Follow-Up Visits After Kidney Transplant Surgery

Your Guide to Kidney Transplant:
Your Kidney Transplant | Follow-Up Visits After Kidney Transplant Surgery | Resuming Life After Kidney Transplantation | Organ Rejection after Kidney Transplant | Nutrition After Kidney Transplant | Immunosuppressant Medications | Infection After Kidney Transplant

Before leaving the hospital, you will receive a schedule of follow-up clinic visits for lab tests and checkups. The purpose of these important visits is to track your recovery progress and detect any potential complications as early as possible.

On the days you are scheduled to see the transplant team, bring your medication list. You need to be at the clinic to have your blood drawn one hour before your morning dosage of medication is due. Afterwards, you will take your medication. This is necessary so we can get an accurate reading of the immunosuppressant levels in your blood.

The lab tests we perform monitor your blood counts, kidney function, liver function, electrolytes, and the medication levels in your blood. Other tests may be ordered as necessary.

Blood Count

WBC tells us if your white blood cells have increased (usually a sign of infection) or decreased (indicating a lower defense against infection). HCT measures your hematocrit, the percentage of red blood cells present in your blood. Red blood cells carry oxygen to all parts of the body. When your HCT is low, you may feel tired or have little energy.

PLTS measures the level of platelets in your blood. Platelet cells form blood clots when your body is injured. Low platelet levels may cause you to bruise easily and to bleed for a longer time period.

Kidney Function

Creatinine and BUN tell how well your kidney is working by measuring levels of creatinine and blood urea nitrogen, waste products normally removed from the blood by the kidneys.

Electrolytes

Dissolved minerals

Calcium, phosphorus, magnesium, potassium, and sodium are naturally occurring electrolytes in your blood. They all will be monitored and supplemented when necessary.

Additional Blood Tests

Drug levels measure the amount of Prograf®, Neoral®, and Rapamune® in your blood. They need to be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection. Please Note: The desired level (normal range) will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant.

GLU measures glucose (levels of sugar) in the blood. Some medications may produce a diabetes-like condition in which blood sugar levels are too high.

Kidney Biopsy (Bx)

A kidney biopsy is usually performed to check for rejection or drug toxicity and other possible problems. A local anesthetic is used, a biopsy needle is inserted, and a small piece of kidney tissue is removed.

What are the Risks of a Kidney Biopsy?

The primary risk with kidney biopsy is bleeding from the site of the needle's entry into the kidney, but this occurs in less than 1% of patients. Other very rare complications include puncture of other organs such as the colon or a blood vessel. You will be monitored closely for several hours after the procedure to make sure no complications arise.

Instructions for Patients Having a Kidney Biopsy

The office staff will set up the appointment for your kidney biopsy and call you with the date, time, and location of the biopsy. Please be sure to follow these instructions:

  1. You must abstain from medications containing aspirin and ibuprofen, such as Advil®, Motrin®, Nuprin®, and Aleve®. Tylenol® is OK. Notify your physician if you are taking blood thinning medication such as Coumadin®, warfarin, or Plavix®.
  2. It is not recommended that you drive or return home unattended. Plan to have someone accompany you to the procedure or pick you up afterward.
  3. After the doctor performs the biopsy, you must rest in bed for several hours. Before you return home, your blood pressure will be monitored and your urine will be checked for bleeding.
  4. Call the Transplant office at (212) 305-6469 if you experience any of the following symptoms after your biopsy:
    • Bloody urine
    • Swelling and/or pain near your kidney
    • Fever
    • Lightheadedness/dizziness
    • Low blood pressure

Ultrasound

This non-invasive diagnostic test, which uses sound waves to image the internal organs, may be performed after your transplant operation, or when your kidney function tests change. An ultrasound allows us to be certain that the main blood vessels leading to the kidney are functioning normally. It can also be used to check for:

  • the build-up of abnormal fluid around the kidney,
  • an obstruction, or
  • to localize for biopsy.

During the test, a gel is spread over your abdomen and a transducer (wand-like instrument) is passed over the abdomen's surface. Images of your kidney appear on a monitor and are recorded on film.

Health Concerns After You Leave the Hospital

Once you leave the hospital, you are NOT alone.

The team's social worker will assist you and your family with the discharge preparations. The transplant coordinators will order your medications from the pharmacy of your choice so that all the medications you need will be available when you leave the hospital. The nurses in the hospital will help educate you about how to care for yourself.

Inevitably, questions will arise after you have left the hospital. A member of the team is always available to answer your questions. The central phone number for the Kidney Transplant Program is (212) 305-6469. Below are some general guidelines for taking care of your health after a kidney transplant:

Vital Signs

After you leave the hospital you will be asked to monitor your temperature, blood pressure, and weight, and to keep a record of your laboratory test results. The office can provide you with a recording chart.

Temperature

It is important to take your temperature every day in the morning. An increase in your normal temperature can be a symptom of either organ rejection or infection. Both rejection and infection are easier to treat when recognized early. Someone whose immune system is suppressed does not always get high fevers. Call your transplant team any time your temperature reaches 101° F (39.5° C).

Blood Pressure

High blood pressure is a common side effect of both Neoral and Prograf. It can also indicate that you are retaining fluids. Once you return home you will need to take your blood pressure twice a day, once in the morning and once in the evening, and keep a record of the results.

You may be discharged on medications that control blood pressure. You can help keep your blood pressure under control by eating a low-salt diet, and by losing extra weight. The team's nutritionist can help you achieve this goal.

Your nurse will teach you how to measure your blood pressure. The top number (systolic) is noted at the first sound you hear and the bottom number (diastolic) is noted when the sound changes (not stops). It is important that you know your normal blood pressure, normal fluctuation range, and when you should be concerned. You should notify your transplant team or local physician if your blood pressure measures:

  • Systolic: more than 160 or less than 100
  • Diastolic: more than 90 or less than 60

Headaches can be a symptom of high blood pressure. If you develop a headache, take your blood pressure. If it is above normal for you, call the transplant team. Also check your blood pressure if you are feeling dizzy or light-headed. These symptoms can be caused by low blood pressure. If your pressure is atypically low, call the transplant team.

Weight

You should weigh yourself on a standard bathroom scale at the same time each morning after going to the toilet. Record your weight. If you gain more than 2 pounds per day, you could be retaining fluid. Report this to your transplant team or local physician.

How to Stay in Touch with Your Renal Transplant Team

Routine Calls

The office is open from 9am to 5pm for non-emergency issues. These include questions about your care, reporting or inquiring about lab results, scheduling appointments, tests, and procedures, and prescription refills. Contact office at (212) 305-6469.

Emergency Calls

A physician from the team is available 24 hours a day for medical emergencies. If you are ill and need to speak with us, please do not hesitate to call (212) 305-6469. The answering service will have the physician return your call promptly.

Call 911

If you have any of the following symptoms, you or someone close to you should call 911 to summon an ambulance to bring you to the hospital:

  • Chest Pain
  • Difficulty Breathing
  • Bleeding
  • Loss of Consciousness

Contact Information

Be sure to keep the Transplant Office informed of your correct address and phone number(s), and any changes in your referring doctor's name, address, or phone number(s). Also, it is important to tell us whom to contact in case of emergency, including their name, address, phone, and beeper numbers.

Your Guide to Kidney Transplant:
Your Kidney Transplant | Follow-Up Visits After Kidney Transplant Surgery | Resuming Life After Kidney Transplantation | Organ Rejection after Kidney Transplant | Nutrition After Kidney Transplant | Immunosuppressant Medications | Infection After Kidney Transplant

Transplantation is a life-altering procedure. We’re here to be your partners every step of the way. Call us at (212) 305-6469 to get started today, or sign up with one of our online forms: 
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