TRANSPLANTATION SERIES

Transcription

1 TRANSPLANTATION SERIES What are the Complications of Transplantation Key points: Possible problems after a transplant Risks of immunosuppression General side effects of taking immunosuppressant drugs

2 What are the complications of transplantation? Transplantation has a number of possible complications and there is also a small risk of dying after a kidney transplant. Possible problems after a transplant Although a transplant is an excellent treatment, for most people with kidney failure, transplantation is not problem-free. Most of the complications are due to two factors. First, many people having a transplant have health problems in addition to kidney failure. These can include diabetes, high blood pressure, heart disease, or other complications of being on dialysis. Secondly, the body recognises a transplant as an invader, in the same way it would recognise a germ. This means that the body will try to destroy the transplant, and this is what is called rejection. Rejection can be prevented by drugs, but all these drugs interfere with the good things the immune system does, as well as preventing rejection. Therefore, infections and cancers occur as side effects. In addition, the anti-rejection drugs cause complications such as high blood pressure, high cholesterol and diabetes. All these can lead to a heart attack or a stroke. Research is being done all over the world to try and develop anti-rejection treatments that do not cause all these complications, but this research has not been fully successful yet. Having said that, the drugs available now are better than a few years ago and the numbers of complications that occur have been reduced markedly.

3 Risk of dying after a transplant Within one year of any transplant a small percentage of people die, about 3% (three out of one hundred) in most units. However, this is no greater than the percentage that would have died if they had remained on dialysis. Long term survival depends very much on not getting heart problems and cancer. There are increasing numbers of people who have had a functioning transplant for over 20 years and who are very well. However, on average, about 70% (seven out of ten) transplant recipients are alive ten years after a transplant. The other main complications of transplantation are: 1. problems with the transplant kidney itself, such as rejection, or problems with the blood supply or urine drainage (see leaflet Transplant Rejection) 2. infections, such as urine infection or pneumonia, (see leaflet Infection after Kidney Transplant) 3. high blood pressure and high cholesterol levels, (see leaflet on Blood Pressure) 4. cancer, which is most commonly a small skin cancer (see leaflet Cancer after Transplant) There are risks associated with all major and minor operations, which can lead to serious complications or even death. The transplant operation and the days immediately after it carry the same risks. These will have been explained to you by the transplant co-ordinators, kidney doctor (nephrologists) and surgeon during your pre-transplant assessments. They will be explained to you again at the time of your transplant before you sign the consent form.

4 The risks for patients undergoing kidney transplantation: The kidney failing in the first year 10 out of 100 Bleeding needing blood transfusion 5 out of 100 Problem with the join between the kidney and the bladder 7 out of 100 Blockage of the blood vessels supplying the kidney 2 out of 100 Narrowing of the blood vessels supplying the kidney 5 out of 100 Wound infection 5-10 out of 100 Collection of fluid around the kidney 7-10 out of 1-00 Blood clots in the legs 1-3 out of 100 Acute rejection of the new kidney 15 out of 100 Delayed kidney functioning requiring the need for dialysis Risks of acquring infections or transmisssible cancers from the donor 40 out of out of 2000* Risks of immunosuppression *Approximately 1 in 2000 donors have a hidden cancer or 1:100 an infection that we do not know about, we cannot predict which donors have these hidden cancers or infection, even though the assessments are quite robust and viruses are checked for. Such diseases may be inadvertently transmitted to you from such high risk donors and thus the need for further treatment for life for example with antivirals.

5 Your consultant may feel that it is in your best interest to receive a blood transfusion during or after the transplant. The reasons for a blood transfusion will be discussed with you before the operation. The risks of blood transfusion are low and you will receive a leaflet about this. You may develop other conditions related to receiving a kidney transplant. However the risks are very small and the consultant will discuss these with you fully before the operation prior to you signing your consent form. These drugs are very powerful and common side effects include the following: General side effects of taking immunosuppressive drugs The drugs stop you rejecting the kidney by weakening your immune response. A consequence of this is that you are more susceptible to some infections and cancers. The infections tend to be viruses or other infectious agents that are already in your body at the time of the transplant. They may also be in the transplanted kidney, rather than infections that you catch from other people. The most common virus to cause problems is called cytomegalovirus. Some patients are given a drug called valganciclovir to prevent infection. Transplant patients are more likely to get skin cancer and it is important to take precautions to avoid sunburn. Two out of every 100 patients transplanted will get a cancer of the blood called lymphoma (see later section).

6 Potential side effects of specific drugs Tacrolimus Tremor of your hands Hot flushes and tingling in the hands and feet hands Increase in blood pressure Increase in blood cholesterol Diabetes in 10 of every 100 patients transplanted Nightmares (first two weeks) Constipation and wind pains (first two weeks) Prednisolone Weight gain due to increased appetite Round moon shaped) face which can change how you look Increase in blood pressure Diabetes Personality change - very rarely Osteroporosis (thinning of the bones)

7 Mycophenolate mofetil Abdominal cramps and/or diarrhoea Abnormality of bone marrow function. This may make you more susceptible to infection or bleeding and it may result in you becoming anaemic The side effects are related to the dose of the drugs, which are reduced gradually over the first three months. They may be treatable, for example with blood pressure tablets. Many are self-limiting and they will usually go within a few days or weeks of the transplant. These do not need to be treated.

8 The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor National Kidney Federation (NKF) All rights reserved Written by Dr. Rob Higgins, Renal Consultant, Walsgrave Hospital, Coventry Updated by John Black, Surgical Registrar and Atul Bagul, Consultant Transplant Surgeon, Leicester Last reviewed November, 2016