1. I got a kidney transplant!! Now what?
Divya Jain Arwindekar, DO
Transplant Nephrologist
Loyola University Medical Center
April 14, 2018

2. Kidney Transplant
Not a cure for kidney disease, but it is a very effective treatment
Patients still have chronic kidney disease

3. Why do people get kidney transplants?
To get off of dialysis
To live longer

5. Types of Kidney Transplant
Deceased Donor
Also known as a cadaver donor
The kidney was donated after death
On average, lasts about 10 years
Living Donor
Does NOT need to be from someone who is related to you
On average, lasts about 18 years

7. What can I do to keep my kidney from failing?

8. Know the players Patient—You!!
Transplant surgeon—performed the operation and will manage the surgical issues
Lymphocele—a collection of fluid that can occur after the operation
Wound infection
Ureteral leak

9. Know the players
Transplant Nephrologist – kidney doctor specialized in the care of the kidney transplant patient (both before and after), immunosuppression and other complications from kidney transplant
Transplant Coordinator – takes care of everything! Keep their name, phone number and fax number on you.
Transplant Pharmacist – reviews your medications, looks at the interaction between medications, guides the team with new medications

10. Know the players
Transplant Social Worker – helps with emotional and social issues that arise, finds the needed resources for the transplant to succeed
Dietician – reviews your health and nutritional status and how its effect on your kidney transplant
Your nephrologist – your kidney doctor prior to your kidney transplant who will take care of you afterward
Your primary care doctor

11. Compliance
Compliance – the act of doing what you have been asked to do
You are asked:
To keep your appointments
To take your medications the way that you are instructed
To let the team know if there are any problems/issues

12. Compliance
If you weren’t compliant, you would not have received a kidney transplant
But, it’s easy to forget appointments and medications when you feel healthy or are no longer on dialysis

13. Appointments 2-3 times/week in the very beginning
After 4-6 weeks, this usually decreases to once a week appointments
Once every 2 weeks
Once a month
Continue the taper
After about a year, you should follow with your regular nephrologist every 2-3 months
Still need to see the transplant center annually

14. Medications
Maintenance Anti-Rejection Medications – immunosuppressants
Tacrolimus – a.k.a. Prograf, Hecoria
Cyclosporine – Neoral, Gengraf, Sandimmune
Sirolimus – Rapamune
Everolimus – Zortress
Mycophenolate mofetil – mycophenolate, Cellcept
Mycophenolic acid – Myfortic
Prednisone – steroid medication
Belatacept – Nulojix
Leflunomide – Arava
Eculizumab, rituximab…

15. What does my level mean?
Many of your medications are monitored by checking drug levels
Ideal drug levels are drawn as close to your next dose of that medication
Medication doses are adjusted from the drug levels

16. Other Medications Valganciclovir – Valcyte
anti-viral to prevent cytomegalovirus (CMV) infection in those at risk
Acyclovir – anti-viral for those at very low risk for CMV.
Trimethoprim-sulfamethoxazole – Bactrim
Antibiotic to prevent a certain pneumonia
If not tolerating Bactrim, may receive dapsone or inhaled pentamidine

17. There are too many medications!!
In order to maintain your kidney transplant, the medications are necessary to prevent rejection and infections.
Anti-rejection medications are not all the same

18. Why am I still on certain medications?
Remember, kidney transplant is a treatment, not a cure
You still have kidney disease after transplant and may still be on medications for:
Anemia – low hemoglobin
Hyperparathyroidism – bone disorder
High blood pressure

19. How can I remember to take my medications?
Pillbox
Alarm
List – keep it up to date!!
Calendar

20. Will I ever come off of some of these medications?
Possibly
As long as you don’t have a virus, you will likely not be on your anti-virals
Some patients come off the pneumonia medication
Talk to your transplant nephrologist about this

22. What can I do to lessen my medication burden?
Maintain a healthy lifestyle
Diet
Exercise
Healthy weight
Compliance
Don’t smoke

23. What are some of the side effects from kidney transplant?
Increased risk for certain diseases
High Blood Pressure
Diabetes
Cardiovascular Disease
High Cholesterol
Gout
Infections
Certain Cancers – although the overall risk of developing cancer is still low after transplant

24. What types of cancers am I at increased risk for?
Skin and Lip cancer
Cancers caused by viruses
Lymphoma

25. What should I do? Mammogram Pap Smears Prostate Cancer Screenings
Colonoscopy
See a dermatologist (skin doctor) annually
Wear sunscreen no matter your race or the weather
SPF 30+

26. Is it safe for me to get vaccines?
Yes!! – But, only certain ones
Every year FLU SHOT
No inhaled flu vaccine – because it’s a live vaccine
Make sure up to date for pneumonia vaccine
Pneumonia booster every 3-5 years
Two different types of pneumonia vaccines

27. What about other vaccines?
Ok to get the following:
Haemophilus influenza B
Tetanus
Diphtheria
Pertussis
Salk polio (inactivated)
Hepatitis B – if not vaccinated prior to transplant

28. What about other vaccines?
AVOID Live Vaccines:
Inhaled flu
Shingles or Zoster vaccine
Measles
Mumps
Rubella
Chicken pox – VZV
Oral Polio
BCG
Yellow fever
Typhoid

29. What if I want to travel?
It’s okay to travel, but let your transplant center know where you are going
You might need vaccines or medications prior to travel

30. What if I want to get pregnant?
Talk to your transplant doctor about this
Ideally, you should wait at least 1 year after transplant
Some medications may need to be changed
If you are on mycophenolate, MMF, mycophenolic acid, Myfortic, Cellcept  do NOT get pregnant
You need to be using contraception if you are not post- menopausal

31. Why might my kidney fail?
Rejection
Recurrence of disease
New kidney disease
Diabetes
High blood pressure
Gout
Medications

32. If my kidney fails, can I get another?
Possibly
The overall goal though is to maintain your kidney transplant

33. Questions???