Long Term Health: Guidelines Following Transplantation

A new kidney transplant is an exciting and unforgettable change in life. Although there are huge advantages to having a transplant, the change can take some emotional adjustment. The medicines that are needed to help someone accept a new kidney can bring sudden and unexpected mood changes. Frequent office visits to the doctor, blood tests and the complicated medication schedule can be difficult to adjust to. But the routine becomes much simpler after a few weeks.

The combination of your hospital stay and new medicines may cause muscles to feel weak. The best way to improve strength is to exercise. Any enjoyable exercise is an excellent way to improve muscle strength. Ask your doctor or any member of your transplant team if you have questions about specific exercises.

We strongly recommend never smoking anything. Smoking causes lung cancer and injures the lungs, increasing the risk for lung infections. It also decreases your red blood cells' ability to transport oxygen throughout your body and decreases healing ability and energy. Smoking constricts blood vessels, especially those in the legs, arms and heart. It also increases the secretion of gastric acids and this will slow healing if ulcers should occur. All of these problems are more serious and even life-threatening with someone who is taking immuno-suppressive medications.

The consumption of alcohol in moderation will do no harm unless liver damage has already been diagnosed. However, intoxication causes forgetfullness. Forgetting to take medications could jeopardize the health of the new organ. If you don't drink, don't start! If you do, use restraint and common sense.

Potency and sex drive are influenced by many factors. If sexual function was affected by the illness that caused CKD, it may improve following a successful transplant. Certain medications can cause sexual dysfunction. Psychological reasons may also contribute to this problem. Practice safe sex. You are more susceptible to infections. If you are with a new partner, ask your partner about any infections. The use of condoms is advised to decrease the incidence of sexually transmitted diseases.

Annual pap smears and breast exams/mammograms are advised. A self-breast exam should be performed monthly. Learn how to do a breast self-exam and report any changes to your primary care provider. The subject of birth control needs to be discussed with a physician if you are of child-bearing age. We recommend planning all pregnancies with a health care provider experienced in transplantation. Since some medications can cause abnormalities in the fetus, adjustments may need to be made by your physician.

If you did not experience impotence while on dialysis, your sexual function will probably remain as it was before your transplant. Impotence, or not being able to have an erection, is a frequent problem for men with kidney failure. If you notice a change in your sexual ability, please consult your physician. An annual prostate and testicular exam are advised.

The risk for infection is greater for people on anti-rejection/immunosupression. Signs and symptoms of infection may not be as obvious. When signs/symptoms do occur, it is important that you pay close attention and report them to your physician if they worsen. The following list are measures you can take to minimize your risk of infection:

• Avoid individuals when they are ill, avoid sharing their food and eating utensils, personal towels and linens, and request that they cover their mouth when they cough or sneeze.
• Wash hands often to avoid transmission of disease (Hands are a significant source for passing on infections).
• Avoid close, crowded situations (i.e. elevators, restaurants, waiting areas, etc.) for the first three months.
• Contact your physician if you are exposed to any communicable disease (i.e. chickenpox, measles, mumps, etc.) that you have not had before.
• Report to your physician any exposure to children who have recently received live vaccines.
• Guard against the spread of cold sores. Contact your physician for treatment advice should you develop a cold sore. Do not kiss individuals with an obvious outbreak of a cold sore.
• Seek treatment when symptoms of yeast infection occur in the mouth or vagina.

It is extremely important that good dental and mouth hygiene is practiced. Increased growth and swelling of gum tissue may result from the long term use of Cyclosporine/Neoral. Guidelines when visiting a dentist:

• Inform your hygienist about your immuno-supression medications.
• Ask your physician if a preventative antibiotic is necessary when having an dental work done.

Follow-up care will be provided by many different healthcare providers (nephrologist, ophthalmologist, gynecologist, dentist, surgeon, etc.). It is extremely important they are aware of the transplant and all the medications. Keep your medication list handy and supply it at each visit or bring all the medications with you.

Because it is important to be in close contact with your transplant physician during the first six months after the transplant, this is not a good time to plan distant vacations. After things are routine, when planning a vacation or trip away, inform your physician ahead of time. Always bring a sufficient supply of medications for the duration of any trip. When traveling by plane, carry your medications with you. Do not check them with your baggage. If medical attention is required while traveling, be sure to inform the provider you are a transplant recipient. Carefully consider the use of any new medications. They may interact with the current regimen.

Animals can be very important members of the family. It will not be necessary for you to limit your contact with your pets after transplant. However, there are a few guidelines to follow:

• Wash hands thoroughly after handling or petting.
• Avoid letting a pet lick your face.
• Wear protective gloves when cleaning cages and litter boxes. Consider wearing an isolation mask.