Medical issues
Medical issues after a kidney transplant
Rejection
Rejection is when your immune system starts to attack your transplanted kidney because it recognises the kidney has come from a different person. Immunosuppressant medicines or anti-rejection medicines help prevent rejection by lowering your immune system’s response. But rejection can still happen – even if you’re taking all of your medicines. This usually depends on the differences between you and your donor’s immune system.
Your team will regularly check your kidney function using your blood tests and other investigations. They will also check if you are developing antibodies against your new kidney.
This makes it very important to go to all of your clinic appointments. If rejection is picked up early it can usually be treated successfully.
Diabetes and post-transplant diabetes mellitus (PTDM)
Diabetes is a condition that affects how your body makes and uses a hormone called insulin. Foods we eat, particularly carbohydrates and fats are changed into a sugar called glucose which our bodies use for energy. To turn glucose (sugar) into energy our bodies must produce insulin. Insulin ‘unlocks’ the body’s cells, allowing glucose to enter.
- Type 1 diabetes, typically found in young people but not exclusively, is when the body does not produce any insulin at all.
- Type 2 diabetes is much more common. It usually starts in middle age although it is becoming increasingly common in younger people. It occurs because the body is resistant to insulin. If insulin is not made or used in the right way, glucose will build up in the blood.
- Post-transplant diabetes (PTDM) is a type of diabetes that can occur after a transplant.
What if you have diabetes?
One of the complications of diabetes is kidney damage. So, good diabetes care is very important to maintain the wellbeing of your new kidney. All types of diabetes are serious and are linked with many other health problems, for example: heart disease, eye disease, high blood pressure and stroke; particularly if left untreated or uncontrolled.
How you can lower your risk of developing diabetes if you don’t already have it?
Diabetes can affect anyone but some people are more at risk than others. Some things you can’t change, for example, diabetes tends to be more common in some families and some ethnic groups are more at risk.
Being overweight is a major risk factor for Type 2 diabetes, so trying to lose weight will help. Try to make sure you eat a healthy, well-balanced diet and take regular exercise.
How is diabetes diagnosed?
Your glucose levels are checked by regular blood tests at the clinic, so we can diagnose diabetes as quickly as possible and give you advice.
What treatment will you need?
The treatment you need will depend on the symptoms and results from the tests you have. For some, good weight control, healthy diet and exercise may be enough to keep blood glucose (sugar) levels under control. For others diabetes tablets may work well and for some, insulin injections may be needed.
Be aware that these treatment options will probably change as time goes on. Diabetes is a complicated condition and everyone responds differently.
It is very common to find that if you had diabetes before the transplant you will need more diabetes medicines after the transplant. This is nothing to worry about.
Some of the anti-rejection medicines that you take after transplantation can increase your risk of developing diabetes. However, these drugs are vital for the wellbeing of your kidney so must not be stopped unless advised to do so by your doctors.
Diabetes is treatable and there is a lot of support available for you. If you are diagnosed with diabetes you will be referred to a local diabetes team to help you manage the condition on a day-to-day basis. They will advise you about important regular screening that will help to protect your kidney and overall health.
You can also find support and advice from these sources:
- Diabetes UK Telephone helpline: 0345 123 2399, Email: Helpline@diabetes.org.uk
Diabetes UK is the leading charity for people with diabetes in the UK and has lots of useful information explaining, for example, what diabetes is, different types of diabetes, foods to eat and self-management. Videos and much, much more.
- Know Diabetes is a North West London designated website for people living with diabetes. It has lots of information about prevention of diabetes, food choices, local support groups and education courses.
Post-transplant diabetes mellitus (PTDM)
A condition called post-transplant diabetes mellitus or PTDM may develop in some people who did not have diabetes before their transplant. This type of diabetes affects 10 to 40 per cent of patients who have solid organ transplantation.
Though post-transplant diabetes is very like Type 2 diabetes, it is not exactly the same. The risk factors for developing post-transplant diabetes are similar to Type 2 diabetes but for some people the risk is increased by transplant-related factors such as anti-rejection medicines and some infections. Some people will get diabetes as a result.
The main priority after a kidney transplant is to prevent rejection and protect your kidney. So, the anti-rejection medicines must always be taken as advised.
How PTDM is diagnosed and treated
After your transplant you will be monitored very closely, with regular blood tests to ensure your new kidney is working well. Blood tests are routinely taken to check your sugar (glucose) control, so this will be monitored closely too and if there are any abnormalities they will be picked up quickly. Post-transplant diabetes commonly occurs in the first 12 weeks after a transplant but can also occur later than this.
Like all types of diabetes, it will need treatment. This will depend on your symptoms. Treatment is the same as for other types of diabetes, and could include diet and exercise, tablets and insulin. Your treatment is likely to change over time. One of the complications of diabetes is kidney damage, so you need to be aware that good diabetes control is vital for the wellbeing of your new kidney.
Will PTDM go away?
Unfortunately, we cannot predict accurately who will get PTDM and who won’t. For some people the diabetes will be permanent, meaning it will not go away, and for others it will be temporary, meaning it will go away. If it does go away you should be monitored once a year at your GP surgery to check that it doesn’t come back.
You may feel overwhelmed if you develop post-transplant diabetes. Be assured you will receive support from the renal team and local diabetes teams to help you manage it well and keep you and your kidneys in good health.
Anaemia
Your haemoglobin will be monitored. This tells you if you are anaemic. Treatments for anaemia include iron infusions and/or a hormone injection called erythropoietin (EPO).
Bone health
The kidneys play a role in keeping your bones healthy. A blood test to monitor the calcium, phosphate and parathyroid hormone level will tell us how your bone health is. Read more about bone health in kidney disease
Kidney disease coming back in the new kidney
The chance of having the disease that affected your kidneys in your transplant kidney (recurrent kidney disease), depends on the cause of your kidney disease. For some diseases, this is common, for others, very rare. In some cases, the disease can come back very quickly (within hours or days), and others very slowly (after five to 10 years).
Your kidney transplant team will let you know before transplantation if there is a significant risk of your kidney disease coming back and affecting the transplanted kidney.
Skin cancer
Skin cancers are particularly common in kidney transplant patients. You will have an assessment of your skin in your 1-year post-transplant surveillance clinic. To minimise the risk of skin cancer, wear factor 50 sunblock every day and a long-sleeved shirt and a hat if you are in the sun. Also, avoid staying out in the sun for long periods and do not use sunbeds at all. If you notice any changes in your skin always let the doctors know.
About this page
- Last updated
- Author Lucy Trevallion