?
Each time a kidney of your blood type becomes available, your blood serum is matched with cells from the donor. This test checks to see if your serum reacts against the donor's cells. The transplant hospital or your doctor calls you if the cells do not react (this is a negative cross match) and the computer has listed you as the best choice. Staff then make plans for the transplant surgery.
Will my transplant work right away?
There is a chance your new kidney may not work right away. If so, you may need to have dialysis for one to three weeks until the kidney begins to function.