Possible Complications

People who receive a transplant may develop complications after surgery. Your transplant team will help you understand the warning signs of possible complications, discuss your care, and recommend further treatment when necessary. The more common complications include rejection of the organ, infection, acute tubular necrosis and post-transplant diabetes.

Donor organs are screened for various diseases in accordance with standards required by the United States Department of Heath and Human Services—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 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)

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

Because of the immunosuppressant medications, you will be at risk for infection with CMV after transplant. 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." A CMV infection can range from flu-like symptoms to more serious infections involving your stomach, kidney, or lungs (pneumonia).

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

Polyoma BK virus is another very common virus. About 90% of people in the United States are affected with this virus by the time they are 12 years old. The symptoms at the time of infection are non-specific, like cold symptoms that go away. 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. Currently, the primary treatment of the virus is to decrease the immunosuppressive medications, to allow your own immune system to fight off the virus. This treatment may require a more intense monitoring of your kidney function tests. Unfortunately, there is no drug that has been shown to effectively treat the virus.

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 that 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 get diabetes, you will be given special teaching about 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. 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.

Transplant Center