Dos and Don'ts for kidney transplant recipients

Lot of prominent personalities in India from various fields (cinema, politics) have undergone kidney transplantation surgery in the last few years. A very famous senior politician from Bihar has recently undergone kidney transplantation in Singapore with daughter being the donor. Since then, there is a lot of discussion and hype in the social media and main stream media about the pros and cons of kidney transplantation.

No doubt, kidney transplantation is the better modality of treatment for patients suffering from end stage kidney disease (permanent form of kidney failure). Alternative option is dialysis which has its pros and cons. However, kidney transplantation is also not devoid of all problems. Even though the quality of life is much better after kidney transplantation when compared to dialysis, the recipient has to be more careful, cautious and responsible after transplantation. To answer that, I am mentioning the dos and don’ts after kidney transplantation surgery.

Do’s:

• Take plenty of oral fluids. During the initial days after transplantation, 3 to 5 litres of fluid intake is recommended.
• Take anti-rejection medications (immunosuppressive drugs) at appropriate dose and at appropriate time as prescribed by the doctor. Keep alarms or reminders in the mobile phone so that you will not skip any dose.
• Wear a surgical mask while going out, take boiled and cooled water.
• Take freshly prepared food from home. If you are non-vegetarian, cook the meat and fish properly before consuming.
• Regular exercise for 30 to 45 minutes a day for at least 5 days in a week (total of 150 minutes in a week). Brisk walking, running, cycling and swimming can be considered.
• You can get back to your job, three months after the transplantation surgery if the clinical status is stable.
• Regular follow up with the doctor as advised is very much important. During initial days, you may have to visit the doctor twice a week and the frequency of visit will reduce over a period of time.
• Your appetite increases considerably after the transplant. There is a risk of weight gain and developing diabetes and high cholesterol after kidney transplantation owing to the medicines used. Following a healthy diet is very important. Consume food rich in fruits, vegetables, fiber, whole grains, lean meats, poultry and fish. Reduce the salt intake, reduce fatty foods and high carbohydrate diet.
• Isolate yourself if any family member develops fever, cold and cough till their symptoms subsides.

Don’ts:

• Avoid lifting heavy weights for at least one month after kidney transplantation surgery.
• Don’t skip anti-rejection medicine without the doctor's advice. Non-compliance with medicines can trigger rejection. If you miss a dose, please take a tablet immediately when you remember it.
• Avoid NSAID’s (pain killers) and other nephrotoxic medications (medicines which can damage the kidneys). Always consult a nephrologist before taking any new medicine.
• Avoid grapefruit and grapefruit juices. Avoid pomegranate and its juice. Both these fruits will interact with the anti-rejection treatment.
• Certain antibiotics also interact with the anti-rejection treatment. Take the opinion of the treating nephrologist before taking it.
• Avoid half cooked meat. Avoid eating food from outside or getting food parcels from outside and consuming it.
• Avoid crowded places like visiting malls, religious worship places, and family functions. Be careful while using the public transport system especially in the early stages.
• Avoid too many visitors during the initial days after surgery as there is increased risk of infection. In our country, it is a common practice for friends, relatives, and neighbors to pay a courtesy visit to a person after any major illness. That should be strictly avoided.
• Immunosuppressive medications are given to prevent rejection of the transplanted organ. If you miss a dose, it can lead to rejection. At the same time, these medicines reduce your body immunity and thereby increase the risk of infection. Strict adherence to infection control practices is of utmost importance. Finding the right balance between these two factors determines the success of transplantation.

Dr. Vinod Kumar, Consultant - Nephrology & Renal Transplantation, Aster RV Hospital