Possible Kidney Transplant Complications

People who receive a transplant may develop complications after their surgery. Your transplant team will help you understand the warning signs of possible complications, discuss your care, and recommend further treatment when necessary.

Donor organs are screened for various diseases in accordance with standards required by the United States Department of Heath and Human Services (HHS), Centers for Disease Control and Prevention (CDC) and the United Network for Organ Sharing (UNOS). However, transplant recipients may be at risk for contracting certain diseases from the organ donor, such as various types of infectious diseases and cancers, which are not detected during the organ donor screening process.

Rejection

Rejection occurs when your immune system recognizes the transplanted kidney as foreign and attacks it. The immune system is your body's natural defense against foreign invaders such as viruses, bacteria, and some types of cancers. To help prevent rejection of your new kidney, you must take immunosuppressant medications which will weaken your immune system. These medications must be taken on time, and as prescribed, in order to reduce the risk of rejection. It is necessary for you to take them as long as your transplanted kidney is functioning.

Sometimes your immune system can overcome the effects of the medication and begin to reject the new kidney. You may feel good and have no symptoms, yet still be experiencing rejection. The best way for the transplant team to recognize possible rejection is to follow your lab work closely. An increase in your serum creatinine or an increase of protein in your urine may be warnings of rejection. This is why we will check your lab work frequently during the first few months after surgery. Most rejection episodes can be treated successfully with medication, especially if detected early.

Infection

Immunosuppressant medications decrease the risk of rejection of the transplanted organ; however, they also increase your risk of infection. This risk is greatest in the early period after transplant when dosages of medications are at their highest. It is important to protect yourself from exposure to infection. Here are some suggestions:

• Wash your hands frequently.
• Avoid contact with people with known infections like colds or the flu.
• Clean cuts or scrapes with soap and water.
• Avoid sharing eating utensils with others or drinking from the same container.
• Notify a member of the transplant team if you notice any possible signs of infection.

Acute Tubular Necrosis

Acute tubular necrosis (ATN) is the medical term for a transplanted kidney which is slow to function due to factors associated with the transplant procedure. This condition is sometimes called a "sleepy" kidney. If this condition occurs, you may need dialysis temporarily to give the kidney time to heal. Limiting potassium and fluids may also be necessary. It may take several weeks for a transplanted kidney to start to function. You will return to your local dialysis center until your kidney begins working. You will continue to be followed closely by the transplant team.

High Blood Pressure

Some immunosuppressants can raise blood pressure, so some transplant recipients must take additional medications to control their blood pressure. Your blood pressure is recorded as a top (systolic) and bottom (diastolic) number. Normal blood pressures range from 100/70 to 130/80. After your transplant you will take and record your own blood pressure daily. Notify a member of the transplant team if your blood pressure goes above 170/100 for two readings in a row. Untreated high blood pressure may damage your heart and other organs.

Post-Transplant Diabetes

Some of the immunosuppressant medications you take may increase the likelihood of diabetes. Diabetes is an increased level of sugar in your blood. Signs of diabetes may include excessive thirst, frequent urination, blurred vision, drowsiness, or confusion. Notify the transplant team if you notice any of these signs.

In some cases, high blood sugar can be reduced and managed by weight loss, careful diet, and exercise; however, you may need an oral diabetes drug or insulin injections. If you develop diabetes, you will be educated on how to deal with this problem.

Lymphocele

A lymphocele is a collection of lymph fluid around the kidney. It is normal for some fluid to collect around the kidney after transplant, but usually your body reabsorbs this fluid during the healing process. Sometimes, however, a large build-up of fluid may put pressure on the kidney and the ureter and prevent urine from draining easily. In these cases, the lymph fluid will need to be removed. This can be done by placing a drain tube through the skin into the fluid collection and allowing it to drain into a bag over several days. Another option is for the lymphocele to be drained surgically. This operation is relatively simple and usually requires an overnight stay in the hospital.