Kidney Transplant

WHAT YOU SHOULD KNOW

IF YOU'RE HEADING FOR THE HOSPITAL...

Before You Go

• The Week Before Surgery:
• You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take any over-the-counter medicines.
• Your doctor will tell you whether you need to have blood drawn.
• The Night Before Surgery:
• Your physician may suggest you take a sleeping pill.
• Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.

When You Arrive

• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
• Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The surgeon will check this picture of your lungs and heart to make sure they can tolerate the operation.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• Special Tubes: To help check on your condition, the following tubes may be inserted in an artery or vein:
• Arterial Line: This tube, also called an "art line" or an "A-line," is inserted into an artery, usually in the wrist or groin. It can be used to measure blood pressure or to draw blood for tests. It will be kept filled with liquid to keep it from getting plugged.
• Swan-Ganz: This type of tube is threaded into a vein near your collarbone or neck. It is then guided through your heart and into your lungs. One end of this tube is hooked to a machine that monitors the heart. Another part may be used to give medicine.
• Cardiac Outputs: These tests show how well your heart is working. A liquid is pushed very rapidly into the Swan-Ganz. Doctors then measure the time it takes for this liquid to move through the heart---an indication of the heart's pumping capacity.
• General Anesthesia: To kill pain during the operation, this medicine is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube put down your throat. You will be completely asleep during surgery.

During Surgery

After Surgery

• Activity: You'll need to stay in bed for a while after surgery. But even while you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Day/Night Confusion: Patients in the ICU often can't tell whether it's day or night, due to round-the-clock lighting. If you're taken to the ICU to recuperate, you too may have this problem. However, it will resolve as soon as you are moved to a regular floor.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
• Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Incentive Spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Drains: Thin rubber tubes may be put into the area around your incision to drain off excess fluid. They will be taken out when no longer needed.
• Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
• Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• Foley Catheter: This is a tube that is sometimes inserted into the bladder to drain your urine. The catheter may make you feel as though you have to urinate. Relax and the catheter will drain the urine for you.
• Liquid may be run through the catheter to clean out blood clots after the operation---a procedure that sometimes causes painful cramps. If this happens, don't hesitate to tell the doctor, so that your pain medicine can be increased.
• Don't pull on the catheter because this could cause injury.
• Don't kink the catheter; this will stop the flow.
• Don't lift the bag of urine above the catheter. If you do, the urine will flow back into your bladder, possibly causing an infection.
• The catheter will be taken out when you can urinate on your own.
• Medicines:
• Anti-Rejection Medicines: (Also called immuno__suppressives [IH-mew-no-suh-PREH-sivs].) These medicines discourage your body's immune system from attacking the new kidney. Although you will probably need large doses at first, the amount you will need to take on a permanent basis is generally much smaller.
• Antacids: Anti-rejection medicine can stimulate production of stomach acid, leading to indigestion and even ulcers. Your doctor will probably prescribe an antacid to keep the acid in check. Take the antacid between meals right before your medicines. Do not take it with meals.
• Antibiotics: These medicines help prevent bacterial infection, which is a real danger while you are taking anti-rejection drugs. The antibiotics may be given by IV, as a shot, or by mouth.
• Anti-Fungal Medicine: Immunosuppressive drugs also make you susceptible to fungal infections. To fight them, anti-fungal medicines may be given in your IV, by mouth, or as a cream.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Diuretics (DI-u-REH-tiks): (Often called "water pills") Fluid may build up in the body while the new kidney is becoming established. Diuretics help rid the body of this extra fluid. They can be given as a pill or in your IV. They will make you urinate more frequently.
• Stool Softeners: These medications make bowel movements softer so you won't need to strain.
• Heat: After the first 24 to 48 hours you may use heat for pain or swelling. Use a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the surgery and helps it heal faster.
• Nasogastric Tube: This type of tube, also called an NG tube, is threaded through your nose and throat and down into your stomach. It is attached to suction, which will keep your stomach empty. It may also help to get your bowels working. Food or medicine is sometimes given through the tube.
• Nuclear Medicine Scan: This special x-ray machine uses a computer to take pictures of the new kidney. Before the scan, you'll be given a small amount of radioactive dye through your IV to make the donor kidney show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp), may be allergic to this dye. If you have this allergy, be sure to warn the doctor.
• Oxygen: At times during your stay, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
• Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
• Ultrasound: This painless test uses sound waves to build a picture of internal organs such as the new kidney. The picture shows up on a TV-like screen.

After You Leave

• Be sure to take your anti-rejection medicine without fail. Do not change the amount, type of medicine, or time that you take it unless your doctor tells you to. You must take this medicine for the rest of your life. If you stop even briefly, you're likely to lose the new kidney.
• Every week, check how much medicine you have left. Refill your prescription when you're down to a 1- to 2-week supply. It may be easier to get all your medicines from the same drug store.
• If you forget a dose of your anti-rejection medicine, do not double the next dose. Just return to your regular schedule. Call your doctor if you forget more than 1 dose.
• You may be given steroid medicine to reduce inflammation of the donor kidney. Steroids often cause side effects such as a "moon face" and other changes in your face, abdomen, and back. Even if these side effects develop, continue taking the steroids until your doctor says it's OK to stop. Abrupt withdrawal of the steroids can cause problems.
• If your doctor has prescribed antibiotics, use up the entire prescription, even if you begin to feel better. Stopping the drug too soon can allow a few hardy germs to survive and re-infect you.
• Ask your doctor before taking any over-the-counter medicine.
• Anti-rejection medicine may cause cataracts. Be sure to get an eye exam every 6 months to help keep your vision at its best.
• Steroid medicine can increase your appetite and cause weight gain. Try to keep your weight under control. Extra weight can increase blood pressure and lead to heart disease.
• Fluid build-up can also cause a sudden gain in weight. Weigh yourself on the same scale every morning before dressing. Call your doctor if you gain more than 3 pounds in one day.
• Your medicine may cause skin problems. You may find that you bruise easily or develop a rash or acne on your face, chest, or back. Ask your doctor if you get a rash or acne. Always wear a 15 SPF or higher sunscreen when going outside.
• Because anti-rejection medicine and steroids will lower your resistance, avoid people who have an infection such as colds or the flu. Also try to stay away from large groups. Consider getting shots to prevent flu and pneumonia.
• Take your blood pressure twice each day. Rest at least 5 minutes beforehand. Take it at the same times each day and in the same position---either sitting, lying, or standing. Call your doctor if the reading goes up.
• Take your temperature every morning before you get out of bed. Call your doctor if you are running a high temperature.
• Always urinate into a container and measure and record the amount before flushing it down the toilet. If you urinate during the night, measure this, too. At the end of each 24 hours, add up all the numbers. This is called your daily urine output. Call your doctor if it is less than 20 ounces.
• In a notebook, jot down the following things each day: weight, blood pressure, and daily urine output. Bring this notebook with you to your appointments with your doctor.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water and then put on a clean, new bandage. Change the bandage any time it gets wet or dirty.
• Do not lift anything heavier than 10 pounds for 6 weeks after surgery.
• Slowly start to do more each day and rest when needed. Once you feel stronger, start a regular exercise program, gradually increasing the difficulty. Ask your doctor for an exercise plan. Working out will make the heart stronger and lower your blood pressure.
• Do not drive a car for 8 weeks after surgery. Put a small soft pillow over your incision before closing your seat belt. Keep the seat belt loose.
• Wait 6 weeks after surgery before having sex. If you are a woman, use birth control because a pregnancy could put your new kidney at risk.
• You may be able to return to work 6 to 8 weeks after surgery, depending on such factors as your age and the type of job you have. Your other medical problems will also affect when you can go back to work. Talk with your doctor to decide what is best for you.
• Drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day unless your doctor says otherwise. Limit caffeinated beverages, such as coffee, tea, and soda.
• You should not drink alcohol for 1 year after your transplant. It is best if you do not drink alcohol at all. On special occasions, limit yourself to 1 glass of wine or beer.

Call Your Doctor If...

• You have tenderness over the new kidney area.
• Your incision is swollen or red, or has pus coming from it. This is a sign of infection.
• Your stitches or staples come apart.
• Your bandage becomes soaked with blood.
• You are running a high temperature.
• Your blood pressure is high.
• You have pain or burning when urinating.
• Your daily urine output is less then 20 ounces.
• You gain more than 3 pounds in 24 hours.
• You have diarrhea or vomiting for more than 24 hours.
• You have a cough or sore throat.
• You have sores in or around your mouth.
• You develop sores in the area between your legs.
• Your ankles become swollen (a sign of fluid build-up).
• Your skin becomes itchy or swollen, or you develop a rash. This could be sign of allergy to one of your medicines.
• You feel that something is not right in your body. This may be the first sign that something is wrong with your new kidney.

Seek Care Immediately If...

• You suddenly have trouble breathing. This could be a warning of a blood clot in your lung or an allergy to one of your medicines.
• You are too dizzy to stand up.
• You feel as though you are going to pass out.