Going Home After Your Transplant

Going home after your transplant is very exciting. However, it can also seem overwhelming. Before you go home, we will thoroughly review with you and your family what you need to do to take care of yourself and your new kidney. Your transplant coordinator, pharmacist, social worker, and nurses will begin preparing you for discharge the day after surgery.

Vital Signs

You will need to check your temperature and blood pressure daily. The nurses will teach you how to check these vital signs so that you will feel confident doing this before you go home. If you do not already have a blood pressure cuff and thermometer, you will need to buy these from a pharmacy or medical supply store.

A daily journal is provided for you to record your vital signs. Your nurse will tell you acceptable ranges for the vital signs so that you know when to call if a reading is abnormal. It is important that you keep good records and bring these with you each time you come to the Outpatient Transplant Clinic for follow-up.

Daily Weight

You need to weigh yourself every day. Please try to do this at about the same time each day (preferably in the morning after you have emptied your bladder) and while wearing about the same amount of clothing. Record your weight with your vital signs in your daily journal. If you have gained more than three pounds in a day, or more than five to seven pounds in a week, you should call the transplant team. This weight gain may be a side effect of your medications or possibly a sign of transplant rejection.

Medical Alert Identification

We suggest that you obtain a special medical alert bracelet or necklace. In case of a car accident or other type of emergency, this will inform health care professionals that you have had a transplant. The identification bracelet or necklace can be purchased at many pharmacies or ordered through the mail for a nominal cost.

Discharge from the Hospital

If you live a great distance from Emory, you may be asked to stay in the Atlanta area for a few additional days so we can closely monitor your progress.

The Mason Guest House of Emory University offers private, low-cost lodging for transplant candidates, recipients, and families. Individuals from out of town coming to a transplant evaluation or follow-up care may also stay at the Mason Guest House (see section on Mason Guest House for more information).

When to Call the Transplant Team

You should call the Transplant Team if you experience any of these symptoms, or any time anything about your health changes, even if it is not related to your transplant:

• Temperature of 100° Fahrenheit or greater
• Blood pressure greater than 170/100 for two readings in a row
• Weight gain of more than 3 pounds in a day or 5 to 7 pounds in a week
• Cough, shortness of breath, sore throat, chills
• Nausea, vomiting or stomach pain
• Diarrhea
• Decreased appetite
• Blood in the urine or bowel movements, painful urination
• Increased pain, redness, or pus-like drainage at the incision
• Pain, tenderness or swelling in the area of the new kidney
• Feeling unusually tired
• Persistent headache or flu-like symptoms
• Any unexplained rash, sores, or bruising
• Swelling of the hands, feet or ankles
• Unable to take medications for any reason
• Anything that concerns you about your health

Going for Check-Ups

Outpatient Transplant Services

Your kidney transplant follow-up appointments will be scheduled in the Outpatient Transplant Clinic which is located on the sixth floor of The Emory Clinic Building B. On the day of discharge, we will schedule your first appointment for lab work and a follow-up visit. This office visit will include seeing a member of the transplant team who will perform a physical exam, review all of your medications, and discuss how you have been feeling. This is a great opportunity for you to express any concerns or ask questions. Please remember to bring your daily records and a list of all your medications with you to each follow-up visit.

When you arrive for a clinic follow-up appointment, blood will be drawn for lab tests and you will be asked to give a urine sample. A nurse will check your vital signs and weight and ask some general questions about your health. It takes one hour for your lab results to come back. During this time you can wait in the waiting area, or you may wish to go to the cafeteria or gift shop. When your lab results are ready, the results will be discussed with you by a member of the transplant team.

Clinic Visits and Lab Tests

For the first four weeks after your transplant, you must come to Emory once a week for a follow-up visit. You will have lab work done and see the transplant team. After four weeks, if all is going well, visits and lab work will be needed less frequently. Eventually, you will need a follow-up appointment at Emory only once every year.

In addition to your weekly visit at Emory, you must have blood drawn for laboratory tests one additional time each week for the first six weeks. These tests can be done locally at your doctor's office, hospital, or dialysis center. We will provide a special order form for laboratories outside Emory. It explains what lab tests need to be drawn and how to send the results to us. If you prefer to have your lab work done at Emory, please call the Outpatient Transplant Clinic at (404)712-5676 in advance to make an appointment.

If your lab work is abnormal, the transplant coordinator will call you with any medication changes and let you know when to have your blood checked again. You may be asked to come to Emory to be seen by a transplant physician.

Routine Blood Tests

Monitoring your blood through lab tests is one way that we can make sure your kidney is working well and check for possible side effects of your medications. When we draw your blood we will do several lab tests that measure your kidney function and the level of medication in your blood:

• cyclosporine (Neoral®/Gengraf® /Sandimmune®) or Prograf® level - the blood level of immunosuppressant medication. This will tell us if a change in your dosage is needed.
• creatinine - measures kidney function. Creatinine is a waste product that is normally removed from your blood by the kidney. Creatinine may be increased for several reasons including rejection, dehydration, or high cyclosporine or Prograf® levels.
• potassium - a mineral that is regulated by the kidney. It may be elevated after transplant depending on kidney function, diet, and medication levels. Potassium levels may be low if you take diuretics or water pills.
• hematocrit - measures the number of red blood cells. The hematocrit may be low in patients with kidney disease or after surgery. It generally improves after transplant.
• white blood cell count (WBC) - measures the number of white blood cells. It may be elevated because of infections or due to high doses of prednisone. The WBC can also be low due to viral illnesses or as a side effect of Cellcept® or other immunosuppressant medications.
• cholesterol - a substance produced by the liver. Cholesterol levels can be increased as a side effect of cyclosporine, Prograf®, Rapamune®, and prednisone. High cholesterol levels can contribute to heart disease; limiting the fat intake in your diet helps control your cholesterol levels, but medication may also be required.
• amylase/lipase - enzymes secreted by the pancreas, part of the routine lab work in pancreas transplant recipients. An increase in either of these enzymes indicates the pancreas may be inflamed or irritated.

Ureteral Stent Removal

Most transplant recipients will have a ureteral stent placed as part of their kidney transplant surgery. If you have a stent, you will be informed of this by the transplant team. The urine which is made in your new kidney flows to your bladder through the ureter. The ureter came with the donor kidney and was connected to your bladder with a small incision. The stent is a thin hollow tube which is placed inside the ureter to keep it open and allow the connection to your bladder to heal.

The ureteral stent needs to stay in place for about six weeks after the transplant. By this time, healing will be complete and your stent can be removed. A urologist who works with the transplant team will remove the stent during a brief procedure called a cystoscopy. You will not be put to sleep, and no incision or surgery is needed. A flexible tube (the cystoscope) is inserted into your bladder, and the stent is removed through the cystoscopy tube. You may feel some brief discomfort or pressure. This procedure takes about 30 minutes.

It is important to know if you have a stent. If you have one, it is important to confirm that you have an appointment to have it removed.

Follow-Up Care Post Kidney-Pancreas Transplant

After discharge, you will be seen at least once a week, for the first six weeks, in the Outpatient Transplant Clinic which is located on the sixth floor of The Emory Clinic Building B. You should continue to check your blood sugar at least twice a day at home. Record your blood sugar levels along with your daily weight, temperature, and blood pressure. Bring these records with you to your clinic visits.

Some kidney-pancreas transplant recipients still require insulin injections at the time of their discharge, usually due to the side effects of the large doses of prednisone after transplant. Usually, as your dosage of prednisone is decreased, or tapered, you will no longer need extra insulin.

Transplant Center