CONTENTS
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The surgery to implant a kidney from some other person into a human body itself is a major procedure. It's important that such surgery is done in big hospitals with all facilities available to manage any type of complication in the immediate post operative phase. Such patients are on rather high doses of immunosuppressive drugs, which suppresses the body's defence mechanisms. Hence they are very prone to infection. As a consequence they have to be treated in special isolation room where except for a nurse who is continuously there and doctors and trained menial staff who come to attend on him intermittently during the day; no other personnel is permitted inside. Even this staff should enter the room with change of slippers and wearing a gown. The doctor and nurse must wash their hands with soap solution containing and antiseptic, so as not to transmit any infection to the patient through their hands.
After a minimum of 72 hours after surgery the patient's total isolation could be reduced. He could be allowed to go to the dining hall where he can eat his food and meet his one relative or friend for short period. He should receive well-boiled water and only well cooked and wholesome food in order to prevent gastrointestinal infections. His respiratory tract is kept free from infection by preventive measures like us of steam inhalations 2-3 times a day and regular respiratory exercises which should be taught by the physiotherapist. The immediate post operative period is used to educate the patient regarding Do's and Dont's to be followed after transplantation and changes in life style that he/she should bring about as an absolute necessity.
At discharge the patient should be given a copy of discharge summary, giving all details such as drugs administered in the hospital; all post operative events and these medications which have to be continued at home.
Do's to be emphasised include:
Taking all drugs regularly and at appropriate time as per instructions given by the doctor.
Regular checking of blood pressure and adjusting the dosage of the same drugs appropriately.
Diet should be fresh well cooked and adequate in calories, proteins and salt restricted fats should be restricted to 50 grams or less, but its important to use proper combination of fats such as
Polyunsaturated + Mono and Diunsaturated
1/3rd quantum 1/3rd quantum
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Saturated fat 1/3rd quantum.
Fruits must be well washed in boiled and warm water and skin could be peeled off before eating.
Regular brisk walking exercise for a minimum of 1/2 an hour twice a day in an area which will be devoid of excessive number of people, dust and automobile/industrial fumes. In crowded cities like it's essential to wear masks.
To see that a regular follow up is done by a doctor from the transplant team with checking of blood pressure and clinical examination. It's essential to have date of laboratory tests like:
Routine blood count and urine for routine and culture examination.
- Chemistry done for kidney and liver function test.
Blood sugar estimations - Fasting, Post lunch as some of the immunosuppressive drugs(steroids and Cyclosporin) can elevate the blood sugar levels in non diabetic individuals. It's essential to do these tests from one and the same laboratory one each follow up.
The follow up initially is once or twice a week followed by once in two weeks for 6 months. Thereafter, it would be once a month for one year.
Any cuts, abrasions, scrapes etc. must be promptly attended to by cleaning with soap and water and using clean dressing.
Utmost attention must be given to personal hygiene such as using mouth washes to cleanse the mouth after every feed, bath twice a day particularly in hot and humid weather, frequent hand washing with particular attention after evacuating bowels etc. Environmental hygiene in your own surroundings should be well looked after.
Any other abnormal symptoms appearing which were not present previously must be reported to the doctor immediately by additional in-between visit.
The Dont's include:
Avoid going into crowded places like bazaars, cinema houses etc. for the first time.
Don't take any additional drugs except for a dose or two of aspirin for fever and pain. Many drugs interact with immunosuppressive drugs and produce problems.
- Do not allow any sick person to visit you.
Do not delay reporting any unusual symptoms however minor you may feel it. It's for the doctors to decide the significance of the same.
Avoid contact sports like motorcycling, horse riding, skiing etc. to avoid blows and strains to the kidney. These may be gradually resumed in those who were doing it before transplant, after proper consultation with the doctor.
Sexual activity could be resumed after 3 months following surgery, but female should avoid pregnancy for at least two years.
The level of physical activity to be permitted will vary from patient to patient depending on involvement of other organs like heart and lungs. It's best to use moderation until you find out what activity level is best for you. If you wake up tired after a full nights rest, then you know its too much. If you are alert and refreshed, then that should be the right amount.
It's important to get yourself educated about problems of transplantation. The main problem is of rejection. The difficulty arises as body can recognise a foreign tissue and body's defence mechanism starts operating to destroy what is not a part of itself. There are 3 types of rejection:
Hyperacute rejection: This can occur on the operation table or a few hours after transplant. This is not treatable and kidney has to be removed.
Acute Rejection: This can occur between the first week and one year after surgery. Minor episodes of such rejection do occur in practically all patients and is treatable, provided early symptoms are reported and its diagnosed early. The symptoms include:
- Decreased urine output
- Sudden weight gain,
- fever,
- fatigue,
- blood in the urine,
- pain and swelling over the kidney.
ITS IMPORTANT TO REPORT TO YOUR PHYSICIAN PROMPTLY. The doctor may order for X-rays, ultrasound examination; renal scan/renogram, fine needle aspiration cytology (FNAC) or renal biopsy. These must be got done by experienced personnel in the field.
Chronic Rejection: This occurs slowly over long period of time and there may not be obvious symptoms until kidney failure sets in and progresses. This is difficult to treat and patient has to return to dialysis and await another transplant.
Infection is the second most important problem. Wound sites, mouth, skin, gastrointestinal tract, urinary tract, para-nasal sinuses, lungs and meninges of the brain are the main sites. These will need appropriate antibacterial agents which will be prescribed by the doctor depending on the infection being bacterial, fungal or viral. Drugs so prescribed must be taken in proper dosage, proper frequency and proper duration of time. One year following transplant one can start normal life with family reunions, social get together etc. Though treating oneself normally, it's important to lead a balanced life remembering some of the Do's and Dont's already mentioned earlier so that this new lease of life given is enjoyable.
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