Keeping Healthy Post Transplant

If you are well and the kidney function is stable, you will usually be discharged home between one and two weeks after the transplant.

After the first six to eight weeks following transplantation you will be monitored once a week, and then in time less frequently. Once you are several years after your transplant, you will generally be seen on a three to six monthly basis – but you will never be discharged.

Despite many years of function, kidneys do deteriorate and the purpose of the outpatient appointment is to monitor the function of your kidney and those factors that will improve the long-term survival of the kidney and your life. These include your weight, blood pressure, the lipids (fats) in your blood, bone disease, heart disease, prescribed drugs and so on. Attendance at outpatient clinics is essential. A lot has been invested in you, not only by your family and your transplant team but also the donor family who have given their loved one’s kidney to you, and it is your responsibility to treasure that gift.

Not taking immunosuppressive drugs as prescribed is a problem which is probably far more common than even doctors are aware of. Every transplant centre has patients who lose their transplant because of this completely avoidable factor. If the drugs that you are taking are causing some problems, talk to your doctors about changing them rather than stop taking them. Your doctor will not insist that you take a drug which you find unpalatable, or causes unacceptable side effects. Monitoring you after transplant is a partnership between you the patient, the transplant unit staff and your GP. If you feel depressed, or have other problems, then contact the transplant unit staff at any time to discuss your concerns and make an appointment with the St George's renal counsellor. Most patients use this facility at some time or other.

Your GP is responsible for the overall care for you and your family, so he or she is very important in monitoring and managing your general health. Many patients and their GPs are happier for much of the care after transplant to be controlled by the transplant centre. However, there is a three-way partnership between you, your GP and the transplant centre staff to try and maintain your good health. The transplant centre should be in regular contact with your GP via your discharge letters and clinic letters, informing the GP of changes in drug prescription, your kidney function and general health.

High blood pressure is a common feature of kidney failure, both before and after transplantation, and the management of this is often a shared partnership between the GP and the hospital doctors. It is important that you participate in this by measuring your blood pressure yourself if you have a machine, or have your blood pressure checked by the nurse at the GP practice. Many GPs and hospital transplant centres run “healthy lifestyle” clinics which are there to monitor and advise you on improving your general health.

Some patients are more comfortable in attending the transplant centre clinic rather than going to their GP if they have a problem. This is understandable and arrangements usually allow for this. However, your GP is the first port of call in an emergency situation. In some areas, GPs will prescribe your immunosuppressive drugs for you, but in other areas your drugs will be supplied by the hospital. Home delivery service of the immunosuppressive drugs has become more available in some areas, and this may be appropriate for you once you are stabilised on a settled dose of your medication.

The immunosuppressive drugs can increase the risk of developing certain cancers, the most common being skin cancer. It is particularly important to avoid excessive exposure to the sun by avoiding sunbathing. Most skin cancer is treated by localised excision
More serious is the risk of cancer of the immune system (lymphoma). The risk of developing this form of cancer exists during the lifetime of the transplant whilst you are taking immunosuppressive drugs, but the overall risk is small.

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