The Saint Barnabas Health Care System (SBHCS) Renal and Pancreas Transplant Centers conduct medically based, post-transplant clinics where organ recipients consult with an experienced team of nephrologists, a nurse practitioner, nurse coordinators, social workers and a dietitian who carefully monitor their overall health. Colleen Walsh, R.N., M.S.N., N.P.-C., Nurse Practitioner, and Melissa Dowd, R.N., B.S.N., C.C.T.C., Supervising Nurse Coordinator, both staff members of the Post-Transplant Clinic at Saint Barnabas Medical Center, represent a total of 20 post-transplant team members (excluding physicians) who assist patients and families in maximizing their capacity and avoiding the risks and complications that can be associated with renal transplantation.
Does everyone who has a kidney transplant experience complications?
Almost everyone experiences some side effects from the immunosuppressive medications, but only a small percentage of our transplant recipients experience any serious complications following transplantation. One of our primary goals is to prevent any problems that could threaten the patients’ overall health or the health of their transplanted organs.
Within days of their discharge from the hospital, we begin to follow the transplant recipients’ progress in our outpatient clinic with physical examinations, blood work and lots of communication. We educate patients and their close family members about all of the possibilities and alert them to the first symptoms of any problems. Patients are encouraged to call the clinic as soon as they are feeling even the slightest bit unwell.
What are some of the complications associated with kidney transplantation?
Most of the complications are directly related to the steroid medication taken everyday as part of the drug regimen that prevents the body’s natural response to reject foreign tissue. Those medications can cause bone and joint problems, diabetes, increased susceptibility to infection and other health problems.
What can be done to prevent bone disease?
To prevent osteoporosis, we recommend calcium and vitamin D supplements, as well as weight bearing exercise. We also ask patients to have a baseline bone densitometry scan. This test is repeated annually and if a patient shows any sign of bone loss, we can halt the trend with medication that rebuilds bone.
What are the challenges faced by people with diabetes who receive kidney transplants?
Many people who are diabetic have difficulty managing their blood sugar and insulin after transplantation – even those who had excellent control of their disease prior to transplant. The SBHCS Transplant Centers’ strong affiliation with the Joslin Diabetes Center provides patients with access to endocrinologists and nurse educators who can help them manage their blood sugar and insulin levels.
In some exceptional cases, the immunosuppressive medications can induce diabetes in patients who have a predisposition to the disease due to their family history. They are also referred to the Joslin Diabetes Center. For many of these patients, the diabetes is resolved when some of these medications are reduced.
Why are the red and white blood cell counts of transplant recipients followed so closely?
The results of these tests can indicate infection or anemia. Infection, particularly with the cytomegalovirus (CMV), is a concern primarily during the first six months following transplant surgery. The majority of the population carries the CMV virus without any harmful effects, but when the immune system is compromised, this opportunistic virus can cause significant illness. All kidney transplant patients are encouraged to call the clinic if they notice any fatigue, weakness or flu-like symptoms. CMV can be treated successfully with intravenous anti-viral agents.
People on dialysis are also at higher risk for developing anemia. This may be overcome after a kidney transplant, but in some cases, iron supplements or medication may be necessary to stimulate the bone marrow to produce red blood cells. Hematologists are available for consultation if a patient’s red and/or white blood cell counts do not respond to standard treatment.
Do these risks and complications persist over the lifetime of the transplanted organ?
For most patients, the complications and side effects associated with renal transplantation are greatly reduced after one year following their transplant. It is important to note that during the first year following transplantation, the dosages of the immunosuppressive medications are slowly tapered. Oftentimes, this alone will alleviate any problems the patient has experienced.
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