Frequently asked questions about Kidney Trasplant
Blood tests are especially important to monitor creatinine values and glomerular filtration rates (parameters that measure kidney function), the presence of proteinuria (an excess of protein in the urine), and levels of immunosuppressive drugs.
Normal creatinine figures are less than 1.2–1.5 mg/dl, although a kidney with higher figures can function perfectly for many years. Each patient will have different creatinine figures depending on the type of donor and the patient’s own characteristics. It is also normal for creatinine figures to fluctuate slightly at each check-up. If these fluctuations are significant, the nephrologist will indicate what should be done.
It is important for the patient to periodically measure their blood pressure, monitor their diuresis (volume of urine produced) daily, and check for the appearance of oedema (ankle swelling), so that these details can be discussed at their check-up visits. If the patient notes a sudden decrease in the amount of urine they produce, they should go to the emergency room.
After the transplant, the kidney may or may not produce urine immediately. When the kidney begins to produce urine in the transplant operating room, it is called immediate diuresis. Kidney function will improve progressively and quite quickly.
When urine is not produced immediately, it is usually due to acute tubular necrosis, that is, the death of kidney tissue cells. This alteration is produced by damage caused to renal tissues during the extraction, preservation, and transplantation period (ischemia-reperfusion damage). Normally this damage is limited, and the kidney recovers spontaneously, although kidneys sometimes show delayed graft function which requires some temporary dialysis until the kidney begins to function.
During a biopsy, the kidney is punctured to extract a sample and examine it under a microscope. It gives doctors information about the state of the kidney that other imaging tests such as radiography or analytics do not provide, and so it can help in decision making. Biopsy usually requires a 24-hour hospital admission and is performed by ultrasound and under local anaesthesia. It is especially important to rest for a few hours after the biopsy (8–12 or 12–24 h, depending on the patient’s characteristics) to avoid complications.
A biopsy is generally performed when there is a medical indication because of protein loss in the urine or an increase in creatinine levels. Protocol biopsies are performed when no alterations in the analyses are detected in order to detect potential asymptomatic abnormalities and to adjust the patient’s treatment.
After transplantation, it is advisable to monitor the amount of urine produced daily so any sharp drop can be detected, and to monitor blood pressure and body weight.
If you do not feel well, you should take your temperature to check for a fever and consult your doctor.
It has been shown that tobacco is very harmful to everyone and that transplant patients are even more sensitive to smoke, meaning that they have a higher risk of developing lung or laryngeal cancer and an increased risk of cardiovascular disease (myocardial infarction, stroke, aortic aneurysm, or arteriosclerosis in the legs). Tobacco has also been shown to shorten the lifespan of the grafted kidney. Smoking marijuana or any other type of drug is also strongly discouraged.
You can drink 1 or 2 coffees a day if you do not have heart disease or heart rhythm disturbances, although drinking caffeine after 5:00 p.m. can interfere with night-time sleep.
Arteriovenous fistulas are not closed according to a fixed schedule. Each case will be evaluated individually according to the risk of rupture, the presence of pain, or heart overloading. In some cases, the fistula ends up becoming thrombosed and the patient notices it because they feel the resulting thrill and the fistula feels hard, painful, and is sometimes red. In this case, the patient should consult their doctor.
The peritoneal dialysis catheter is usually removed during the same surgical procedure as the transplant.
The venous dialysis catheter may be temporary or permanent. Temporary catheters will be removed (by the ward nursing staff) before discharge if the transplant is working properly. Permanent catheters are fixed under the skin and so will be removed by the staff at the Functional Unit for Vascular Access (FUVA) at a scheduled appointment. The patient must attend regular check-ups (at the out-patient day hospital infirmary and external consultations) up until the time of withdrawal.
It is best not to get vaccinated during the first six months after transplantation.
After six months, there is no contraindication for vaccination with inactive viruses or bacteria such as influenza, tetanus, pneumococcus, whooping cough, hepatitis A or B, salmonella, meningococcus, or parenteral poliomyelitis.
Live or attenuated bacteria or virus vaccines (measles, rubella, mumps, chickenpox, yellow fever, oral polio, oral typhoid fever, or bacillus Calmette-Guerin for tuberculosis) are contraindicated in people who have received a kidney transplant because these can cause disease in these patients.
Your specific situation will always be evaluated.
Patients wishing to travel to tropical areas should always get additional information specific to transplant patients at their hospital’s traveller care centre.
It is also important for the relatives or caregivers of transplant patients to get vaccinated every year against the flu to avoid contagion.
In general, the quality of life of patients who have received a transplant is higher than that of patients on dialysis given that they feel physically and emotionally well and because they are no longer dependent on dialysis.
Sometimes complications appear which prevent patients from feeling good. Patients may also fear rejection and having to re-start dialysis which can also dampen their enjoyment of the moment. In short, patients may feel insecure. These are all normal experiences as long as they are not exaggerated. As time goes by, you will gain more confidence in the new situation. If, on the contrary, you feel that you are not starting to feel more confident, ask your doctor or nurse for help. Sometimes low spirits and sadness when facing any sort of event can indicate depression, which can be treated. Professional support, along with support from the patient’s family and social environment is important.