The Most Important Topics to Talk to Your Kidney Doctor About After a Transplant

You have been given the gift of a kidney donation.

You have energy and strength that you haven’t had in a while.

You have a new lease on life, and it’s a new day.

Now what?

Be Sure to Ask Your Transplant Doctor About These Important Topics

Now that you have had a kidney transplant, you are going to want to lead your healthiest life so you can protect your gift.

So, let’s get down to the nitty-gritty and discuss 7 topics to discuss with your nephrologist.

1) When to Take Your Medications

Anti-rejection medications protect your transplanted organ from your body’s immune system. There are many types of anti-rejection medications, and you remain on them for the life of your transplanted organ.

Common anti-rejections medications include:

  • Calcineurin Inhibitors: Tacrolimus and Cyclosporine
  • Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium, and Azathioprine
  • mTOR inhibitor: Sirolimus and Everolimus
  • Co-stimulation Blocking infusions: Belatacept, Iscalimab
  • Steroids: Prednisone

Not taking anti-rejection medications is a leading cause of transplant failure.

“Anti-rejection medications overpower your body’s ability to attack and destroy your transplanted organ,” says Reginald Gohh, MD, a nephrologist who is medical director for the Division of Organ Transplantation at Rhode Island Hospital and a professor of medicine at Alpert Medical School of Brown University. “To maintain the health of your transplanted organ, it is important that you take your immunosuppressant [anti-rejection] medications at the exact time each day, or as directed by your doctor.”

Discuss with your kidney doctor what medications you should take—and how you should take them—at every appointment as these may change, especially in the first year.

If you are having a tough time managing your medications, try the AlloCare™ app for transplant patients. In addition to features like medication photos, you can set reminders and even log medications you have taken.

For more information about AlloCare, click here  or download the app from the app store.

2) Possible Side Effects to Expect from Your Transplant Medications

According to the United Network of Organ Sharing (UNOS), many transplant patients experience annoying short-term side effects from their anti-rejection medications. Some of these side effects include:

  • Hair growth or hair loss
  • Acne
  • Mood swings
  • Weight gain

“Side effects from taking anti-rejections medications tend to diminish or even go away in time,” says Dr. Gohh. “If you are concerned and need advice on how to manage these side effects, talk to you doctor or transplant team.”

3) Frequency of Labs

After your transplant—but before leaving the hospital—you will receive a schedule of follow-up visits for lab tests.

The purpose of these lab tests is to track your recovery progress, manage your care, and detect—as early as possible—any potential complications.1

These lab tests monitor many things, including:

  • Organ injury (AlloSure® or KidneyCare)
  • Anti-rejection medication levels (eg., Tacrolimus, Sirolimus, Cyclosporin, Everolimus)
  • Urinary Protein / Creatinine Ratio
  • Complete Blood Count
  • Urinary Protein/Creatinine Ratio
  • Complete Metabolic Profile + Mg + Phos
  • Viral PCR (BK/CMV/EBV)

“The number of appointments you have post-transplant will vary depending on your personal health history as well as by transplant hospital,” says Dr. Gohh. “Talk to your doctor about your own post-care plan and how often you will need your labs.”

Typical plans may look something like this:

  • Months 1- 2 after surgery – Weekly
  • Months 3 & 4 after surgery – Every Two Weeks
  • What about month 5 or 6 after surgery – Monthly
  • Year 1+ after surgery – Every 3-4 Months

Your labs may coincide with your regular doctor’s appointments and can often be done at your center at the time of your appointment.

If you are virtually seeing your doctor or trying to limit your exposure to COVID-19, convenient at-home mobile-phlebotomy services like RemoTraC™ are specifically available for transplant recipients.

With RemoTraC, patients can get routine transplant panels along with AlloSure surveillance and routine transplant panels.

For more information about RemoTraC, click here.

4) Exercise with a New Kidney

The amount and type of activity you can handle after your transplant depends on your age and health.

After your kidney transplant, your treatment team may set up a routine exercise program to meet your needs.2

“Your doctor may recommend that you participate in 30 minutes of moderate exercise, like brisk walking,” says Dr. Gohh. “Or he or she may suggest bicycling or low-impact strength training. It’s different for each transplant recipient, so be sure to talk to your doctor about what is right for you.”

5) Going Back to Work

Many kidney transplant patients are able to return to work within a few months following a successful surgery.3

How soon you can go back to work will depend on the nature of the work you are doing.

“If it is physically demanding work, you might want to wait until your body is strong enough to handle those work demands,” says Dr. Gohh. “If it is office work, the transplant recipient needs to be vigilant against easily transmittable cold and flu viruses that circulate in offices and on commuter trains and buses.”

6) Engaging in Sexual Activity After a Transplant

Many people wonder if they can have a healthy sex life after a kidney transplant. Getting pregnant and having a child is possible, however, the National Kidney Foundation (NKF) says a woman should not become pregnant for at least one year after a kidney transplant—even with stable kidney function.4

You and your partner might also be concerned that sexual activity could harm the transplanted kidney. After receiving a transplant and prior to engaging in sexual activity, the NKF says it is important to wait until the scar has begun to heal.5

If you are planning to get pregnant or if you just want the greenlight for sexual activity, be sure to talk with your doctor.

7) Signs of Organ Rejections

The NKF reports that 93% of recipients still have their transplanted kidney after one year.6

However, not all transplanted kidneys are a success. The NKF says there are several things that can cause a transplanted kidney to fail, including:

  • Blood Clots
  • Infection
  • Medication side effects
  • Non-adherence to anti-rejection medication

Signs and symptoms of kidney rejection include:9

  • Feeling like you have the flu: body aches, chills, headache and more
  • Fever
  • Urinating less than usual
  • High blood pressure
  • Sudden weight gain
  • Ankle swelling
  • Pain or tenderness over the area where your transplant was done
  • Feeling very tired

Routine check-ups with your transplant team can help detect transplant complications. Be sure to work with your doctor to monitor these rejection signs.

Ask Your Doctor About Surveillance Options

When it comes to taking care of your transplanted kidney, discuss healthy options with your doctor. Suggestions from the American Kidney Fund include talking to your doctor about:8

  • Healthy eating plans that will work for you and your new kidney
  • Exercises and exercise routines that are right for you
  • How to take anti-rejections medications
  • Your overall mental health

Also, ask your doctor about surveillance options for your transplanted kidney. One such surveillance option is AlloSure—the first liquid biopsy that evaluates the health of a transplanted kidney.

AlloSure does this by measuring donor-derived cell-free DNA (dd-cfDNA) levels that circulate within the blood of transplant recipients.

dd-cfDNA levels increase in the blood of a kidney-transplant recipient if there is injury to the donor kidney. By measuring dd-cfDNA in the blood, AlloSure detects the potential for rejection of the transplanted organ.

By accurately determining active rejection, AlloSure lets your doctor better manage your transplanted kidney. Compared to just measuring creatinine alone, using AlloSure after a kidney transplant gives your doctor an extremely useful and superior measurement of your transplant’s health.

Furthermore, AlloSure could help you avoid an invasive and unnecessary tissue biopsy.

To learn more about AlloSure, click here.