Patient Information:


Signs to Watch Out For :

While primary concerns involve infection and rejection, many other problems, such as colds or flu, adjustment of other medications, and minor infections can be handled by a local physician. A patient needs to take precautions and learn to watch for signs of infection and rejection that necessitate notifying a local physician or your treating physician immediately.
These include:
a fever that continues for more than 2 days
shortness of breath
a cough that produces a yellowish or greenish
Special warning to parents of children who have had kidney transplant:
Postoperative Complications
Cyclosporine /Tacrolimus / Predinisolone..
discharge20
Rejection
a dry cough that continues for more than 1 week has a reason to take aspirin, other pain relievers, or cold remedies prolonged nausea, vomiting, or diarrhea an inability to take prescribed medication by mouth due to illness a rash or other skin changes vaginal discharge or itching pain or burning discomfort with urination feeling urgent need to urinate or need to urinate frequently blood in the urine strong odor to the urine decrease in urine output exposure to mumps, measles, chicken pox, or shingles unusual weakness or light-headedness emergency-room treatment or hospitalization pain, redness, tenderness or swelling at the incision site fluid retention/weight gain thinks the directions on the label may be different from what he was told. feels he is having a reaction to the medications. has had a change in health or eating habits. has a new prescription from his local doctor or a change in a current rescription. experiences any unusual symptoms or side effects, as they may be related to the medications he is taking. is undergoing dental work of any kind.Rejection is a common problem in transplantation. The body has a normal defense mechanism, called the immune system, which protects it from foreign substances, such as bacteria and viruses. The body sees a renal graft as foreign and attacks it to get rid of it. This process is called rejection, and is a normal response of the body's immune system.The types of rejection are :

Resuming Normal Activities :

Hyperacute Rejection : This is very rare and occurs within minutes or hours after transplantation. The rejection is permanent. The rejected kidney is removed and the patient may return to dialysis.
Acute Rejection: This usually occurs after the person has recovered from surgery. Acute rejection is the most common form of rejection and occurs in 50 to 60 percent of cadaver donor transplants and in 10 to 15 percent of living donor transplants. Acute rejection can be reversed in more than 80 percent of cases.
Chronic Rejection: This occurs at any time. Baby has a continuous tendency to reject to the new kidney. This rejection does not happen to every patient.If your body totally rejects the transplanted kidney in the first few months, or if the new kidney does not function, the transplanted kidney may need to be surgically removed from you body. You will have to return to dialysis and, wait for another kidney. Late failure of the transplant may not require its removal.After transplant surgery your immune system is controlled/depressed by special medicines to stop rejection .The medicines used to prevent rejection are called immunosuppressants.
These medicine are - cyclosporine / tacrolimus, azathioprine (Imuran) & prednisolone, which have already been mentioned before. It will be necessary for you to take some immunosuppressive medication for as long as you have the graft. Because the body never accepts the kidney as part of itself, rejection can occur even years later, particularly if you stop your medicines. These medicines have some possible side effects & should be taken exactly as directed. There is a fine balance between taking too little and risking rejection, or too much calling for side effects such as infection. However, it will be possible to reduce the dosage of medications gradually over time, as the risk of rejection lessens with time. Appropriate changes will be made as required to ensure you are getting the best possible immunosuppression at the same time minimizing the side effects. All currently available immunosuppressive medications have side effects. Some of these are common to all such drugs, and some are particular for the individual drug.The most important side effect these drugs have in common is that by reducing the body's immune defenses, they may actually increase the risk of infection. Because theydepress the body's immune system in a non-specific way, the body is less able to fight off some kinds of infection. This does not mean that you will be ill frequently, but rather that there are some kinds of infection only contracted by patients taking these or similar drugs. Most of these infections are treatable, if detected early enough. Therefore, it is very important that you report any symptoms such as fever or a cough consult your doctor without delay. Despite the risk, these infections are not common; only about 15% of transplant recipients ever have any significant infection. Cyclosporine has a number of special side effects, of which the most important is kidney toxicity.
Sometimes cyclosporine will cause your creatinine to rise, even in the absence of any other problem. Usually this improves with a reduction in the dose. Serial cyclosporine blood levels are currently available to help decide the best dose for an individual patient. Other side effects rarely caused by cyclosporine include mild hand .
Side Effects of Immunosuppressive Drugs22
tremors, hair growth, and inflammation and swelling of the gums. These generally improve if the dose is lowered.
Side effects secondary to prednisolone occur much less commonly now than they did years ago, because much lower doses are used.
The most common side effect now seen is a tendency to gain weight and develop a fat face.
Other possible effects include fluid retention, stomach irritation or ulceration, thinning of the hair, acne, mood swings, bone disease, and delayed wound healing. Sugar control will be more difficult for diabetics, and an occasional borderline diabetic may require insulin for the first time.
Many of these side effects improve as the prednisone dose is lowered over the first year.There is a small but increased risk of developing certain cancers later on. You should therefore :
a. Examine your skin and body and report any unusual lumps or spots to your doctor.
b. Reduce exposure to sunlight
Upon leaving the hospital, the patient will receive a schedule of follow-up clinic visits for lab tests and checkups. The purpose is to track your progress and detect potential complications as early as possible. On days when the patient is scheduled for follow-up visits, he should bring his medication list and his handbook. He will be given specific instructions for routine lab work or special tests that he might need.