A Life-Saving Kidney Transplant constitutes the best treatment for kidney failure or end stage renal disease (ESRD) otherwise known as end-stage kidney disease (ESKD). A kidney transplant is made possible by a donor which may be a deceased donor or a living donor. A kidney transplant from a living donor confers the best benefit.
Eligibility for a Life-Saving Kidney Transplant
In order to find out if you are eligible for a kidney transplant, keep your appointments with your nephrologist who will monitor your kidney function level and determine when you are eligible to be referred for evaluation by a transplant team. Typically you are eligible to be considered if your GFR level (a measure of kidney function) reaches 20 or below, and other criteria are met. Learn more about how to understand your kidney blood tests here and to learn more about the race modifier in estimation of the GFR click here.
At a GFR of 20 or below you can begin to accrue time on a transplant waitlist after your transplant evaluation team has determined that you fulfil the other necessary criteria.
If you are African-American, of African descent, or identify as Black, it is important to know the good news that the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF) no longer recommend use of a race modifier in calculating your estimated GFR. You may therefore qualify for a referral to a transplant team earlier than that which your blood test report states in the line that reads African-American.
It is important to understand that, unfortunately, not everyone is eligible for a life-saving kidney transplant. It is dependent upon the status of your health and some other diagnoses, among other criteria.
Talk to your doctor to learn more.
Have You Already Received a Life-Saving Kidney Transplant? The Information below is Important
Like all medical treatments, a life-saving kidney transplant has associated risks and benefits. There are therefore prudent rules to follow to help ensure the best outcomes. Visit the National Kidney Foundation to learn more.
Your new transplanted kidney is considered as “foreign” or “not welcome” by your body because it did not create your new kidney. Your body will therefore naturally try to reject it. In order to help your body accept the new kidney, your doctors will have to give you special medicine to help your body to not reject the new kidney.
These medications are referred to as anti-rejection medications or Immunosuppressive therapy/medications and create a condition called immunosuppression. This immunosuppression will help your body accept the new kidney. However, because this immunosuppression works by impairing your immune system, these medications also (simultaneously) increase your risk of certain infections and some cancers. It is therefore important for you to carefully follow the rules and instructions of your Healthcare Transplant team.
Protecting Your Life-Saving Kidney Transplant
If you have received a transplant, take good care of it. Below is a short list of helpful tips for protecting your precious new transplanted kidney and for helping you to live in the healthiest possible way.
- Follow your doctors instructions
- Do not miss doctors’ appointments
- Do not miss lab appointments
- Take your medication as prescribed
- Report any new symptoms to your Transplant Team or your nephrologist (depending on the time since your transplant and the instructions of your transplant team)
- When you have new supplements, new over-the-counter medications, or new prescription medicines: discuss them with your transplant team or your general Nephrologist.
- Vaccinations are very important: Be up-to-date regarding your vaccines but please remember that there are some vaccines that are contraindicated because of your immunosuppression status. You must avoid live vaccines and avoid people who have just received a live vaccine like MMR, oral polio vaccine (children), chicken pox (varicella) vaccines. Visit the national kidney foundation to learn more.
- Eat well: a heart healthy diet is recommended.
- Be careful of your cholesterol intake: your transplant status, particularly the medications needed, will increase your risk of having high cholesterol. Help negate this by watching your cholesterol intake, for example eggs contain 60 to 70% of the recommended daily allowance of cholesterol for a normal person and even higher for someone who has high cholesterol
- There is an increased risk of new onset diabetes after transplant (called NODAT): limit your intake of sugary snacks and high carbohydrate meals. Learn more at the national kidney foundation here.
- Avoid foods and supplements that can interfere with your transplant medicine. These are special plants and/or fruits that can interact with liver enzyme pathways: grapefruit, grapefruit juice, pomegranate, pomegranate juice, St John Wort
- Know your status regarding gout and your uric acid blood test results, and comply with the medications that your doctor has prescribed for this. Your transplant status requires being on certain medications (like calcinuerin inhibitors) that may increase your risk of gout or hyperuricemia after transplantation.
- Take good care of your oral health: you are at increased risk of infections and poor oral health is one an important risk factor for infections: talk to your transplant team about the frequency of dental visits they recommend- most teams recommend once per year
- Be sure to visit your dermatologist at least once per year regardless of your race or prior history concerning your skin. Your Transplant status increases your risk of skin cancer significantly especially squamous cell carcinoma. After your initial visit your dermatologist will help determine how frequently you need to be seen as some patients require more frequent visits than yearly
- Do not miss cancer screening tests
Protecting Your Life-Saving Kidney Transplant – Follow Your Doctors Instructions: Do Not Miss Appointments & Take Your Medications as Prescribed.
For the first year after your transplant your kidney transplant team will be an integral part of your care with regular appointments as that team sees fit. This team is typically comprised of your your transplant surgeon and your transplant nephrologist, coordinator, social worker and behind the scenes, your transplant pharmacist. There are many unique things regarding your transplant that result in the need for this close attention and multidisciplinary team. Your susceptibility to rejection of the new kidney, the medications required, and your risk of infection are central parts of this uniqueness.
Take your medications as prescribed to help avoid rejection of your new kidney and to help keep yourself healthy.
Comply with any and all orders your doctor makes for you tests including blood and urine tests. It is very important to ensure that your blood is monitored and medication levels remain in what is called the therapeutic range. There are instances when the levels can become too high. The opposite can also be true: instances when the levels are too low so that you become at risk of rejecting your new kidney. It is therefore very, very important to comply with the ordered tests. If you have any concerns or any financial difficulties reach out to your team including your social worker because they can help: do not miss lab appointments.
Protecting Your Life-Saving Kidney Transplant: Report any new changes to your transplant team.
It is important to know that sometimes the symptoms of some transplant-related conditions for example: unique, transplant-related infections or medication side effects may be mild or begin mildly and if caught and treated early, your outcome may be better. Therefore be observant and report any new symptoms- for example, pain, fever, blood in the urine, tiredness, fatigue, malaise, abdominal pain, nausea, vomiting, diarrhea, numbness, tingling, tremors, confusion.
Protecting Your Life-Saving Kidney Transplant: Report Any new supplements or medications
In order to protect your Life-Saving Kidney Transplant, whenever you have new supplements, new over-the-counter medications, or new prescription medicines, discuss them with your transplant team or nephrologist. Whenever you have a new provider, inform them that you are a transplant patient and provide a list of your medications as this will be useful in checking for any possible interaction when new medications are being prescribed. Some commonly prescribed medications that can interact with your transplant medicine in an important way. The list of these medicines include but are not limited to:
- Some blood pressure medicines
- Some seizure medications
- Some antifungal medications
Examples of these medications that can increase the levels of your tacrolimus or cyclosporine (calcineurin inhibitor medications) to high or maybe even toxic levels include:
- Diltiazem
- Verapamil
- Fluconazole and other similar antifungal medications
- Erythromycin
- Clarithromycin
- Protease inhibitor antiviral medications like ritonavir, indinavir, atazanavir, saquinavir, nelfinavir, darunavir
Examples of these medications that can decrease the levels of your tacrolimus or cyclosporine (calcineurin inhibitor medications) to a low level (which may cause rejection of your new kidney) include:
- Dilantin (phenytoin)
- St John wort
- Ciprofloxacin
- Rifampin
Please also remember that a few foods foods and supplements that can interfere with your transplant medicine. These were mentioned above and are special plants and/or fruits that can interact with liver enzyme pathways.
Those that can increase the levels of your tacrolimus or cyclosporine (calcineurin inhibitor medications) to high or toxic levels are:
- Grapefruit
- Grapefruit juice
- Pomegranate
- Pomegranate juice
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