Long Term Management

Eating right: your nutrition and diet

Good nutrition is an important part of the recovery process. A common problem after transplant is weight gain. Prednisone will increase your appetite, especially for sweet, sugary foods. Plus, you may be tempted to indulge in foods you were restricted to eat while on dialysis. Moderation is the key to your eating habits after a transplant. A dietitian is available for consult to help you develop a specific individual nutritional plan.

A few warnings about food after your transplant

• Prograf, Neoral, and Prednisone can increase your blood sugar. Some individuals will become diabetics once they are on these medications. If you are already a diabetic on insulin, your insulin requirements will increase. If you are a diabetic on oral medications or diet control, it is possible you will require insulin after transplant. If you have a strong family history of diabetes or are overweight, you also are at increased risk for diabetes after transplant. Symptoms of diabetes include an increase in thirst and frequency of urination, blurred vision, and confusion. Please notify the transplant team immediately if you develop these symptoms.
• Prograf and Neoral can increase your potassium. Some individuals will be required to monitor their potassium intakes. Some individuals will also require medication to keep their potassium normal.
• Prograf and Neoral can deplete your magnesium. Some individuals will be required to take magnesium supplements after transplant.
• Rapamune may increase your cholesterol. We will monitor this with your labs. You may need to take medication to reduce cholesterol.

Exercising

After transplant it is recommended you participate in a regular exercise plan. We encourage you to start exercising in the first 2 to 4 weeks post-transplant. Discuss your exercise plan with your doctor before you start.

• No lifting more than 10 pounds for the first four to six weeks post transplant
• No sit-ups for the first six months post transplant. Sit-ups can cause hernias in the incision if done too early.

Caring for your skin

1. Prednisone and other medications cause transplant recipients to have an increased risk for skin cancers. Avoid extended exposure and wear a sunscreen lotion of at least SPF 15 while outside. Remember sunscreens wear and wash off with swimming and sweat. You may have to reapply lotion often.
2. Prednisone can cause acne on your face, shoulders, chest, or back. If you develop acne it is recommended you wash the affected area three times per day with a mild cleanser.
3. Dry skin can also become a problem for some transplant recipients. Use mild soap with body lotion after bathing.
4. If you are taking Prednisone your skin will not heal as quickly as it once did. Minor cuts and scrapes should be washed with soap and water daily. An antibiotic ointment may be applied with a clean bandage. Report any redness, swelling, or drainage to your transplant team immediately.
5. Prednisone can affect the condition of your hair. Perms, permanent hair dye, tints, and bleach make hair brittle and break off. Use a good conditioner and advise your hairdresser you are on medication that can affect the condition of your hair.
6. You may experience excessive hair growth due to cyclosporine/neoral. Hair removal creams (depilatory), bleaching, waxing, and electrolysis are options you may want to use to remove or hide excess hair growth. Remember to follow directions carefully when using these products.

Caring for your teeth

You will need to have regular dental checkups and cleanings. If you experience any dental pain you need to contact your dentist immediately. You will need to take antibiotics before any dental work and cleanings. Please inform the transplant team or primary care physician of your dental appointment at least 5 to 7 days in advance.

Caring for your surgical incision

Good hygiene is essential in the immunosuppressed transplant recipient. It is important to clean your incision with soap and water on a daily basis. You may even be asked to shower twice a day to improve the healing of your incision. If you notice any thick, foul-smelling drainage from your incision, if the area around your incision is red or warm to the touch, or if there is any widening or opening of your incision, contact your transplant team immediately.

Using alcohol

Do not drink alcoholic beverages. Alcohol and some of your medications are broken down by the liver. Mixing alcohol and your medications can lead to liver damage. The medications that are broken down by your liver are Cyclosporine, Neoral, Prograf and Imuran.

Smoking

It has been determined by the Surgeon General that smoking can be harmful to your health. It is recommended that you do not start smoking after transplant. If you already smoke, it is strongly recommended that you stop smoking.

Driving and returning to work

This will depend on your recovery, and length of recovery is individualized. The usual time for returning to work is 4 to 6 weeks. For driving the usual time is 4 weeks.

Traveling and immunizations

If you plan to travel please let your transplant coordinator know ahead of time. Foreign travel may require immunization. Transplant patients can not receive live virus immunizations (small pox, measles, etc.). Ask your transplant team to send a letter to your local passport bureau stating that you cannot receive these vaccines. Because you are not immunized, some foreign travel may not be safe for you.

Sexual activity

You may return to sexual activity as soon as you feel well enough. Like driving and working, this is dependent on your recovery period. You may discuss any problems or concerns you have with your transplant team at your clinic appointments.

Becoming pregnant

There have been a number of successful pregnancies among women who have had kidney transplants. Pregnancy may cause special risks for the baby and the transplant recipient. Women should avoid pregnancy for one year following transplant and any attempt to become pregnant should first be discussed with the transplant team. You should also discuss with your transplant team which method of birth control you would like to use.

Finding support

Receiving a transplant can be a stressful, overwhelming experience. Keeping yourself and your new kidney healthy is a lifetime commitment. You are not alone. The transplant center has monthly transplant support group meetings, and transplant social workers are available to help with support programs and coping.