Kidney Transplant Patient Guide
Pretransplant tests, as well as giving a clear picture of the patient's overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success.
The following procedures help in evaluating a patient's health status:
- Physical exam - Gives the doctor an overall picture of the patient's conditions.
- Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.
- Complete medical and surgical history - Determines what additional tests may need to be done.
- Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.
- Ultrasound with Doppler examination - Determines the quality of the iliac vessels.
- Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed.
- Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" (see crossmatch testing).
- Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen.
- Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.
- Lower GI series - Ensures that the patient is free of intestinal abnormalities.
- Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.
- Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney.
- Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion, pregnancy, a previous transplant or a current infection.
- Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome.
- Mammogram - X-ray of a woman's breast that can detect signs of breast cancer.
- Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer.
- Echocardiogram - Reveals any abnormalities in the heart.
- Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.
- Other tests - Any special tests or doctor visits that might be needed for the transplant workup.
Histocompatibility Laboratory Tests
Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you.
Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection.
Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible".
Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests.
Clinical Laboratory Tests
Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.
Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment.
Preparing and Waiting for A Kidney Transplant
Days and weeks may pass while the transplant team waits for UNOS to locate the right kidney for a specific patient. During this time, the patient should prepare as much as possible and take positive steps to deal with the stresses of waiting, always staying focused on reaching the goal of transplant.
The Telephone as a Lifeline
As soon as a donor kidney becomes available, the coordinator will call the recipient to get ready. Since this call could come at any time during the day or night, the transplant team should be able to reach the patient whether he is at home, at school, at work, or on vacation.
The patient should provide his team with the phone numbers of family members and close friends as well, and do everything he can to make sure that he can be contacted immediately.
When the Phone Call Comes
When that phone call comes, everything will seem like a blur. The coordinator will advise the patient when to be present at the transplant center. The patient must move quickly, getting to the transplant center without delay. When a kidney becomes available, there is a time limit!
Make a List and Pack Ahead of Time
The patient should pack an overnight bag in advance as soon as his name is put on the waiting list. He should make a list of items he will need in the hospital after surgery, as well as a list of people to be contacted when the kidney becomes available. The patient should give this list ahead of time to a trusted family member or friend to pack any last-minute items and make the calls while the patient is on his way to the transplant center.
Getting to the Transplant Center
If the transplant center is nearby, the patient should plan to have a designated driver - if possible, someone who will be standing by when the phone call comes. This person should be available at all times and reachable by phone. The route to the transplant center should be mapped out in advance.
If the transplant center is farther away, the coordinator can assist the patient and family with transportation arrangements.
If the patient chooses to make his own travel arrangements, he should call the airlines in advance, and get regularly updated information about flight times and routes every month. If possible, a direct flight is the best option. Because flights might be delayed, the patient should have a backup plan. Choose another airline as a backup, or another mode of travel (bus, train, etc.).
To make it easier on loved ones, they should arrange to stay within driving distance of the transplant center.
Dealing With Pretransplant Stress
Waiting for a transplant can trigger a patient's feelings of stress and anxiety. To help manage stress, the patient should:
- eat right, take prescribed medications, and follow a daily exercise program. The transplant team will create a plan based on the patient's medical needs.
- keep up with studies, work, and leisure activities, to the best of his abilities. The patient shouldn't have to put everything on hold.
- know it's ok to share feelings of depression or uneasiness. The transplant team can answer questions, and help alleviate fears. The social worker is more than a good listener -- he or she can put the patient in touch with a support group in the area.
- find a creative outlet, enjoying a hobby to the fullest. This will distract and help a patient relax. Or the patient could pursue a new interest - something that will absorb pent-up energy and leave positive feelings of fulfillment. The patient should ask his doctor for guidelines on these activities.
- spend time with family and friends. Good company will take a patient's mind off waiting. Laughter really is the best medicine.
- learn relaxation techniques, like reading and listening to music or relaxation tapes.