RECOVERING AFTER A KIDNEY TRANSPLANT

After a prolonged and anxious waiting period on the kidney transplant waiting list, you have finally received a new kidney from a suitable deceased donor. Congratulations, now begins a new chapter in your life where you bear the responsibility of taking good care of this gift of life that you have been lucky to receive. Please remember, some donor, unrelated to you had to die for you to receive this kidney.

Generally, most patients either wake up in the post-operative recovery room or in the ICU, where they are closely monitored for not only how well the kidney is functioning but also other vital signs such as the temperature, heart rate and blood pressure. If everything is stable, oral diet with liquids followed by solid food is initiated in a few hours after the operation. The medications that will prevent rejection, known as immunosuppressive medications are begun in the peri-operative period. Most patients today receive three to four different medications. The risk of rejection is the highest right after the procedure and therefore all these medications are given in higher doses initially. As the days go by and the transplanted kidney is functioning well, the doses are slowly tapered down and you are then put on “maintenance” doses of the different medications. Each transplant center has its own policy regarding what combination of drugs they like to use, so please adhere to the ones they want you to take. In general, you will be on two or three oral medications for the rest of your life in order for the transplanted kidney to work well without any rejection episodes. In addition, there may be additions or changes to the already existing medications that you were taking prior to the procedure. Some medications may no longer be required and will be discontinued.

Early post-operative complications can sometimes occur. These include:

1. Allergic reaction to the general anesthetic
2. Bleeding – either in the urine (hematuria) which usually stops spontaneously or from around the anastomoses, that is where the renal artery and vein are sewn to the major blood vessels in the pelvis. This can cause a blood clot or hematoma which can press on the kidney and cause dysfunction of the graft. In most circumstances, surgery to evacuate this hematoma is required.
3. Leakage or blocked ureter - this is due to leakage of urine from the site where the ureter is sewn to the bladder, causing renal dysfunction. In most cases, inserting a urinary catheter into the urinary bladder will help with the healing but sometimes surgical intervention may be required.
• A blocked ureter is most likely due to a tight anastomosis or a blood clot within the ureter itself. Both these problems may need surgery.
4. Infections, mainly over the incision can be seen early after a transplant. This is called a surgical site infection and is more likely in obese, diabetic and elderly patients
5. Rejection or failure of donated kidney. Early rejections are uncommon because of the careful pre-operative matching processes that are now in place prior to any kidney transplant. However, they do occur and often need a biopsy to confirm that the dysfunction is from rejection. Treatments with high dose steroids or other special immunosuppressants such as thymoglobulin etc are started to save the kidney from becoming irreversibly damaged. Hyperacute rejection is due to the presence of pre-existing antibodies in the recipient which will lead to an immediate failure of the transplanted kidney, the treatment of which is to surgically remove the kidney.
• A phenomenon known as delayed graft function (DGF) is observed in a few deceased donor kidney transplants. It is defined as the need for dialysis within the first week after the transplant. There are many factors that can give rise to DGF but most kidneys do recover to then have a long half life.
6. Heart attack/stroke –especially if the patient has pre-existing severe vascular disease, diabetes or hypercholesterolemia or due to intra-operative complications such as excessive bleeding.