The nursing staff will make sure that you are comfortable and will monitor the transplanted kidney to make sure it is working well. When you wake up you will notice that you will have a number of different plastic tubes in your body, the most common ones will be: A tube in your neck to help us measure your fluid volumes and give you temporary dialysis if required. A small tube in your hand or arm to give you medications and pain relief. A plastic drain tube in your abdomen to help drain away any blood and fluid from the operation. A urinary catheter, a tube which passes up your urethra into the bladder, to help us monitor your urine output and allow the internal stitching to heal. Most of these lines should be removed after 2-3 days. The urinary catheter will remain for 5 days to allow the sutures to heal. During the transplant you will also have a small plastic tube (ureteric stent) placed between your new kidney and your bladder to help maintain the flow of urine. The stent will be removed after 6 weeks as a day case procedure using a local anaesthetic. Page 1
Recovering from the operation Eating and drinking is usually encouraged as little as six hours after the operation. Whilst you are in hospital, your transplant nurse will encourage you to record everything you drink and measure the urine you pass, even after the urinary catheter has been removed. This will help us to check how well the kidney transplant is working. On the first day after your operation your nurses will help you out to your chair for a few hours where you will be taught how to carry out deep breathing exercises. You will be encouraged to be mobile around the ward as soon as possible as this will help speed up your recovery and reduce your chances of getting a blood clot in the leg or a chest infection. You are likely to be in hospital for 6 to 10 days following a kidney transplant. However this could be longer depending on your condition and your doctor s opinion. Although you will be able to carry out daily activities when you get home, we advise you to rest for about 6 weeks and to allow a few months until you really get back to normal active work. Following discharge you will be seen in the outpatient clinic very regularly usually twice a week to start with. Looking after the new kidney Following your discharge from hospital, the transplant team will ask you to attend regular transplant clinics twice a week to monitor you for possible complications such as rejection or infection. If you were referred from another dialysis unit, your initial clinic visits will be at the Addenbrooke s Hospital outpatients department. However, once your doctors are happy with your progress they may refer you back to your local hospital; this is usually about three months after having had your transplant. In due course appointments will become less frequent. If possible, you should arrange your own transport to and from the outpatients department. It is important for you to recognise that caring for your kidney transplant is the best way of ensuring its success and keeping you free from dialysis. You can contact the transplant clinic on 01223 274 593 or 01223 217 452. Page 2
For further information on looking after the new kidney you can download our kidney transplant guide: Page 3
Possible complications You can minimise the risk of complications by following instructions carefully and keeping your transplant team informed of any problems that occur. Possible complications after having a kidney transplant may include: Problems associated with the kidney transplant operation: About 5 in 100 patients experience a urine leak where the donor ureter joins your bladder. This usually requires a return to theatre for an operation to have the leak repaired. About 5 in 100 patients experience internal bleeding which may require a blood transfusion and possibly a further operation to stop the bleeding or remove any clots that have collected. About 2 in 100 patients have a blood clot form in the vein or the artery of the new kidney. This means the blood supply to the kidney will stop. If this happens you will have to go back to theatre and, unfortunately, it usually results in the kidney having to be removed. There is a small chance that you could develop a lymphocoele (a collection of lymph (tissue) fluid). The fluid usually collects in a small pocket next to the transplant kidney and can block the flow of blood to the kidney or the flow of urine from the kidney. If this happens it will need draining. Following all surgery there is a risk of Deep Vein Thrombosis (DVT) clots forming in the veins of the leg. To prevent this happening you will be given injections of a blood thinning drug whilst you are in hospital. You will also wear surgical stockings to encourage the blood flow in your legs whilst you are less mobile. Problems associated with the medication taken after transplantation: There is a small chance that you could develop diabetes (raised blood sugar) as a side effect of your anti-rejection (immunosuppression) drugs. It is usually treated with a change in diet and/or tablets. Sometimes there is a need for insulin injections. High blood pressure is very common following a kidney transplant, particularly during the early months. Many people after a kidney transplant require blood pressure lowering drugs. It is vital to control high blood pressure as, if left untreated, you could be at risk of heart Page 4
disease or a stroke and it can damage the transplant kidney. The anti-rejection drugs will make you more likely to develop infections. The risk is greater in the early stages after your transplant because the doses of anti-rejection drugs are higher. It is important to inform your transplant team if you think you have an infection. If you know family or friends who have a serious infection it is a good idea if you avoid visiting them while they are unwell. About 1 or 2 in 100 patients will develop cancer as a result of the anti-rejection drugs you will take after your kidney transplant. In particular you will be more prone to developing skin cancers. For this reason we encourage you protect yourself from the sun by using powerful sun screens and avoiding direct exposure to the sun. Problems associated with organ transplantation: About half of all transplanted kidneys will experience delayed graft function. It may take several days for your new kidney to start working and you may need haemodialysis during this time. If your kidney takes more than a few days to start working properly or temporarily stops your doctors may take a tissue sample of the new kidney to see if you have rejection. Roughly 30 in 100 patients will experience acute rejection within the first 6 months of their transplant. Your body will recognise that your kidney is foreign and the natural response is to attack and reject it. You will be given anti-rejection medication to reduce the chance of this happening; these medications will need to be taken for the life of your kidney transplant. Rejection is treated by changing the dose of anti-rejection drugs and / or by prescribing a new drug in addition. As rejection can be detected following one of your regular blood tests it is critical that you attend your clinic appointments regularly. Some patients will experience anxiety and mood swings. The transplant operation can put a lot of stress on you and your family. It is very common for patients or relatives to have anxieties. There are counselling services to help you adjust to life at home. Please ask your transplant team for more information about these services. Page 5
Your medication After your transplant operation you will find that many of the medications you used to take will have changed. Don t worry, as during your stay the nursing and pharmacy staff will educate you on what to take, when to take them and why you need to take them. Following your transplant you will meet the specialist transplant pharmacy team who will help with the supply and education of your new medications in preparation for your discharge. The team consists of: Bridget Featherstone, Lead Pharmacist for Transplantation Kate Thorndike, Specialist Transplant Pharmacy Technician Pharmacist on the Transplant Rotation Once you have been discharged you will attend clinics in Addenbrookes on a regular basis. On the day of your clinic appointment: Please bring all of your medications with you. Please ensure that you don t take your tacrolimus (Advagraf, Adoport or Prograf), Ciclosporin (Neoral) or Sirolimus (Rapamune) medication until you have had your morning bloods taken at the hospital. If you are readmitted to hospital please also bring all of your medicines with you. Unfortunately we are not able to use medicines on the ward from a dossette box, so it is more helpful if you bring medicines in original containers. Obtaining Further Supplies of Valganciclovir and Immunosuppressant Medication i.e. Tacrolimus (Advagraf, Adoport, Prograf), Ciclosporin (Neoral), Sirolimus (Rapamune), Azathioprine, Mycophenolate and Prednisolone. NHS England has directed that the prescribing of immunosuppressants for transplant patients should be done by the doctors at the hospital s transplant clinic rather than the GP surgeries. A scheme has been set up at Addenbrookes to facilitate this. All newly transplanted patients will be included in this scheme. The scheme will be explained to you after your transplant. For older transplant patients we plan to gradually transfer the prescribing and supply of the immunosuppressant medication (a process known as repatriation ) from the GP to the hospital over the next year. We shall contact everyone individually about this. It is important that you continue to get your immunosuppressants from Page 6
your existing source until you are told otherwise Should any issues arise with obtaining further supplies of immunosuppressant medication, whilst you are under the care of Addenbrooke s you can contact the transplant pharmacy team either by email transplant.pharmacy@addenbrookes.nhs.uk or by leaving a message on 01223 254934 Obtaining Further Supplies all other medication i.e. anything that is not Valganciclovir or Tacrolimus (Advagraf, Adoport, Prograf), Ciclosporin (Neoral), Sirolimus (Rapamune), Azathioprine, Mycophenolate and Prednisolone. Please arrange further supplies from you GP Page 7
Dietary info One of the benefits of a successful kidney transplant is that you can enjoy a more varied diet. Potassium Successful transplants should mean that your previous potassium restriction is relaxed. Your dietitian and doctor can further advise you about how to reintroduce high potassium foods, such as bananas, coffee, nuts and chocolate. When you have been advised you can reintroduce potassium containing foods, be sure to do this gradually for example, one new item a day and not everything all at once. Phosphate Phosphate binders are stopped after a kidney transplant and you should no longer need to follow a phosphate restriction. Calcium Long term steroid use can weaken your bones and increase the risk of fractures. Sufficient calcium intake may help prevent this. Good sources of calcium include milk, cheese, yoghurts, tofu, calcium-enriched soya products (choose lower fat options if you are conscious of your weight). Salt Continuing to follow a no added salt diet is recommended to help prevent high blood pressure. Avoid adding salt when cooking or at the table, instead you could try using pepper, herbs, spices, lemon juice, vinegar etc which will not affect your blood pressure. Grapefruit After a transplant you should avoid eating grapefruit or drinking grapefruit juice because grapefruit interferes with the levels of the anti-rejection medication. You should also check things which may contain grapefruit such as mixed fruit juices. For more information download the patient information leaflet: Page 8
Clinic info Day Clinic number Time Monday 12 9-11:45 Wednesday 5 9-11:45 Thursday 12 9-11:45 Bring your post-transplant medication list and a urine sample. Do not take your morning immunosuppression for that day until you have had your preclinic blood test. Clinic 12: telephone: 01223 217 452 or clinic12@addenbrookes.nhs.uk Clinic 5: telephone: 01223 216 217 or clinic5@addenbrookes.nhs.uk Page 9