What to Expect After Kidney Transplant Surgery
After the transplant operation, you will be taken to the transplant intensive care unit, where a team of trained transplant specialists will take care of you. You will meet physicians, nurses, pharmacists, residents, and social workers all of which specialize in transplant care. While you are in the hospital, you will be watched closely. We will be teaching you how to care for yourself and your kidney. Specific tasks, which will be done by the nurses that you should be aware of, include the following:
- Vital Signs: Your nurse will take your temperature, pulse, and blood pressure. You will be taught how to take your temperature. Have someone bring a thermometer from home so we can show you how to use it. You will need to take your temperature once a day at home.
- Intake and output: Accurate measurement of your fluid intake and urine output is very important. If you are on a fluid restriction, you must limit the amount of fluid you drink. Inform your nurse of your entire fluid intake. Your output includes your urine, and other waste products your body makes. You will be taught how to measure liquids so you can monitor your own intake and out put at home.
- Daily weights: All transplant patients are weighed daily. If you can walk, a standing scale in the hallway will be used. If you are unable to get out of bed, a bed scale will be used. Be sure to urinate before being weighed. A full bladder will make you weigh more. You will weigh yourself once a day when you are at home.
- Blood drawing: During the first 24 hours after your surgery, your blood will be drawn every six hours. If you are doing well, expect to have your blood drawn at once a day between 4:00 and 5:00 am. Several tubes of blood are drawn at this time. Routine tests check levels of creatinine, potassium, white and red blood counts and anti-rejection medications. Bloods are drawn early so the results are available to the doctors for their morning rounds. Your medication dosages may change because of these tests. If you are a diabetic or become a diabetic after receiving your kidney, expect to have your blood drawn more often. This will be done until your glucose level is under control.
- Specimen collection: You will be obtaining urine specimens every other day while you are in the hospital and when you come to the clinic.
Although you have a new kidney, sometimes it takes a while for it to work properly. You may need dialysis until the new kidney functions normally. Sometimes it can take several weeks to a month before the kidney works well. If you continue to need dialysis, you will still get all the medication for your new kidney, and follow the same routines as other transplant patients. The difference would be that your diet, fluid intake and medications are adjusted to make up for your kidney not working completely. Do not let this get you depressed and prevent you from learning about your care. It is still very important for you to learn.
Some kidney transplant patients will undergo plasmapheresis, a process where their blood is circulated through a machine and the plasma containing antibodies or substances that can cause rejection are removed. The plasma will be replaced with plasma or Normal Saline IV and albumin, a fluid containing naturally occurring protein in your body. Your plasma can be removed through a central line, fistula, or graft and the procedure generally takes about 1.5 - 2 hours.
Plasmapheresis begins on some patients preoperatively and continues in the immediate postoperative period for 5 - 10 sessions more. Possible side effects for this procedure include shortness of breath, rash, itching, or muscle cramps. You will be monitored closely and given medications to reduce any side effects you may experience.
Several tests are often done on transplant patients. These include the electrocardiogram (EKG), x-rays, renal scans and ultrasounds. The renal scan and ultrasound are tests that tell the doctors how well your new kidney is working.
Sometimes, physicians need more invasive testing. A kidney biopsy is one of these tests. This test requires a small sample of your kidney to be obtained so that it can be looked at through a microscope. After your biopsy, you must remain in bed for six hours. These precautions are needed to prevent any bleeding from the biopsy site. It is also needed to prevent any damage to the kidney. You may eat and drink after the test.
Periodically, you will be contacted at home to come in for a kidney biopsy to monitor your transplanted kidney. The procedure will be done on an outpatient basis but you will be expected to spend most of the day at the hospital. More information will be given to you at the time of scheduling.