Transplant Surgery – Kidney Transplantation
Because you will have questions about procedures, your own health and future, and the impact that transplant will have on your family, we offer support and resources every step of the way, including a comprehensive patient handbook. Highly trained coordinators are the primary contact people for any questions you have while awaiting transplant, as well as for educating you about caring for yourself after transplant. Our transplant pharmacist helps you understand your medications, and our transplant nutritionist offers counseling before and after transplant. Our transplant financial counselor reviews your insurance coverage and explains how it applies to your surgery and medication costs. Experienced transplant social workers support you and your family throughout the evaluation and transplantation. Staff assistants ensure that your tests and clinic appointments are promptly scheduled.
Frequently asked questions
Who can I talk to if I’m not sure a transplant is right for me?
Talk with your nephrologist about the transplantation process. To set up a clinic appointment to learn more about transplantation, call our office at 800-525-5395 or 717-531-6092. Clinic meetings are scheduled every Thursday morning from 7:30 a.m. to 12 p.m.
After an appointment is scheduled, call the transplant office if any changes in your schedule occur that would prohibit you from keeping your appointment. You may reschedule your appointment at this time. A packet of information will be sent out to you. Please fill in the information requested, and return it to our office as soon as possible.
What do I do if I have a person(s) to donate a kidney?
Have your donor(s) call our office at 800-525-5395 or 717-531-6092 and ask to speak to our Living Donor Coordinator. Our Living Donor Coordinator will screen your donor(s) over the phone with a few questions.
If your donor(s) appears to be a suitable candidate. We will send them a packet of information in the mail regarding living kidney donation, along with a script to get their blood type tested. The donor’s blood type must be compatible with yours in order to donate.
We also offer educational sessions for potential donors to attend to find out more about the living donor process. We encourage friends and family to attend as well.
What do I need to do after the clinic meeting?
A letter will be sent out to each patient stating whether or not they are considered a candidate for transplantation, along with a list of tests that need to be completed for listing. This letter will also be sent to your nephrologist, your dialysis unit, and your primary care physician.
How do I get all these tests completed?
Your nephrologist’s office or family doctor can schedule all the tests for you, if you are not currently on dialysis. If you are on dialysis, the staff can usually help schedule tests.
You may also have your testing completed here at Penn State Milton S. Hershey Medical Center. Our office can schedule the tests for you.
When will I be put on the list?
When all testing is completed and the results are faxed to our office, the transplant team will review your records. If at this time, no further testing is indicated, you will be put on the list. One of the pre-transplant coordinators will call you at home to let you know when you are listed. You will also receive a letter in the mail. You are NOT listed until you are called by one of our staff, or you receive this letter.
Do I need to do anything after I am listed for transplantation?
You will need annual testing to remain active on the transplant list. Also, we will request a blood sample be taken monthly or bi-weekly from your physician’s office, local lab, or dialysis unit. It will be sent to our lab so we may have a current sample on each patient. This allows us to start testing your compatibility with a potential donor before you arrive at the hospital.
One month survival
- Penn State Health Milton S. Hershey Medical Center average: 96.9%
- National average: 97.6%
One year survival
- Penn State Health Milton S. Hershey Medical Center average: 91.9%
- National average: 93.6%
After your transplant
You will be asked to monitor your weight on a daily basis and your blood pressure and temperature twice a day and record them on the chart that will be included in your patient teaching manual.
- Take your temperature in the morning and in the evening. Call the transplant team if your temperature rises above 100 degrees F. Do not take medication to lower your temperature unless instructed to do so by your transplant physician.
- Check your weight every morning before breakfast, after you have gone to the bathroom. An increase in weight may mean that you are retaining fluids, or that you may need to control your calories.
- Take your blood pressure every morning and evening. If the top number is > 160 or if the bottom number is > 100 report it to the transplant team.
The biggest problem facing all transplant patients is the possibility of rejection. Rejection is the body's attempt to get rid of a foreign substance, in this case your new kidney. There are several kinds of rejection, and they can be a common and life-long issue.
- Hyperacute - This severe form of rejection happens within minutes or hours after transplant surgery. The new kidney must then be taken out. This form of rejection is very rare.
- Acute - This is the most common type of rejection, and while it can happen anytime, it more frequently occurs during the first six months after transplant.
- Chronic - This type of rejection can happen at any time, including years after the transplant.
A common cause of (chronic) late rejection is not taking your medication, skipping days, or taking the wrong dosage. The medicines that you take will help lessen the number or severity of the rejection episodes, but may not completely prevent them. Most rejections that happen shortly after surgery can be treated medically. If you have rejection symptoms, call the transplant office. The quicker you receive treatment, the more successful the treatment is likely to be.
Some of the signs of rejection are:
- Fever above 100ºF
- Swelling or tenderness over the new kidney
- Flu-like feelings
- Weight gain of four or more pounds overnight
- Decrease in urine output
- Elevated blood pressure
It is also important to remember that you may be experiencing rejection without any obvious signs or symptoms. That is why it is so important to have your blood tested on a regular basis and to follow the schedule outlined under the "Daily Medical Tasks" tab. If it is felt that you are having rejection you may have to have your kidney biopsied. This can be done on an outpatient basis. If it is determined that you are in rejection you may need your steroid doses increased. At the end of three days, if your BUN and Creatinine have not decreased, you may have to have IV medication to reverse the rejection and will need to be admitted to the hospital.
The medications you take to prevent rejection will also place you at greater risk for infection, as they suppress your immune system. Common areas for infection are your lungs, bladder, or the incision site. You will be on medication for the first six months to help decrease your risk of getting an infection. Be sure to tell your family that family members who are ill should not come to visit.
Notify the transplant coordinator
- If you have a cough that lasts longer than three days
- If you get pain in your chest or short of breath with the cough, or if you cough up anything green or yellow
- If you have any pain or burning when you urinate
- If you have any blood or blood clots in your urine or the urine becomes cloudy or foul smelling
- If you notice your incision getting red, swollen, or secreting pus or fluids
Delayed graft function
The functioning of your kidney transplant may be delayed, causing a need for dialysis or longer hospital stay until the kidney "wakes up." Delayed function may last from several days to several weeks.
Some of the immunosuppression medications you take may cause diabetes. Diabetes is an increased level of glucose (sugar) in your blood. Signs of diabetes may include being thirstier, urinating more often, having blurred vision and being confused. Call your transplant coordinator if you have any of these signs. Your blood glucose levels will be monitored for the first year to help detect any problems early.
If you should develop diabetes, you will be given teaching on how to deal with this problem. In some cases, diet, weight loss and exercise can control it. Some people need oral hypoglycemic medications or insulin to help control their diabetes.
High Blood Pressure
High blood pressure is also a common side effect of some of the medications you take. You may need another medication to control your blood pressure. Following your vital signs schedule carefully will help detect this problem and allow early treatment to avoid complications from high blood pressure. Call your transplant coordinator if your blood pressure consistently reads higher than 160/100.
You will be taking medication for the rest of your life in order to prevent your body from rejecting your new kidney. While hospitalized, you will be told what medicines to take, what each medicine does, and common side effects of each medicine by the pharmacist, your nurses, and coordinator. You must become familiar with the names, dosage, and recording of all your medications. The number and dosage of the medicines will be lowered as you improve. Never stop taking a medicine without talking to the transplant team.
Also, you must never take prescriptions from your family doctor or over-the-counter medicines, without first talking to the transplant team. This includes common medications such as aspirin or Tylenol. Many drugs cause serious side effects in patients taking anti-rejection medications. Telephone the transplant program before taking new medicines, even on an emergency basis and even if ordered by a physician in an emergency room. Call your transplant coordinator FIRST!
For further information please visit the Scientific Registry of Transplant Recipients (SRTR) website.
Data source: UNOS/Scientific Registry of Transplant