Maintaining Your Kidney Transplant

Transcription

1 Maintaining Your Kidney Transplant Darshika Chhabra, MD, MPH Transplant Nephrologist and Medical Director Advocate Christ Medical Center March 29, 2014

2 Why get a kidney transplant? Improved survival

3 Transplant-Related Quality-of-Life Benefits Maintenance of employment Relatively unrestricted diet Freedom to travel Ability to become pregnant and bear children Can engage in athletic training Lifestyle free of dialysis constraints

4 The pathway to transplantation.

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6 Pretransplant evaluation

7 Evaluation Education by the team at the transplant center Detailed physical Thorough testing Blood work Imaging Cardiac workup Cancer screening And much more

8 Finally put on the wait list.

9 Some numbers As of March 28, 2014: Number of patients awaiting solid organs: 121,997 Awaiting kidneys: 99,869 In 2013: Transplants performed Total number of kidney transplants: 16,893 Deceased donors: 11,161 Living donors: 5,732 Organ Procurement and Transplantation Network

10 Followup while on the wait list Maintain contact with the center Keep them informed of any changes medical, social and / or financial Follow-up visits: at least yearly Update testing

11 Finally get transplanted!!!

12 Staying healthy with a kidney transplant Looking after yourself AND Looking after the kidney

13 At increased risk Heart disease Infections Cancer Diabetes

14 Heart disease High risk after kidney transplantation Some Risk factors: Diabetes High blood pressure Untreated high cholesterol Cigarette smoking Being overweight Reduced kidney function

15 High Blood Pressure Checked at each visit Monitor at home Check with your doctor for your recommended range Know when to call your doctor Take your meds Lose weight if needed Watch your salt intake Regular exercise

16 High Cholesterol At risk for high cholesterol levels, which can clog blood vessels

17 High Cholesterol Recommended medication: STATINS Work with your transplant doctor Take your meds Lose weight if needed Watch your diet- calorie and fat intake Regular exercise Educate yourself

18 Maintain a healthy weight High Blood pressure Overweight Diabetes High cholesterol High risk for heart disease

19 Goals? Obesity Weight checked at each visit BMI= Body Mass Index Overweight - BMI of 25 to 29.9 Obese - BMI 30 Waist circumference important Men are at risk if > 40 inches (102 cm) Women are at risk if > 35 inches (88 cm)

20 Diabetes Diabetes, especially if poorly controlled puts you at increased risk for: Heart disease High blood pressure Stroke Vision problems Circulation issues Poor wound healing

21 Control Diabetes Work with a diabetes specialist Check your blood sugar Work to control your blood sugar daily Take medications /insulin Educate yourself Lose weight if needed Follow your recommended diet Regular exercise

22 Reducing your cancer risk

23 Skin and lip cancers Common after transplant Increased risk Age Prior history of skin cancers Exposure to sun over time Fair skin Long-term use of medications that prevent kidney rejection

24 Preventing cancer Know the signs and symptoms Seek your physician s advice promptly Avoid sun exposure; use sun screen year round Stop smoking Follow the current recommendations for cancer screening Know your family history of cancers and let your team know

25 Protect your skin!

26 Reducing your infection risk

27 After transplant Your immunosuppressant medications make your body's immune system less active Harder to fight off infections Fifty percent of transplant recipients get an infection during the first year Infections can be mild to life-threatening Your risk for infection usually lessens over time

28 Reducing infection risk Improve your overall health Maintain good nutrition and balanced, healthy eating Get your vaccinations as recommended Ask your transplant team about children and others in the household Wash hands often and well with soap Careful with long nails Monitor yourself and temperature if needed Report promptly to the transplant center

29 Reducing infection risk Avoid contact with people who have an active infection Report without delay if: any new symptoms Fever, nausea, vomiting, diarrhea Not feeling well Redness, oozing or tenderness of a sore; Any changes in moles Prolonged colds, coughs Take all antibiotics or anti-viral medications as ordered

30 You should: In Summary Be seen by your transplant team on a regular basis and follow their advice Take your medications Take your anti-rejection medications daily in the proper dose and at the right times Follow the recommended schedule for lab tests and clinic visits to make sure that your kidney is working properly Follow a healthy lifestyle including proper diet, exercise, and weight loss if needed

31 Takes a team effort to keep you and the kidney transplant healthy!

32 Kidney Transplant Team at Advocate Christ

33 Ning Ramos: An asset to our team

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36 National Kidney Foundation of Illinoishttp:// United Network for Organ Sharing Gift of Hope Organ and Tissue Donor Network

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38 Infection Recommended vaccines post-txp DPT H.influenza B Hepatitis B Hepatitis A (if travel to endemic region) Pneumovax (+ q 3-5 years) Inactivated polio Influenza A, B annual Meningococcus: if high risk Typhoid Vi

39 Contraindicated Vaccines Varicella zoster BCG Smallpox Intranasal influenza Live oral typhoid Measles (except during outbreak) Mumps Rubella Oral polio Live Japanese B encephalitis Yellow fever

40 Pregnancy in transplantation Counsel about contraception Wait 1-2 yrs post txp, to ensure stable graft function and immunosuppression Limited data National Transplantation Pregnancy Registry (NTPR) MMF - increased risk of birth defects and miscarriages, low birth weight and prematurity Cyclosporine impaired immune function