Post-Transplant for Simultaneous Pancreas-Kidney

Education

You will learn all about your new pancreas-kidney, how to take care of it, how to prevent infection, your medications and your clinic and lab schedule. The coordinators, nutritionists, pharmacists and nurses will teach you how to take care of yourself now that you have your new pancreas and kidney. You will have received a transplant manual. This is your lifelong guide that you will need to continue to refer to. The transplant team expects you and your social support to participate in your education during your hospital stay. The transplant coordinator and the pharmacist will come to your room to answer questions and review your medications.

Caring for Yourself After Simultaneous Pancreas-Kidney Transplant

You are the most important member of your care team. You need to be actively involved in your care by attending clinic appointments, getting your labs drawn, communicating with members of your care team, and understanding how to take care of your new pancreas-kidney.

To help care for your pancreas-kidney, you will need to:

  • Take medications as directed, and ask your doctor before taking any other medications, including over-the-counter medications and dietary supplements.
  • Eat a healthy diet, avoid alcohol and do not smoke.
  • Contact your doctor if you are feeling ill, and avoid anyone with colds or infections.
  • Have your labs drawn as directed by your doctor, including any additional testing.
  • Follow lifting, walking, showering and activity restrictions.
  • Resume employment 4-6 weeks post-transplant.

Diet and Nutrition After Simultaneous Pancreas-Kidney Transplant

Your diet will change after your transplant. If your new pancreas-kidney is slow to start functioning you may need to remain on your dialysis diet of low sodium, low potassium, low phosphorus and limited fluid. However, as pancreas-kidney function improves, you will be able to enjoy much more variety.

Diet After Transplant

Safe Food Handling

Food Safety for Transplant Patients

Medications

It is very important to learn how to manage your medications. You will need to understand what they are for, when they need to be taken, how it is given, and what side effects you might experience. There can be many possible drug interactions between your post-transplant medications and herbs/over-the-counter dietary supplements.

Do not take herbs or dietary supplements without first consulting with your transplant physician.

Transplant patients should never take medications or herbs intended to "boost" their immune system. Only the transplant team should make changes to your kidney drugs (immunosuppression medications). If any of your other doctors want to make changes, please have them contact the transplant team.

Post-Transplant Labs for Simultaneous Pancreas-Kidney

You will need to have blood tests done on Monday and Thursday mornings for several weeks. The Self Reporting Records section of the post transplant handbook is provided to track the results of your blood tests. As your pancreas-kidney function stabilizes, the frequency of blood tests will decrease.

Lab Results Recorder

Guideline of labs needed

Time Post Transplant Lab Schedule
Discharge - 3 Months Post Transplant Labs Monday & Thursday
4-6 Months Post Transplant Labs Monday
7-12 Months Post Transplant Labs Every other Monday
1 year - 1½ years Post Transplant Labs Monthly
1½ years - 2 years Post Transplant Labs Every 3 Months
2 years Post Transplant and Thereafter Labs Every 4 Months

Simultaneous Pancreas-Kidney Post-Transplant Biopsies

A biopsy is a procedure used for diagnosing rejection. The doctor will numb your skin with a local anesthetic and take a very small piece of your kidney using a needle. After the biopsy, a sandbag will be placed over the biopsy site for four hours to prevent bleeding. The biopsy results will be available in about 36 hours.

If you are on any blood thinning agents such as, Aspirin, Plavix, Persantine or Coumadin, you need to call your coordinator to discuss a plan prior to being scheduled for a biopsy.

Simultaneous Pancreas-Kidney Post-Transplant Viral Monitoring

CMV

Cytomegalovirus (CMV) is a virus that is common in the general population. It is estimated that more than half of the general population has been infected with CMV by age 50. However, most adults who have been exposed to the virus do not develop CMV disease (an infection that causes symptoms and makes you feel sick).

Once infection occurs, a healthy immune system can keep the virus quiet, or dormant, in the body for a long period of time. The virus can become active if a person's ability to fight infection is reduced. If CMV disease does occur in a healthy adult, it usually causes only mild flu-like symptoms including fever, chills, and body aches. This is the mildest form of the disease. CMV disease can also be much more serious. It can cause complications that affect your lungs, liver, stomach, eyes, and intestines.

After transplant surgery, you will receive immunosuppressant medications. These drugs are important to help prevent you from rejecting your new kidney, but they also leave the body less able to fight infection. In the transplant recipient, a CMV infection can develop into CMV disease and cause serious health problems such as fever, pneumonia, gastrointestinal infection, retinitis (an infection of the retina of the eye), hepatitis or rejection of your transplant. Rarely, pneumonia can be fatal. A CMV infection can also make you susceptible to other infections by reducing your level of immunity even below what is caused by the immunosuppressant medications.

Understanding CMV

BK

The BK virus is a member of the polyomavirus family. Past infection with the BK virus is widespread, but significant consequences of infection are uncommon, with the exception of the immunocompromised and the immunosuppressed.

The BK virus rarely causes disease since many people who are infected with this virus are asymptomatic. If symptoms do appear, they tend to be mild: respiratory infection or fever. These are known as primary BK infections. The virus then disseminates to the kidneys and urinary tract where it persists for life. It is thought that up to 80 percent of the population contains a latent form of this virus, which remains latent until the body undergoes some form of immunosuppression. These cases are usually more severe and lead to renal dysfunction.

EBV

Epstein-Barr virus (EBV) is a member of the herpes virus family and one of the most common human viruses. The virus occurs in a vast majority of the population, and remains latent until the body undergoes some form of immunosuppression.

Vital Signs Monitoring

Your care does not stop once you are discharged from the hospital. All the things you have learned during your hospital stay will play an important part in your care at home. It will be your responsibility to perform the following measures and assist the transplant team in evaluating your health care and kidney function as an outpatient. The Self Reporting Records section of the post transplant handbook is provided to track the results of your temperature, weight and blood pressure.

Vital Signs Recorder

Temperature

Take your temperature at least once a day and record it. If your temperature is 100˚ Fahrenheit or greater, call the transplant nurse. If you feel like you have a fever or the chills, take your temperature and record it more often. If you have a fever of over 100˚ Fahrenheit after three months post-transplant, call your local doctor.

Celsius and Fahrenheit equivalents

37˚ C = 98.6˚ F
38˚ C = 100.4˚ F
39˚ C = 102.2˚ F
40˚ C = 104.0˚ F

Weight

Weigh yourself every morning at approximately the same time, wearing the same amount of clothes, on the same scale, and record it. Use your scale as a guide to help control weight gain. If you gain more than two pounds over one day or four pounds over seven days, call the transplant nurse.

Blood Pressure

Take your blood pressure at about the same time every day, two times per day, and record it every time. Know what your blood pressure should be before you leave the hospital. Do not take your blood pressure on the arm with a dialysis fistula or graft. Remember, blood pressure that is too high or too low can damage your pancreas-kidney.