Kidney Transplant Patient Guide
A number of postoperative complications are possible:
Immunosuppressive medications interfere with a patient's natural immunity; therefore, the patient will be more susceptible to infections after transplant surgery. The following are some of the most common infections:
Cytomegalovirus (CMV) - CMV is one of the viral infections that occur most frequently in transplant patients. The risk of CMV is highest in the first months after transplantation. Signs include fatigue, high temperature, aching joints, headaches, visual disturbances, and pneumonia. Treatment may include hospitalization.
Herpes-simplex virus type I and II - These viruses most often infect the skin but can also occur in other areas such as the eyes and lungs. Type I typically causes cold sores and blisters around the mouth, and type II causes genital sores. Herpes is an infectious disease and can be transmitted sexually. Herpes infections in transplant patients, however, were not necessarily transmitted sexually.
Most herpes-simplex infections are mild, but occasionally they can be severe. Although there is no cure for herpes, it can be treated. Depending on the severity of the infection, the treatment is either topical, oral, or intravenous (IV). A patient should contact the transplant team immediately if he believes he has herpes.
Symptoms of herpes include feeling weak and having painful fluid-filled sores in the mouth or genital area. Women should also be aware of any unusual vaginal discharge.
Herpes zoster (shingles) - Shingles appear as a rash or small water blisters, usually on the chest, back, or hip. The rash may or may not be painful. A patient should notify the transplant office if such a rash ocurs.
Candida (yeast) - Candida is a fungus that can cause a variety of infections in transplant patients. It usually appears in the mouth and throat but may also be in the surgical wound, eyes, or respiratory and urinary tracts. Candida is most severe in the bloodstream. If infection occurs in the mouth or throat, it is called thrush. Thrust produces white, patchy lesions (raw areas), pain or tenderness, a white film on the tongue, and difficulty swallowing. Candida can also infect the esophagus (the tube from your mouth to your stomach) or, in women, the vagina. Vaginal infections usually produce an abnormal discharge that may be yellow or white. A patient should notify the transplant office if a Candida infection ocurs.
Wound infections - Bacterial wound infections occur at the surgical site. If a patient has a fever or notices redness, swelling, tenderness, or drainage at the incision, he should notify the transplant team. After a wound culture (a test for bacteria) is taken, an antibiotic will be prescribed if infection is present.
Pneumocystis carinii is a germ similar to a fungus, and it is normally found in the lung. In people whose immune systems are suppressed, it may cause a type of pneumonia (PCP). Early in the illness, a mild, dry cough and a fever may occur. If a patient suspects that he has a cold or flulike illness, he should contact his physician immediately.
High Blood Pressure
High blood pressure and heart disease are common disorders that become more frequent as people grow older. High blood pressure is also a side effect of some medications. A patient may need to take a medication to control his blood pressure.
There are many different types of drugs available to control high blood pressure. A patient may need to try several different medications. The transplant team or local physician will select the one that works best for each specific patient.
A diuretic (water pill) may also be prescribed to lower blood pressure, increase urine output, and remove extra fluid.
This happens when your body's immune system thinks your new organ is "foreign" and attempts to destroy it. You will take immunosuppressive medications for the rest of your life to prevent rejection.
There are several types of rejection:
Hyperacute rejection - happens when the body immediately destroys the new kidney, this is rare because of the crossmatch testing used before transplant.
Acute rejection - although this can happen at any time after the transplant, most often it happens during the first several months. This can be treated by giving you higher doses of medication by mouth or by intravenous infusion. You may get this treatment as an outpatient if it is recognized early.
Chronic rejection - this may happen months or years after the transplant. This type of rejection is resistant to treatment with current medications. This will cause your new organ to slowly stop working.
The term diabetes means that your blood sugar levels are too high. This can be caused by some of the medications you are taking for your transplant, such as Prednisone, Prograf®, and/or Cyclosporine. You may need to start taking insulin or increase your dose to help control your blood sugar.
Acute Tubular Necrosis (ATN)
This is a condition when the kidney doesn't work right away after transplant. ATN is usually temporary. It can be caused by a long organ storage time on ice before transplant or by medications. The symptoms are treated in two ways: 1) By limiting the salt, protein, potassium in your diet, and fluid intake, or by dialysis. 2) The transplant team will look at the lab results, your weight, your limiting fluid intake, urine output, and vital signs to decide which treatment you will need.
Some of the immunosuppressive medications may cause diabetes. Diabetes is an increased level of sugar in the blood.
Symptoms of diabetes may include: increased thirst, increased frequency of urination, blurred vision, and confusion. A patient should notify his transplant team or local physician if he experiences any of these symptoms.
Blood sugar can be reduced through weight loss, careful diet, and exercise. An oral diabetes drug or insulin injections may be necessary.
If a patient develops diabetes, he will receive specialized teaching about how to deal with this problem.
Notifying the Transplant Team
There is no way to predict accurately which patients will have problems. The transplant team will do their best to reduce the likelihood of complications and to treat them promptly if they occur. Following instructions carefully and keeping the transplant team informed of any difficulties will help a patient return quickly to a normal, active life.
A patient should notify the transplant team if he:
- has prolonged illness (nausea, vomiting, diarrhea).
- is unable to take medicines by mouth due to illness.
- thinks the directions on the label may be different from what he was told.
- has trouble removing child-resistant caps.
- has a reason to take aspirin, TYLENOL® (acetaminophen), other pain relievers, or cold remedies.
- feels he is having a reaction to the medications.
- has had a change in health or eating habits.
- has a new prescription from his local doctor or a change in a current prescription.
- experiences any unusual symptoms or side effects, as they may be related to the medications he is taking.
- is undergoing dental work of any kind.