Kidney Transplantation - Medical Questions
What are the common medical complications after kidney transplantation?
Common medical complications are infections, electrolyte problems, high BP, diabetes, anemia and kidney not working well after transplantation. Infections include - bacterial infections involving wound, urine, lung and blood. Viral infections such as CMV, BKV and EBV are also common after transplantation. Rarely fungal infections can occur. Weight gain and bone disease including osteoporosis are also common. Occurrence of cancers such as skin, cervical cancer, lymphoma and cancer of the native kidneys are also common after transplantation. Cardiac problems including heart attack, heart failure and arrhythmias can occur after transplantation.
What medications are required to prevent rejection after transplantation?
Patients will be receiving 2 or 3 medications after transplantation to prevent acute rejection. Common medications are Cellcept or Myfortic (available in generic), Prograf, also known as - Tacrolimus (available in generic) and Prednisone. Some centers will manage patients without any maintenance prednisone.
What medications are required to prevent infections after transplantation?
All patients will be on Bactrim for the prevention of rare pneumonia (Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP). In case a patient is allergic to sulfa drug, he/she will receive Dapsone or Pentamidine (inhalation) as an alternative agent to prevent PJP/PCP infection. Patients will also receive either acyclovir (or Valtrex) or valganciclovir (valcyte) for 3 or 6 months after transplantation. Transplant center will determine the agent and duration of treatment based on patients risk profile.
What is CMV infection? How do you prevent and treat CMV?
CMV infection can occur in 10-20% of kidney transplant patients. This can be some what prevented by taking Val ganciclovir (valcyte) for 3 or 6 months after transplantation. CMV infection again will be treated with valganciclovir (Valcyte) for few weeks at a higher dose.
What is BKV infection? How do you prevent and treat BK virus infection?
It is not possible to prevent this infection. It is important to identify this infection early on by periodic blood and urine testing. Each center will have a scheduled screening protocol. Screening usually is more aggressive during the 1st 6 or 12 months post transplant and taper over 2 or 3 years post transplantation. There is no specific treatment available for treating BKV infection. Common treatment used is reduction in doses of maintenance immunosuppression (Cellcept, tacrolimus and prednisone).
What is EBV infection? How do you prevent and treat an EBV infection?
EBV infection can occur in up to 10% of kidney transplant patients. This may be prevented by taking acyclovir or valganciclovir (valcyte) for first few months after transplantation. EBV infection is usually treated with acyclovir (or Valtrex).
Can my kidney disease return back after kidney transplantation?
Certain kidney disease such as FSGS, IGA nephritis, Membrano Proliferative Glomerulonephitis (MPGN), Membranous nephropathy, HUS-TTP can recur in the transplanted kidney. Some of them can recur very quickly after transplantation and in some it may recur years after transplantation. Patients are advised to discuss this issue with the transplant center.
What immunizations can I take or should not take after transplantation?
Transplant patients can take dead vaccines and should not take live vaccines. Examples of Live vaccines that should not be taken are: BCG for Tuberculosis, Oral polio, influenza (nasal), Herpes Zoster (Shingles), Measles, MMR, Rota virus , Yellow fever and Small Pox. Dead vaccines are DTaP, TDAP, Polio (injectable), Haemophilus influenzae type b and hepatitis A/B, Meningococcal. All patients should discuss with their doctor before taking any vaccine.
Can my family members take immunization?
Family members can take any of the dead vaccines. However, if family members take live vaccines - transplant patient should not have close contact up to 4-6 weeks after vaccination.
When can I travel after kidney transplantation?
Travel can be going back home which is away from the transplant center or travel for personal reasons (family or vacation). Travel time after transplantation varies from one center to another. Transplant center in general recommend travel going back home in about 3- 6 weeks after transplantation once everything is stable and the wound has healed completely.
It is recommended that other travel such as personal, work related or vacation may be delayed at least 3 months after transplantation till everything is stable.
Despite travel needs, all transplant patients will require very close follow-up including labs and MD visits (at the center or with kidney doctor) for the first few years, perhaps indefinitely after transplantation.
Patient to discuss with the transplant center about their travel.
What is the safe time for pregnancy after kidney transplantation?
In general it is preferable to avoid pregnancy at least 1 year after transplantation. Patients should have stable kidney transplant function, good BP control and absence of any infection before planning for pregnancy. Patient to discuss with the transplant center about questions related to pregnancy.
What contraception is ideal after transplantation?
It is recommended to use double contraception as immunosuppressive medications can pose problems to babies. Barrier methods such as condoms are very safe but may not be sufficient by themselves. Patients can use intra-uterine devices, injectable depot hormone preparations or oral contraceptives which are all acceptable. Patients are advised to discuss this issue with their primary care MD or Gynecologist or Transplant team.
Will I gain weight after transplantation?
All patients will gain approximately gain 5-10% of body weight within 1 year post transplantation. Some patients may gain more weight during the first few years. Prevention of substantial weight gain is important. Regular physical activity and diet are mandatory to prevent weight gain. Weight gain is associated with increase in BP, development of diabetes, high cholesterol and subsequent heart disease.
Will I develop diabetes after kidney transplantation?
Approximately 10-15% of patients develop diabetes after kidney transplantation.
Will I need more medications for diabetes after kidney transplantation?
Patients who have had diabetes prior to transplantation will continue to have diabetes after transplantation. Medications requirements including insulin dose will increase once patient has a functioning kidney transplant.
Will I develop high cholesterol after kidney transplantation?
Approximately more than half of the transplant patients will require cholesterol medication after transplantation. This may be due to prior cholesterol issues, post transplant medications (prednisone, cyclosporine, rapamycin, tacrolimus), improvement in appetite after transplantation, presence of diabetes and heart disease.
What kinds of cancers are common after kidney transplantation?
Skin cancers (both squamous, basal cell, melanoma), cervical cancers, lymphoma and cancer involving native kidneys are common after kidney transplantation.
What precautions I should take to prevent cancers after kidney transplantation?
All Caucasians should follow with a skin doctor regularly. In addition, avoiding sun exposure and use of sunscreen are necessary to prevent skin cancer.