OSF Saint Francis Medical Center

Peoria, Illinois

Post-Transplant

Transplant Medications

A transplant patient must take medicine to prevent the immune system from rejecting the new organ. Anti-rejection medicine must be taken exactly as prescribed by your transplant surgeon and transplant nephrologist. These drugs help protect your organ from damage by your immune system. You will need to take these medications as long as you have your transplant.

One of the most important keys to success after transplant is to make sure and take your medicine as ordered by your physicians. You are responsible for taking your medicine as directed. Any questions or problems that you may have can be directed to your physicians, transplant coordinator, or pharmacist. In addition to your anti-rejection medicine, you will also take other medications such as anti-viral medicine and anti-fungal medicine. Some of these medications will only be needed temporarily, but the anti-rejection meds will be long term. Blood pressure medicine may also be needed. Many patients will be instructed to take a low-strength aspirin as well as medicine to protect their lungs. Your transplant coordinator and pharmacist will help you learn about your new medicine.

The most common immunosuppressant or anti-rejection medications are Prograf (Tacrolimus), Cellcept/Myfortic (Mycophenolate mofetil), and Prednisone. They are strong medications and, like all medicine, may have some side effects. They are very important and can be expensive. It is imperative that you never run out of medicine. Please plan ahead and order medication ahead of time to avoid any problems or delays in receiving your medicine.

Follow-up Care

Following your transplant, you will be monitored very closely in the hospital. Length of stay after this procedure can vary greatly from patient to patient. Many patients spend between four to seven days in the hospital, depending on their recovery progress. Some patients need more time before discharge.

After discharge, patients typically need labs two to three times a week and see the surgeon weekly as needed in the office. Initially, all labs are done at OSF Saint Francis Medical Center in Peoria, but as your progress allows, you may get labs at a local facility. It is very important to get your labs drawn and keep your appointments as scheduled by your physician.

You may call the transplant office for questions or problems. If the office is closed and you have an emergent problem that cannot wait until the office opens, you may contact the kidney transplant coordinator on call by calling the operator at OSF Saint Francis. Before transplant, all medical problems should be directed to your nephrologist. After your transplant, the transplant surgeon and transplant nephrologist will manage your care for the first six months, and then you will follow with your usual nephrologist after you are six months post-transplant. In some instances, the transplant office will always manage your anti-rejection medication. Anti-rejection education will be provided at the time of transplant.

Diet and Nutrition

Healthy eating is an important part of your recovery. A dietician can help you develop a healthy diet that will assist in your recovery.

During the first few weeks after your transplant, your body may require extra calories and protein. Meeting your increased nutritional needs will help your body heal and fight infection. Even if your appetite is not strong after surgery, it is still important to eat. Think of food as another medicine to help you get well. Try eating several smaller meals a day rather than two or three large meals.

A low-fat, low-sugar diet can help you to control your weight and blood sugar. Eating right will help keep you at a healthy weight and in the best shape. Certain medications you may take may cause your blood pressure, blood sugar, cholesterol, and weight to increase. To help regulate these factors, it is important for you to limit your daily intake of saturated fat, salt, and sugar. Your use of salt may be restricted to help limit the amount of fluid your body holds and to control your blood pressure and blood sugar. Consult your dietitian about using salt, sugar, and fat in your diet.

Your diet should include a variety of foods, such as:

  • Five fruits and vegetables per day
  • Whole grain cereals and breads
  • Low-fat or non-fat milk and dairy products or other sources of calcium
  • Lean meats, poultry, and fish are good sources of protein
  • Sugar-free beverages

You should try and avoid:

  • Fried foods
  • Concentrated sweets
  • Processed or “convenience” foods.
  • In place of salt, consider using salt-free seasonings such as lemon pepper, garlic, onion powder, vinegar, and herb mixtures.

Psychological and Social Considerations

Transplant is a life-changing event—a day you and your loved ones won’t soon forget. Transplant programs have found that one of the indicators of successful transplant and subsequent long term survival is the presence of a stable support system for the patient. This support may come from a spouse, parent, close friend, or other family member. This person is expected to help the patient during the evaluation and in the critical time after transplant when the patient is unable to care for him or herself, and requires help to do well after leaving the hospital.

Both before and after transplant, it is important to be aware of psychological and social issues that may affect your recovery. It is imperative to have a daily routine that will help you adjust to your new kidney, stay healthy, and get back to the activities you enjoy.

During the transplant process, many people experience symptoms of anxiety and depression. Depression and anxiety are common for both patients and caregivers facing or recovering from a transplant. Some people have trouble adjusting to the transplantation and recovery process. The social worker can help you learn ways to cope with and process the transplant experience.

Signs of Depression

  • Trouble sleeping
  • Trouble concentrating
  • Eating more or less than usual
  • Feelings of sadness and guilt
  • Feelings of helplessness or hopelessness
  • Thoughts of death
  • Fatigue or low energy
  • Not enjoying or not engaging in pleasurable activities
  • Feeling restless or on edge
  • Felling more irritable

Signs of Anxiety

  • Excessive worrying
  • Inability to stop worry or feelings of anxiety
  • Trouble sleeping
  • Excessive fear and worry about death or dying
  • Feeling restless or on edge
  • Easily tired
  • Trouble concentrating
  • Irritability
  • Muscle tension
  • Increased physical problems

Adjusting to Your New Kidney

Adjusting to your new kidney or pancreas—and the lifestyle changes that come with it—will take some getting used to. Living a well-rounded lifestyle is an important way to manage your ability to cope with these changes.

Sleep

Getting enough restful sleep is one of the best ways to remain healthy because it gives your body a chance to recharge and replenish itself. When we are under stress, our body releases a hormone called cortisol that helps us cope with stress. When we are under stress for too long, cortisol builds up in our system and can negatively affect our mood and disrupt sleep and appetite. Therefore, it is important to have a regular sleep schedule that includes going to bed at roughly the same time each night and waking up at the same time. This will help your body relax and regain balance with hormone levels and various body systems. Many people also benefit from taking a short (20-30 minute) rest in the middle of the day as well. Aim for 8-10 hours of sleep each night.

Nutrition

Nutrition is an important part of your recovery. When we are stressed, depressed, or anxious, our eating habits often change for the worse. It is important to eat regularly and make healthy food choices to combat fatigue and increase your energy level. You will meet with the dietician to discuss specific options for your recovery, and it is important for you to follow the plan you develop in order to heal faster and to feel better.

Activities

Along with good sleep habits, being active is crucial to a speedy recovery and a healthy life. It is also a wonderful way to get rid of stress and ward off symptoms of depression and anxiety. Before you leave the hospital, consider how you are going to be able to incorporate activity into your schedule at home. Exercise works best if it involves activities you like and if it is scheduled into your daily routine. Be sure to check with your transplant team for any exercise restrictions.

Many people enjoy playing sports and joining a club after work or school. This is a great way to get support from other people to stay involved and active. If you find yourself having a big drop in energy level or loss of interest in activities you once enjoyed, be sure to check in with the transplant coordinator, as these may be signs of depression. If these signs are not due to a medical concern, your coordinator will contact the social work team members to address these changes.

Helpful Hints

After transplant, your new routine will be much different than it was before surgery. Sometimes, following a set schedule and routine can be difficult. Below are some helpful tips to make it easier to follow the new schedule.

  • Set an alarm, either on a wrist watch or cell phone, to remind you of things you need to do.
  • Have another person check in with you.
  • Make a check-off sheet every day so you remember that you’ve completed every task you needed to get done.
  • Set a goal for the week and reward yourself for accomplishing your goal. For example, if you exercise, eat well, and take all of your medicine, you can buy a new book or do something special with your spouse or friend. Please remember rewards should not be food-oriented.
  • Finally, remember that your transplant team is here to help you. We can’t help you unless we know how you want us to help, so always let us know when you need something.

It is our expectation you will return to work, volunteering, or other daily activities you enjoyed pre-transplant. Transplant is not a condition but rather a treatment option that is offered to improve your quality of life.

Organ Rejection

Organ rejection happens when your body's immune system recognizes something that does not belong in your body and tries to protect you by destroying it. Because rejection is the most common complication after a kidney or pancreas transplant, it is important to get blood tests at least two times a week after a transplant for the first six to eight weeks after your surgery. These blood tests can help the doctor understand how well your kidney and immune system are working. There are two types of rejection:

Acute Rejection

When this happens, your body has a sudden reaction against your transplanted kidney or pancreas. If this occurs, it is usually in the first few months or through the first year after surgery. If it is detected and treated early, good kidney function will usually return. You may have to come to the hospital and get some additional tests. Sometimes the doctor will order an ultrasound, which shows pictures of your transplanted kidney. This ultrasound can tell how well the blood is circulating in and to your kidney. There are several other tests that may be done, but the doctor may order a transplant biopsy of your kidney or pancreas if the possibility of rejection is suspected. During a biopsy, a doctor will remove a small piece of the kidney or pancreas for testing. You will have to remain in bed for a few hours after the procedure. That piece of tissue is sent off to a lab, and the transplant coordinator will call you the next day with results. If it is rejection, the doctor will talk to you about a treatment plan. There are some special medicines that can be used. The best way to prevent acute rejection is to take all your medications exactly how you were instructed in the hospital. You must also tell us any problems you may have, such as a temperature over 100 degrees, weight gain of more than three pounds in a day, tenderness over your kidney or pancreas that is not from the incision, or just not feeling well.

Chronic Rejection

This type of rejection happens when there is a slow, gradual decline in how well your kidney works. This can happen over months or years. Because the process is slow, you may not need dialysis for a long time. The medications that stop acute rejection do not work as well for this type or organ rejection. You should still follow closely with your nephrologist who will continue to watch your lab work. Never stop taking your anti-rejection medicines without checking with the doctor.