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«Introduction 04 Kidney transplantation 05 Before the transplant 11 The kidney transplant operation 14 Going into hospital 24 Transplant medications ...»

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Expected survival of the kidney transplant Kidney transplants do not last as long as healthy kidneys and many people with kidney failure need more than one transplant in their lifetime. About 80 out of 100 kidney transplants from deceased donors will still be working five years after transplantation. For kidneys from live donors, about 90 out of 100 kidney transplants will still be working five years after transplantation.

22 The lifespan of a kidney transplant is quite variable as it depends on the age of the donor, the health of the donor, and many other factors such as your age and other medical problems. Ask your kidney doctor and transplant surgeon if you have more questions about this. Individual risks will be discussed with you before you are entered into the deceased donor pool.

Other issues around transplant risks

• The risk of death after a kidney transplant is low, and in the longterm is lower than staying on dialysis. About 95 out of 100 patients who have a kidney transplant are alive one year after the transplant.

–  –  –

24 How much notice will I be given about when the transplant will take place?

If you are having a deceased donor kidney transplant the transplant team will contact you by telephone and you will need to go to Guy’s Hospital immediately. All kidney transplants are carried out at Guy’s Hospital. If you are waiting for a deceased donor kidney transplant

it is important that you:

• Tell your partner, close family or main contact person(s)

• Plan in advance who will look after any dependents including pets

• Have a bag ready with toiletries, night clothes and information about all the medications you are taking

• Plan how you will get to Guy’s Hospital, particularly at night and during the weekend If you do get the call to have a transplant, you should go to Richard Bright Ward, 6th floor, Borough Wing, Guy’s Hospital. The nearest station is London Bridge train and underground station. You should not eat or drink unless advised otherwise by the transplant team.

If you are having a living donor kidney transplant you and your donor will be able to plan the date of your surgery with your transplant team.

–  –  –

What about my dialysis treatment?

If you have haemodialysis the transplant team will arrange dialysis for you before your transplant.

If you have peritoneal dialysis (PD) you should continue with your exchanges until the operation. Just before the operation you will be asked to drain out and cap off. Your PD catheter may be removed during your operation. If not it will be removed when we are sure your transplant has been successful (usually between three and 12 weeks later).

What tests will I have when I come into hospital?

It is very important that you are fit and have no infections before you have your transplant. It is also important that you tell your transplant team if you have, or have recently had, an infection or a cold. They will then decide whether your transplant should go ahead. Withholding this information may increase your risk of complications after your transplant.

26 Before your transplant you will

have blood tests to check that:

• You are still compatible with the kidney you are going to receive

• You are fit to have an anaesthetic

Other tests include:

• An electrocardiogram (ECG), which records the rhythm and electrical activity of your heart.

• A chest x-ray.

You may also have other blood tests. The doctors and nurses will give you more information about this. They are happy to answer any questions and explain anything you do not understand.

The transplant surgeon will see you and talk to you about the surgery in detail. The surgeon may need to talk to you about any medical problems that the donor had.

–  –  –

You will be given pain relieving medication during the operation.

This will continue when you go back onto Richard Bright Ward for as long as needed.

You may also need dialysis for a short time after your transplant until your new kidney starts working. This is more likely if you have had a deceased donor transplant.

How will I be monitored after my transplant?

You will have blood tests every day to check your kidney function and levels of antirejection medication. The team will also keep a close eye on your blood pressure, temperature and fluid balance.

28 When will I go home?

You will usually be in hospital for five to ten days. If you have a pancreas and kidney transplant you are likely to stay in hospital for two to three weeks.

What will happen after I leave hospital?

After discharge you will have a follow-up appointment at your transplant clinic within one or two days. We will give you the day and time of the appointment before you leave hospital.

After receiving your new kidney you will need to attend the transplant clinic three times a week for the first month, then twice a week for the second month, then once a week until four months. These clinic appointments are important because your risk of transplant rejection or infection is highest during the first few months and the transplant team will need to monitor you closely.





What about my transplant medications?

You will be given your new medications to manage yourself while in hospital, so that you will feel confident about managing your medication at home. Before you go home the ward nurses will give you written information about your new medication, including when and how to take them. Please ask if you are uncertain about any of 29 the medications you are taking.

When you leave hospital you will be given enough medication for at least two weeks. After this the hospital will continue to provide your anti-rejection medication, either through collection from the on-site hospital pharmacy or a home delivery service. Ask your local transplant team for details specific to your hospital.

When you come for your first transplant clinic appointment, please remember to bring all your medication with you. This includes those prescribed by the transplant team, those prescribed by your GP and any that you may have bought for yourself from the chemist. After your first visit you must bring an up to date list of your medication with you to every clinic appointment. We need to keep an accurate record of all your medications and we will also advise you about which medicines you can and can not take.

Please make an appointment with your GP as soon as possible after leaving hospital because your GP will need to prescribe everything other than your anti-rejection medication. It is important that you do not run out of medication. The transplant team will keep your GP updated about all your medications and will notify your GP of any changes.

30Transplant medications

31 After your transplant you will be taking a variety of new medications. Some medications may only be required for a short time or the doses may vary. Others may be required for the rest of the life of the transplant. If you have any side effects or other problems with your medications please talk to your transplant team. You must not stop taking any medications prescribed for you without first talking to your transplant doctor or nurse. Please also read the manufacturer’s leaflet inside the pack for more information about side effects and interactions with other medications.

However, do talk to the transplant team first.

Anti-rejection medication (immunosuppressants) The body’s immune system recognises a transplanted kidney as ‘foreign’ and may try to attack it. When this happens rejection occurs. Rejection can happen any time after a transplant and to prevent this you will be prescribed immunosuppressant (antirejection) medication. It is essential that you take this medication exactly as instructed because your body’s defence system has a good memory and will never forget that the kidney is ‘foreign’.

If the anti-rejection medicines are ever stopped, your body’s defence system may attack and reject the transplanted kidney.

While you are in hospital you will be given this medication to take yourself so that you become confident enough to manage your medication at home.

32

Side effects of immunosuppressants include:

• An increased risk of infection.

• A greater risk of getting skin cancer. Check your skin regularly to be aware of any changes. Your transplant clinic or GP will refer you to your local skin clinic for an annual skin check.

Avoid direct sunlight on the skin. Always wear sun cream with a high sun protection factor (SPF) - at least 25-30 - when outside between March and October and when travelling in hot or sunny countries.

Most patients are prescribed the following

immunosuppression drugs:

• Tacrolimus

• Prednisolone

• Mycophenolate mofetil or mycophenolate sodium Not all of these medicines are suitable to be taken during pregnancy. If you are pregnant or are planning a pregnancy, please speak to your doctor.

If you are worried about any of the possible side effects mentioned, please speak to the kidney team. They will be able to give you further information.

–  –  –

Are there any side effects?

Always read the manufacturer’s information leaflet which is supplied with the medicine. Some common side effects are detailed below.

–  –  –

• Tacrolimus increases your risk of developing diabetes following your transplant.

• Tacrolimus can cause diarrhoea which may last more than a day.

If this happens please contact the transplant team for advice.

34

Certain tablets or food interfere with tacrolimus including:

some antibiotics; epilepsy medications; some heart tablets; oral contraceptives; some pain killers; over-the-counter medicines; herbal remedies; Seville oranges; grapefruit and grapefruit juice. Therefore you must always check with the transplant team before taking any new medications.

Different brands of tacrolimus may result in different levels of the drug circulating in your blood stream. Because of this it is important that once you have been prescribed a particular brand of tacrolimus you do not change to a different brand unless specifically told to do so by the transplant team.

Prograf® and Adoport® are different brands of tacrolimus. These brands of tacrolimus should be taken every 12 hours, for example at 9am in the morning and 9pm at night. By taking tacrolimus at regular intervals, the level of tacrolimus remains stable in your body.

Advagraf® is a slow-release brand of tacrolimus. It is taken once a day in the morning. This should be taken at the same time every day to ensure the levels of tacrolimus remain stable in your body.

Tacrolimus should not be taken with meals.

–  –  –

Are there any side effects?

Always read the manufacturer’s information leaflet which is supplied with the medicine. Some common side effects are detailed below.

–  –  –

• Ciclosporin can make your gums sore and swollen, so good dental hygiene and regular visits to your dentist are important.

• Ciclosporin may result in excessive hair growth. Please speak to your transplant team if this becomes a problem.

36 Certain tablets or food interfere with how your body handles ciclosporin including: some antibiotics; epilepsy medications;

some heart tablets; oral contraceptives; some painkillers; over-thecounter medicines; herbal remedies; Seville oranges; grapefruit and grapefruit juice. Therefore you must always check with your transplant team before taking any new medications.

Different brands of ciclosporin may result in different levels of the drug circulating in your blood stream. Because of this it is important that once you have been prescribed a particular brand of ciclosporin that you do not change to another brand unless specifically told to do so by the transplant team.

Neoral® is a brand of ciclosporin. Ciclosporin is taken every 12 hours, for example at 9am in the morning and 9pm at night. By taking it at regular intervals the level of ciclosporin remains stable in your body.

Sirolimus Sirolimus is rarely used as an anti-rejection treatment during the first few months after the transplant, but may be prescribed at a later stage for some patients. This is a different type of anti-rejection medication to ciclosporin and tacrolimus. You should not take your dose of sirolimus on the morning of your clinic visits until after your blood has been taken.

–  –  –

• Wounds and cuts may take longer to heal.

• It may raise your blood cholesterol levels.

Sirolimus has its own advantages and disadvantages. If your transplant team thinks you may benefit from taking sirolimus they will discuss this with you.

Do not eat grapefruit or drink grapefruit juice while taking ciclosporin, tacrolimus or sirolimus as this may affect your blood levels and may cause serious toxicity and side effects.

Prednisolone Prednisolone is a steroid used to prevent transplant rejection. It is a good anti-rejection medicine but it does have some side effects.

These can be a nuisance but are generally reversible. Your transplant team will try to minimise your dose of prednisolone to minimise these side effects. Where appropriate your transplant doctors will try to discontinue your prednisolone treatment within the first year following your transplant.

We do not recommend that transplant patients take enteric-coated prednisolone tablets, which have a red sugar-coating, because the absorption is less reliable than the non-sugar coated medication.

If your pharmacist supplies you with enteric-coated tablets, you 38 should ask them to supply you with the non enteric-coated ones.

Are there any side effects?

Always read the manufacturer’s information leaflet which is supplied with the medicine. Some common side effects are detailed below.

• Your appetite might increase and you may gain weight.

• The shape of your face may appear more rounded.



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