Possible Kidney-Pancreas Transplant Complications

People who have an organ transplant may develop complications after surgery. Your transplant team will teach you the warning signs of complications and recommend treatments when necessary. The more common complications include rejection, infection, acute tubular necrosis and post-transplant diabetes.

Rejection

Rejection occurs when your immune system recognizes the transplanted kidney and pancreas as foreign and attacks them. To help prevent rejection, you must take immunosuppressant medications to weaken your immune system. These medications must be taken exactly as prescribed to reduce the risk of rejection. It is necessary for you to take them for as long as your transplanted kidney and pancreas are functioning.

Sometimes your immune system can overcome the effects of the medication and begin to reject your new organs. You may not even experience any rejection symptoms. The best way for the transplant team to recognize possible rejection is to follow your lab work closely. 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 chance that your body will reject your transplanted organs; however, they also increase your risk of infection. This risk is greatest in the early period after transplant, when immunosuppressant dosages are at their highest. It is always 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.

Cytomegalovirus (CMV) is a very common virus. About 70 percent of adults have been exposed to CMV at some time. It usually causes a flu-like illness with fever, body aches, and decreased appetite for two or three days. After exposure to CMV, the virus remains in your body but does not cause symptoms. You also form antibodies to the virus. We will do blood tests to check both the transplant recipient and donor for the presence of CMV antibodies.

During the first few months, while the immunosuppressant doses are highest and your immune system is especially weak, the CMV virus can reactivate or "wake up." CMV infection can be serious in people with weakened immune systems.

If either you or your donor were positive for CMV antibodies, you will be given an antiviral medication for the first few months after your transplant. As your doses of immunosuppressants are lowered over time, your risk for CMV will decrease as well, and the medication will be stopped. If you develop an active CMV infection, you will be treated with medication.

Polyoma BK virus is another very common virus. About 90 percent of people in the United States are affected with this virus by the time they are 12 years old. Symptoms are cold-like and go away on their own. However, the virus itself does not totally leave the body. It becomes dormant, asleep in the kidneys and bladder.

When the immune system is weakened with anti-rejection medications, the virus can reactivate, primarily within the first year after transplantation. In general, there are no symptoms that let you know you have been affected by the virus. Therefore, it is necessary that we routinely screen all transplant recipients with a blood test several times during the first year post-transplant.

In some cases, polyoma BK virus can cause severe kidney damage, perhaps even loss of the transplanted kidney. The virus is treated by decreasing immunosuppressive medications to allow your immune system to fight off the virus. This treatment may require more intense monitoring of your kidney function. Unfortunately, no drug has been shown to treat the virus effectively.

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; therefore, 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 is able to reabsorb this fluid as healing occurs. But sometimes, a large buildup of fluid may put pressure on the kidney and ureter and prevent urine from draining easily. In these cases, the lymph fluid will need to be drained. This is 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.