«Introduction 04 Kidney transplantation 05 Before the transplant 11 The kidney transplant operation 14 Going into hospital 24 Transplant medications ...»
• You may have mood changes if you are taking a high dose.
• Your skin may become thin and you may bruise more easily.
• You may develop acne (spots).
• You may develop high blood pressure and high cholesterol.
• Your blood may become thinner.
• You may develop diabetes.
• You may develop osteoporosis (fragile bones) in the longer term.
All transplant patients on prednisolone must carry a steroid card which details your steroid treatment. You must show this card whenever you see a doctor, dentist or pharmacist in case of an emergency. The pharmacy will give you your steroid card when you collect your medication.
Mycophenolate mofetil (Cellcept®), mycophenolate sodium (Myfortic®) and azathioprine Mycophenolate mofetil, mycophenolate sodium and azathioprine are anti-rejection drugs that all work in a similar way and patients can sometimes switch between them under the supervision of the transplant team.
• These drugs all suppress your bone marrow. This means you may have a low white cell count, anaemia or a lower platelet count and this means you will be slightly more vulnerable to infection.
• You may experience stomach cramps, diarrhoea or sickness.
Reducing the dose or sometimes changing the medication can reduce these side effects.
Mycophenolate is harmful in pregnancy. Women of child bearing age must use effective contraception during treatment.
You should not take allopurinol (a medication to prevent gout) if you are taking azathioprine unless specifically advised to do so by your kidney doctor. If you suffer from gout you should speak to your transplant team.
40 Other medication During the first few months after your transplant you will need to take several other medications as well as immunosuppressants.
Please refer to the manufacturer’s leaflet within the pack for information on side effects and interactions with these medications.
Nystatin mouthwash This mouthwash prevents oral (mouth) thrush. You need to rinse your mouth with this, holding it in your mouth for as long as possible before swallowing. This should be done four times a day after meals.
Ranitidine You will be prescribed ranitidine to reduce the risk of stomach inflammation from other medications.
Co-trimoxazole You will take this antibiotic during the first year to prevent a particular infection called pneumocystis pneumonia (PCP). This chest infection is caused by a common yeast or fungus called pneumocystis which is usually harmless to healthy individuals.
However, in individuals with immune systems weakened due to immunosuppressive drugs it can cause a severe pneumonia. Taking co-trimoxazole can prevent this, and can also prevent a number of other infections including urine infections.
Isoniazid This medication is used to prevent tuberculosis (TB) infection and is given to patients who have a high risk of developing it. When you are taking this medicine, you will also need to take pyridoxine.
Pyridoxine Pyridoxine is vitamin B6. This prevents one of the most common side effects of isoniazid – peripheral nerve damage or neuropathy.
Patients with this condition may experience numbness or pins and needles in the hands or feet, sensitivity to touch or muscle weakness.
Please tell the transplant team if you have been in contact with someone who has TB.
Sodium bicarbonate and phosphate supplements After your transplant your kidney may not be able to concentrate urine properly. It often takes a few weeks for this to settle down and during this period you may pass a lot of urine, particularly during the night. You may lose a lot of bicarbonate and/or phosphate in your urine and you may need to take supplements to replace this. If you have had a kidney and pancreas transplant you are particularly likely to need sodium bicarbonate supplements.
42 Valganciclovir and ganciclovir These drugs prevent and treat viral infections, particularly those caused by a particular type of virus called cytomegalovirus (CMV).
You may be prescribed one of these drugs depending on your risk of developing CMV or if the virus is detected during routine blood tests. You may need to take it for up to three months but please do not stop taking it without first talking to your kidney team.
Valganciclovir and ganciclovir are harmful in pregnancy. Women of child bearing age should use effective contraception during treatment. Men should use a barrier method of contraception (condom) during, and for three months after treatment.
Antibiotics Some patients have recurrent water infections or urinary tract infections (UTI) following transplantation. To manage these, your transplant team may prescribe a small daily dose of antibiotic to prevent the infection returning. You may be given different antibiotics to take month by month. It is very important that you do not stop taking these antibiotics unless instructed to do so by your transplant team.
Will I need to carry on taking my blood pressure medication?
If you have high blood pressure after your transplant you will be given medication to lower it. Some of the anti-rejection medication may cause your blood pressure to rise. If you needed blood pressure medication before your transplant it is likely that this will need to continue and your transplant doctors will advise you about this. At your clinic visits we will check your blood pressure and weight. It is important to keep good control of your blood pressure as this will help to keep your kidney and body healthy.
Please talk to your transplant team or your GP before you stop taking any medication, as stopping medication suddenly can in some cases be harmful.
44 Are there any medications I should avoid?
It is particularly important to avoid certain types of painkiller called non-steroidal anti-inflammatory drugs (NSAIDs or antiinflammatories), such as Ibuprofen (Nurofen®). There are other medications which may be unsuitable, including herbal remedies and over the counter medications. Please speak to your kidney pharmacist, nurse or doctor before taking any medications.
Do I have to pay for my prescriptions?
You might be able to get free prescriptions if you:
• receive certain benefits
• are on a low income
• have a fistula for haemodialysis
• are aged 60 or over
• have diabetes mellitus, except where treatment is by diet alone.
There are other reasons why you may get free prescriptions. You can find out more by speaking to your local pharmacist or visiting www.nhsbsa.nhs.uk
46 When you get home after your transplant there are some things
that you will be asked to do. These include:
• Drinking two to three litres of fluid to keep your new kidney hydrated. It is also important that you keep a note of how much urine you pass.
• Being aware of cloudy or smelly urine or pain when going to the toilet. This may mean that you have a water infection (UTI).
• Being aware of other signs of infections such as fever, lethargy and unusual tiredness.
If you do think you have an infection or there is something else wrong, you should contact your transplant clinic.
If you are a Guy’s patient; out of hours you should contact Richard Bright Ward at Guy’s Hospital. Telephone: 020 7188 8817.
If you are a King’s patient; out of hours you should contact Fisk and Cheere Ward in King’s College Hospital. Telephone 020 3299 3298 or 020 3299 3859.
Please do not come to the ward without contacting us first.
At the clinic you may be invited to participate in research studies related to your transplant or kidney disease. Before you decide, it is important that you understand the purpose of any study and what it will involve; you will be given written information and the chance to discuss it with your doctor. It is entirely up to you whether you wish to take part in research studies, and your care will not be affected should you choose not to participate.
Can I continue to exercise?
For three months after your transplant you should avoid strenuous exercise. You should also avoid contact sports such as rugby or martial arts. We encourage you to have an active lifestyle after your transplant. Your doctor will tell you when you can restart sport and exercise.
48 The Transplant Games The British Transplant Games take place annually in a different UK venue, over four days in the summer. From these Games a team is selected to represent Great Britain in the World Transplant Games which takes place every two years. Participants can compete in a variety of sports from athletics, swimming, badminton and tennis to bowling, snooker and darts.
The aim of The Games is to encourage transplant patients to regain fitness and to promote friendship, whilst increasing public awareness of organ donation.
Some people compete to win medals, others go along to participate in their sport at their own pace and generally enjoy a few days of fun and sharing. For further information please ask the transplant team; or visit: www.transplantsport.org.uk The Guy’s and St Thomas’ Kidney Patients Association support the Guy’s Transplant Games Team, please visit: www.gsttkpa.org for details.
In the longer term a healthy diet is important. Eat foods high in fibre and low in saturated fats, salt and sugar. Most people with a healthy kidney will not need to restrict potassium and phosphate in their diet. You are still advised to avoid salt as a diet low in salt will help control blood pressure. Also the medication you need to take after your transplant may increase your cholesterol level and you may gain weight more easily. Controlling your blood pressure, weight and cholesterol will help to reduce your risk of heart disease, stroke and diabetes.
As the immunosuppressive medications can make you more vulnerable to food poisoning, it is important that you follow food
safety advice carefully:
• Store and prepare cooked and raw foods separately
• Keep to use-by dates
• Avoid uncooked eggs and unpasteurised cheese 50 Can I drink alcohol?
Yes, as once you have had a transplant you will no longer need to restrict your fluid intake. However the NHS recommends;
• Men should not regularly drink more than 3-4 units of alcohol a day
• Women should not regularly drink more than 2-3 units a day ‘Regularly‘means drinking this amount every day or most days of the week.
One unit of alcohol is equal to about:
• half a pint of ordinary strength beer, lager or cider
• a small pub measure (25ml) of spirits
• a small glass (125ml) of ordinary strength wine You should try to have one or two days each week without alcohol.
The usual advice is not to go abroad for the first year after transplantation. If you do go on holiday please make sure you have enough medication for your trip, with some extra in case of an emergency. You should carry all your medication, a letter from your doctor with information about your medication and your steroid card in your hand luggage. Ideally, you should not buy over the counter medicines while abroad.
Can I have vaccinations for my holiday?
Yes, providing they are suitable, but you may not fully respond to the vaccines given because of your anti-rejection medications.
You may need to take extra precautions. Please make sure you give yourself plenty of time to find out about vaccinations before you go away.
After your transplant, you must avoid live vaccines. Always check with your transplant team before having any vaccinations. Check the list below to see which vaccinations you can and cannot have.
This list is not exhaustive; always ask your kidney doctor or nurse if you are unsure.
52 Live vaccines - not suitable Yellow fever Live oral typhoid MMR (measles, mumps, rubella) Smallpox Live oral polio BCG (Bacillus Calmette-Guérin) Varicella zoster Suitable vaccines Inactivated polio Influenza (types A and B) Hepatitis A Hepatitis B Pneumococcal Diptheria, tetanus and inactivated polio Polysaccharide Typhoid Meningococcal We advise you not to travel to countries where there is a risk of catching malaria after your transplant. If you need to take malaria medication, please talk to your kidney doctor and your pharmacist.
When will I able to start having sex again?
When you feel well and comfortable enough - there is no specific time.
54 What contraception should I use?
After a transplant many patients become more fertile. If you are a young woman and wish to avoid pregnancy you must use some form of contraception and there are many choices available.
The pill (oral contraceptive) is safe to use, but can interfere with blood pressure control. Please talk to your GP or transplant doctor before taking it. Implants and injections are also safe and effective.
Condoms, foams or diaphragms are safe but less effective in preventing pregnancy. However, these methods of contraception also help protect you from sexually transmitted infections, including chlamydia, gonorrhoea, HIV and hepatitis. Please discuss this with the transplant team. Standard coils are not recommended for women who are on immunosuppressive drugs, but the Mirena IUS is both safe and highly effective.
Can I get pregnant after my transplant?
Women of child bearing age are usually able to conceive after a transplant, but we suggest you wait one year before trying for a baby. This will give your body time to adjust to the new kidney and medication. It is important that you talk to your kidney doctor before you start trying for a baby. You may need to change some of your medications before you become pregnant. During your pregnancy the kidney and pregnancy (obstetrics) healthcare teams will closely monitor you and your baby.
Will I be able to contact the donor family?