Kidney Transplant (cont.)
Prognosis After Kidney Transplantation
Self-Care at Home
The period immediately following the transplant can be very stressful. The patient will not only be recovering from major surgery, he or she will also be anxious about organ rejection.
- The patient, his or her family, and the transplant coordinators must keep in contact and close follow-up with the transplant team.
- Before leaving the hospital, the patient will be given instructions on proper doses of and schedule for antirejection medication. Keeping track of these medications is extremely important, because they can actually harm the transplanted kidney if the doses are not appropriate.
- The patient will be taught how to measure their blood pressure, temperature, and urine output at home, and he or she should keep a log of these readings.
- The social worker and dietitian will counsel the patient before they leave the hospital.
In the first few weeks after leaving the hospital, the patient will meet with members of their team frequently to monitor their recovery, review the logs, undergo blood tests, and adjust medication doses.
The outcome for kidney transplants continues to improve with advances in immune-suppressing medications.
- In the United States, the 3-year graft survival rate after transplantation varies between 83% to 94%.
- The earlier the patient can detect rejection, the better the chance it can be reversed and the new kidney's function preserved.
- Cancer: Certain cancers, such as basal cell carcinoma, Kaposi sarcoma, carcinoma of the vulva and perineum, non-Hodgkin lymphoma, squamous cell carcinoma, hepatobiliary carcinoma, and carcinoma in situ of the uterine cervix, occur more frequently in people who have undergone kidney transplantation.
- Relapse: A small number of people who undergo transplantation for certain kidney disease experience a return of the original disease after the transplant.
- High blood cholesterol level
- Liver disease
- Weakening of the bones
Women who wish to become pregnant are usually told to wait for 2 years after the operation. Many women have taken their pregnancies to term after transplantation, but there is an increased risk of kidney rejection and fetal complications.
Signs of Kidney Rejection
One of the greatest concerns as a transplant recipient will be that the body's immune system will reject and attack the transplanted kidney. If not reversed, rejection will destroy the transplanted organ. For this reason, the patient and his or her family must keep aware of warning signs and symptoms of rejection. The must contact the transplant team immediately if any of these symptoms develop.
- Hypertension (high blood pressure): This is an ominous sign that the kidney is not functioning properly.
- Swelling or puffiness: This is a sign of fluid retention, usually in the arms, legs, or face.
- Decreased urine output
If the patient is a kidney transplant recipient, any of the following symptoms warrant immediate care at a hospital emergency department, preferably the hospital where the transplant was done.
- Fever: This is a sign of infection.
- Abdominal pain
- Tenderness, redness, or swelling at the surgical site
- Shortness of breath: This is a sign of fluid retention in the lungs.
Michael B McDonnell, MD, Staff Physician, Department of Emergency Medicine, University of Southern California
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