AFTER MY KIDNEY TRANSPLANT - WHAT TO EXPECT Some kidneys will work straight away and kidney function improves dramatically. This is of course the ideal. However, many newly transplanted kidneys go through a phase of what we call ‘delayed graft function’. This could last a few days or even many weeks. In this period as long as the kidney has a good blood supply then we don’t worry too much. Nevertheless, there might be reasons for this delayed function which can be treated and so occasionally a kidney biopsy is performed. This is a procedure under local anaesthetic and a small piece of your new kidney is extracted and examined under the microscope. It is a good way of ruling out rejection, viral illnesses and other issues that might affect the function of the kidney. After the transplant you might find that there is lots of swelling (oedema) around the legs and groin area. This normally settles as the kidney starts passing good amounts of urine. For a straightforward transplant a hospital stay might be seven to ten days but if there are complications or if the transplant team prefer to keep an eye on you, as described above, the hospital stay might be up to a few weeks. This doesn’t mean however that you won’t leave hospital with a good functioning kidney. When we join the ureter of the kidney to the bladder during the transplant, to enable the urine to drain out normally from the new kidney, we place a ureteric stent. This is a plastic tube placed in the transplant ureter to maintain good drainage of urine. This will need to be removed a few weeks after the transplant via a small operation using a cystoscope. Most centres perform this three to six week after the transplant as a day case procedure under local anaesthetic. Once the kidney function is stable, overall you will feel better in yourself with more energy and hopefully gradually getting back to all the activities you would like to do that possibly dialysis stopped you doing. For those that have been on dialysis for long period of time, having a kidney transplant can be a transformational and a transitional experience. Often great friends are made on the dialysis unit, and it has become a framework of life and in fact, some might miss their dialysis unit despite that seeming counter-intuitive. Having a transplant is moving into a different phase of lifestyle and each transition is different and sometimes takes a while to adjust to. Feelings of being a little unsettled after a transplant can be normal and settles down. After a transplant, to ensure that your body accepts the new kidney and doesn’t reject it, you will start on long-term immunosuppressant medication. These medications dampen down the immune system. The ward pharmacist and nurses will explain to you how to take these medications and when to take them, so you feel ready when you leave the hospital. You might also start new medications such as antibiotics and anti-viral medicines. When you leave hospital, you will attend clinic appointments very often in the first few weeks, sometimes twice a week which will taper off as time goes by and your new kidney settles in. Your kidney function will be monitored very closely at these appointments. After a few weeks, you will only need to attend every few weeks and then every few months if all is going well. The immunosuppression medication puts you at a slightly higher risk of certain cancers. Please attend all cancer screening programs that the NHS provide and any new skin changes that you might see, discuss with your doctor. It’s important to emphasise that the risk of getting cancer is still small but is slightly higher than the general population. There is also an increased chance of catching certain infections when taking immunosuppression medication. Most commonly these are chest and urine infections. Serious infections are rare but most of these infections can be treated fully with antibiotics. It is also important to have the flu vaccine when offered (this is not a live vaccine as we wouldn’t recommend taking live vaccines). In the week’s months and years after the transplant, if you don’t feel well, have a low threshold for contacting your local transplant team or pitching up to your local transplant unit where you can be investigated and looked after. Symptoms such as a high temperature, feeling sweaty and shivery, diarrhoea and vomiting, shortness of breath, chest pain, general fatigue, pain over your transplant or passing less urine than normal are indicators that you should get checked out. After a kidney transplant many patients want to pass on their tremendous gratitude to their donors’ family. A letter can bring great comfort to the family of the donor who have been through a tragedy. Please speak to your transplant team to find out how you can write this letter. It’s a poignant and lovely thing to do, expressing how, as a transplant community of clinicians and patients, we certainly don’t in any way take for granted the selfless and brave gifts that allow new leases of life to be lived to the full. Overall, it is important to look after yourself, take the medication as described above, eat and sleep well and if you are a smoker think about giving up! Hopefully the transplant will allow you a decent quality of life that you can enjoy and benefit from in the fullest way possible. Download this information in PDF Written May 2022 Jeremy Crane MD FRCS (vasc) Consultant transplant and vascular surgeon at the Hammersmith Hospital West London The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.