Post-transplant care

Green:

Keep watch and inform your team if any of the symptoms below last for more than one day.

• your blood pressure is continuously higher or lower than the target agreed with your clinician 
• your blood sugars are continuously higher or lower than the target agreed with your clinician 
• your legs are more swollen than usual 
• your dressing is leaking after the transplant 
• you are passing slightly less urine than usual 
• you are running low on medication 
• you need advice on how to take medication

What you should do: 

1. check and record your blood pressure, weight, and blood sugar (if you have diabetes) throughout the day.
2. If your symptoms carry on for more than one day, call the Transplant clinic and seek advice from the transplant nurses or the renal pharmacist, contact number: 0203 313 4260/4268. 

Amber:

Stay alert and call the renal assessment unit (RAU) or seek urgent advice from your GP if you have any of the symptoms below.

• your urine has a bad smell or you feel pain when you pass urine (have a wee) 
• you have blood in your urine 
• you are passing a great deal less urine than usual 
• your wound is leaking and has a bad smell 
• you have been feeling more breathless when moving around 
• you are feeling pain over your transplant kidney 
• you feel hot and cold, or have a high temperature / low-grade fever 
• you have diarrhoea or vomiting. 

What you should do: 

1. Check your temperature, blood pressure, weight, and, if you have diabetes, your blood sugar
2. If you have diarrhoea or vomiting, do not take your blood pressure medication. If you are on tablets to control diabetes do not take them (but continue with your insulin) 
3. Contact the RAU on 020 3313 6603/04, or seek urgent advice from your GP, or dial NHS 111. 

Red:

Take action - call 999 or NHS 111 if you have any of the symptoms below:

• you have chest pain that is new or getting worse 
• you have a large amount of blood leaking out of your wound 
• you cannot pass urine or you have not passed any urine in the last 24 hours 
• you have the sensation of fainting and your blood pressure is low 
• you have extreme abdominal pain 
• your blood sugars are very high or very low (the machine can’t read the level of your blood sugar) 
• you suddenly feel short of breath or your breathlessness is much worse 

Clinic and appointments

Outpatient transplant clinic 

Finding the clinic
The Transplant outpatient clinic is at:

Renal Outpatients  
Ground Floor 
A block  
Hammersmith Hospital 
Du Cane Road 
London W12 0HS

When entering the hospital from Du Cane Road, follow the signs to main outpatients. Turn right in front of Subway restaurant. Take the first left by the Friends shop. Keep walking straight towards the main outpatient area. The transplant clinic is on the left, opposite Lloyds Outpatient Pharmacy.

Clinic times
The Transplant outpatient clinic runs every: 

• Monday
• Wednesday
• Thursday
• Friday.

This service runs telephone clinics as well as face-to-face appointments. At first, you will need to attend at least two appointments each week. As you recover from surgery, we will reduce the number of appointments you need to attend. If you have had a simultaneous pancreas and a kidney transplant (SPK), you might be asked to come to the clinic more often.

Transplant clinic follow-up schedule

• week 0 – 6: appointments twice a week
• week 7 – 12: appointments once a week
• month 4 – 6: an appointment every two weeks
• month 7 – 12: an appointment monthly
• month 13 – 18: an appointment every two months
• month 19 – 24: an appointment every three months

Patient information

Who you will see

Outpatient clinic appointments will alternate between the nephrologist and the transplant clinical nurse specialist (CNS). The outpatient pharmacist will see you within two weeks of discharge to give you advice on taking your medications and again at three months after your transplant. 

What will happen at an appointment?

• Your blood pressure and heart rate measured
• You will be weighed
• Your urine will be tested
• Your blood will be tested
• You will get an ureteric stent (your ureteric stent will be removed at three weeks post-transplant unless your transplant surgeon / nephrologist says it needs to stay in)
• Your blood pressure (BP) will be checked

Please measure your BP at home if you can and bring your readings to clinic. You can watch this video to learn how to check your blood pressure at home

Diabetes

If you have diabetes, keep a blood glucose diary and bring it with you to clinic. If you need to change your appointment, please call the clinic on 020 3313 8333.

What happens to your dialysis access (Tesio line), PD catheter or fistula

In most cases your tunnelled line for dialysis (Tesio line) will be removed before you are discharged from hospital, after your surgery.

If you have a peritoneal dialysis (PD) catheter, this is normally removed at the time of your transplant surgery.

We will not usually close a fistula or an arteriovenous graft. However, in some cases we may close a fistula or an arteriovenous graft if it is affecting your heart function or you develop complications such as arm swelling or thrombosis.

If you have any symptoms please let us know. Our vascular access team will assess your fistula or arteriovenous graft and discuss the next steps with you.

Your blood results

During every appointment, we will ask you to have a blood test to help us to monitor your health after the transplant.

We will measure:

• your kidney function (see below for more explanation)
• your blood count (haemoglobin, white cells and platelets)
• your electrolytes (salt, potassium, phosphate, calcium)
• your liver function
• your blood sugars
• the level of the anti-rejection medicines (tacrolimus or mycophenolate).

If there is a problem with your blood results you will receive a call from your nurse or doctor.

How we measure your new kidney function

Your new kidney function will be measured by a blood test that tells us how much creatinine (waste) there is in your blood.

A number called the estimated glomerular filtration rate (eGFR) is calculated which will tell you the level of kidney function. The table below explains the stages of kidney function and how it relates to GFR.

The function expected from a transplanted kidney is different for each patient. How your kidney function is changing over time is often more important than the actual eGFR itself.