Successful transplantation will bring you almost normal renal function. Because the efficiency of human kidney in purifying blood is much higher than that of dialysis machine, your body will feel much better, have more energy and live longer than dialysis. After transplantation, complications such as hypertension, heart disease, osteopathy, neurological disorders, stunted growth of children and female infertility will be much less. Compared with dialysis, time is more free, and you don't have to tie it to the dialysis machine three times a week for three or four hours. Patients undergoing dialysis at home or peritoneal dialysis may be able to arrange their own dialysis time, but they still need to ensure dialysis treatment for 3-8 hours a day. Therefore, dialysis patients are very constrained to travel, and it is impossible to come to a trip that says go; After kidney transplantation, there are no restrictions on travel, and you can enjoy the fun of traveling. In addition, there are few dietary restrictions after transplantation, and there is no need to limit the amount of drinking water like dialysis. After successful kidney transplantation, the quality of life is better than before.
However, we should know that kidney transplantation also has some problems, most of which are caused by anti-rejection drugs. There are several drugs that need to be taken for life after transplantation, all of which have certain side effects. The main side effect is to weaken the immune system, that is, to reduce the body's ability to resist infection and cancer. Therefore, transplant patients are at higher risk of various infections and cancers. Scientists are looking for better ways to control rejection without damaging the immune system. Medical staff should pay close attention to patients to prevent infection and canceration; Or early detection of infection and cancer and timely treatment. Besides infection and cancer, there are other side effects, such as stomach upset, diarrhea, loss of appetite, joint pain, tremor and burning sensation in feet. These symptoms are usually alleviated with the gradual adaptation of the body to drugs, or these side effects can be alleviated by adjusting dosage and changing drugs. In addition, patients may suffer from osteoporosis after taking hormones for many years; If there are signs, it should be treated as soon as possible.
The reexamination in the first year after operation is very time-consuming, which may disrupt your daily routine, especially if you have to go to work in the company. Because of the high risk of rejection in the first year after operation, it is necessary to go to the transplant center for blood tests and various tests frequently, sometimes as many as three times a week; You may need to be hospitalized again for observation, treatment or even surgery. If necessary, ask the doctor to write you a sick note.
Economic burden is another challenge that transplant patients must face. Anti-rejection drugs are expensive, about 2,000 to 4,000 dollars a month. Medical insurance reimburses 80% of them, and commercial insurance covers the remaining 20% or less. Unless you are over 65 or have other disabilities, you will lose medical insurance after three years. Some insurance plans may include medical insurance, but you have to bear a higher self-sufficiency rate. The best way is to go to the transplant center and cooperate with social workers. There are many patient assistance programs that can help you solve the payment problem. Plan the expenses in advance, so that you won't be caught off guard when you suddenly face high medical expenses. (Note: This paragraph is the situation in the United States, for reference only)
In short, transplantation is not a cure for diseases. For some patients, transplantation is indeed the best treatment. In most cases, successful kidney transplantation will significantly improve patients' health, life expectancy and quality of life. However, you still need to consider many factors when you plan to transplant. You should consult a nephrologist and a transplant doctor to get more information about transplantation from the Internet.
After kidney transplantation, the doctor will prescribe some new drugs for you. What do you need to know about these drugs? Why did you take them? How to take medicine more effectively? What are the side effects? We will discuss these issues in two articles. The first article is about anti-rejection drugs. The second is about other drugs to be taken after the operation.
Anti-rejection drugs are also called immunosuppressants. As long as it is a transplant, you need to take immunosuppressants. The most commonly used immunosuppressants in the United States include tacrolimus (Prozac), cyclosporine (Neosulfame, Geff cyclosporine capsules (Gengraf)), mycophenolate mofetil (Miff), sirolimus (rapamycin) and steroid hormone (prednisone). According to the treatment plan of the hospital that performed your transplant, you may need to take two or three of the above drugs.
As the name implies, "immunosuppressants" or "anti-rejection drugs" protect transplanted organs from rejection by suppressing the human immune system. Because the transplanted organ is the invader of your body, the immune system tries to destroy it to protect you from the invader, just like killing bacteria and viruses. Immunosuppressants can reduce the immune system's defense ability, making it impossible to kill the transplanted kidney. This is why you should take anti-rejection drugs as long as you have a kidney transplant. Every time you stop taking these drugs, the immune system will try to kill the transplanted organ. Although you take immunosuppressants, rejection may still occur, but this situation is rare (about 10%), and this rejection can be reversed by treatment. Now, you know why transplant doctors always emphasize the importance of taking anti-rejection drugs strictly according to the doctor's advice. Don't take or stop using anti-rejection drugs without consulting a doctor, otherwise it will cause serious rejection. The transplant doctor will ask you to have regular blood tests to monitor the renal function and the blood drug concentration of rejection drugs, and will adjust the drug dosage according to the test results to maintain the normal blood drug concentration. Too high or too low a concentration is harmful.
Another important aspect of immunosuppressants is the interaction between drugs and between drugs and food. As we all know, some drugs will interact with immunosuppressants, so it is very important to take only those drugs prescribed by doctors. If you need to take some OTC drugs or drugs prescribed by doctors in other departments, please consult the transplant doctor first. Never eat Chinese herbal medicine. Although Chinese herbal medicines may have some benefits for you, they may affect the immunosuppressants you take, resulting in serious side effects. There are many Chinese herbal medicines on the market, but most of them have not studied their interaction with immunosuppressants, so in principle, do not take Chinese herbal medicines. The interaction between food and immunosuppressants is not fully understood. However, we already know that any food containing grapefruit will increase the blood concentration of immunosuppressants. That's why you were told never to eat grapefruit or drink grapefruit juice during transplantation. In the United States, common foods on the market are safe to eat, but some foods from other countries or nationalities have not been studied. To be on the safe side, please consult the transplant doctor and test the blood concentration before adding new food to your daily diet to confirm whether it is necessary to adjust the dose of immunosuppressant.
Each immunosuppressant has its own side effects. Please refer to the list of side effects below. The most common side effect of these drugs is to make you more susceptible to infection. As mentioned earlier, these drugs will suppress your immune system, making it difficult for it to recognize and destroy bacteria and viruses.
When taking these drugs, in order to reduce the risk of infection, you should maintain good hygiene habits; Avoid direct contact with infected people; Vaccination; Take drugs to prevent some infections. Suppression of the immune system can also increase the risk of cancer. We suggest that all transplant patients follow the medical plan of cancer detection, including routine examination of original kidney B-ultrasound, colonoscopy, mammography, cervical smear and PSA (prostate specific antigen).
Not all patients taking immunosuppressants have these side effects. If you have these symptoms, tell your transplant doctor. Most side effects can be solved by taking other drugs or reducing the dose of immunosuppressants or replacing them with immunosuppressants.
In a word, immunosuppressants are a group of drugs used to prevent rejection after organ transplantation. Take the medicine according to the doctor's advice and minimize the side effects, and you can spend many years with your new kidney.
After kidney transplantation, besides anti-rejection drugs, the doctor will prescribe some other drugs for you.
This drug is used to prevent infection caused by cytomegalovirus, which is usually called CMV. People with normal immune system are infected with CMV virus, and the symptoms are very mild or often asymptomatic, or just flu-like symptoms. 50%-80% of adults under 40 years old in the United States are infected with CMV and carry antibodies. Once CMV enters human body, it will be carried for life. After transplantation, you should take immunosuppressants to prevent rejection. Therefore, the fragile immune system provides a good environment for the reproduction of CMV virus, which will cause serious diseases. If the donor who transplanted the kidney carries this virus and you don't have antibodies against CMV before transplantation, then you are infected with CMV at the moment of transplantation. In other words, once infected with CMV, it has always existed in the body, but it is dormant and may be activated now. Either way, it will lead to serious diseases. If it is not found and treated early, it may even be life-threatening. CMV infection can be manifested in many ways, such as pneumonia, gastrointestinal infection, severe influenza (fever and chills), and may also seriously affect renal function. The treatment in the United States is that if you are infected with CMV before transplantation, you should take vancomycin for three months after transplantation. If you have not been infected with CMV before transplantation, you should take vancomycin for half a year after operation if you are positive for CMV during physical examination.
This medicine is an antibiotic and is often used to treat urinary tract infections. Taking this medicine for one year after transplantation can prevent a rare pneumonia-pneumocystis pneumonia (pneumococcal pneumonia), that is, PCP. This kind of pneumonia is caused by Pneumocystis carinii, which is similar to yeast and is common in people with low immune system, such as AIDS patients or organ transplant recipients. In order to prevent PCP, most transplant centers in the United States require patients to take this drug for one year.
This is an oral suspension. Shake it well and swallow it. Take it after every meal and before going to bed. It is used to prevent oral fungal infection and is usually effective within three months after transplantation.
There are many such drugs, such as furantamide, famotidine, pantoprazole, esomeprazole, lansoprazole, rabeprazole (Park Chung-su). The transplant center will choose one of them to prevent gastric acid reflux, especially in the first few months after operation, because taking large doses of prednisone will cause gastric ulcer. You can take it later if you need it.
Most of these drugs only need to be taken for a short time. Generally speaking, after three months of transplantation, you need to take much less medicine. You may also need to take other drugs to control high blood pressure, high cholesterol, high blood sugar, heart problems or other problems. The use of these drugs varies from person to person.
After kidney transplantation, many factors will affect your health, including some chronic diseases, such as hypertension, hyperlipidemia, diabetes and the side effects of anti-rejection drugs. In fact, some drugs you are taking can cause high blood pressure, hyperlipidemia, diabetes, bone diseases and weight gain. In this section, we will focus on how to make you healthier and help you control and prevent the side effects of drugs through daily diet and exercise.
Before transplantation, you may have to observe many dietary restrictions. Fortunately, the kidney function is normal, most dietary restrictions do not exist, and you can eat all kinds of things at will. However, if you choose your food carefully, you can get many health benefits. When you make a diet plan, you should follow the following suggestions:
Low sodium: For most hypertensive patients, the recommended sodium intake is 2 grams per day. Read the sodium content instructions on food labels carefully, use lemon juice instead of salt to improve the taste, and avoid eating deep-processed, canned and packaged foods, which are usually high in sodium. Many of your favorite foods have corresponding low-sodium versions.
Coarse grains: avoid eating fine carbohydrates (flour, rice), namely "starch", which can stabilize blood sugar; Prevent eating and drinking because of hunger; Lowering blood fat; Prevent constipation. Coarse grains are more nutritious and flavorful than flour and rice. Coarse grains include whole wheat, rye, corn, brown rice, millet, quinoa, amaranth and oats. If you have diabetes or are controlling your sugar intake, you should replace starchy foods with coarse grains.
Healthy Fat A healthy diet does not mean that fat should be excluded from the diet. The normal functioning of the body needs fat. Different types of fat have great influence on the prevention of cardiovascular diseases. There are three kinds of fats in food: saturated fat (butter, animal and milk fat, hydrogenated soybean oil), polyunsaturated fat (vegetable oil and corn oil) and monounsaturated fat (olive oil, rapeseed oil and most nut oils, such as peanut oil, avocado, dried fruit and salt-free dried fruit). Fat is also found in some fish, such as salmon and tuna. These fish are rich in omega-3 fatty acids, which can reduce triglycerides, maintain a healthy immune system and prevent cancer. Monounsaturated fat is the most beneficial to health and can also prevent arterial occlusion. You can also eat polyunsaturated fat in moderation. It is forbidden to eat saturated fat. Any fat that is fried or heated to a very high temperature will change its structure and be harmful to the body. Therefore, when cooking, try to eat less fried food and put less oil. When buying processed food, be sure to read the label carefully and avoid buying food processed with hydrogenated oil. Besides, in order to reduce the intake of saturated fat, we should drink skim milk or yogurt instead of ordinary milk and eat fish and skinless chicken instead of red meat.
Healthy drinks are not only what you eat, but also what you drink can help you prevent weight gain and control blood sugar. Now you can drink unlimited water, and you can drink 8- 10 cups a day. Pure water is the best choice; Appropriate amount of tea and coffee can be done without sugar and milk; Don't drink herbal tea, because it has potential interaction with anti-rejection drugs, and consult a doctor before drinking herbal tea. Soft drinks are generally forbidden to drink. If you must drink it, drink the sugar-free version in moderation. Concentrated fruit juice is high in sugar and calories, so drink less. You can drink 1-2 cups of freshly squeezed juice instead of concentrated juice every day. If you drink milk to supplement calcium and vitamin D, you should drink skim milk or soy milk instead of ordinary milk.
Fruits and Vegetables Now you have a functioning kidney with no restrictions on potassium intake. This means that you can start eating all kinds of fruits and vegetables. Fruits and vegetables are rich in vitamins, minerals, antioxidants and fiber. It is reported that a person can eat as many as nine servings of fruits and vegetables every day. Fresh fruit and skim yogurt can be used instead of candy and high-calorie desserts. Perhaps, after kidney transplantation, the potassium content in the body will still be high. If this happens, you should limit the intake of some fruits and vegetables, but you can still eat all kinds of other fruits and vegetables. Consult your transplant doctor to find out which fruits and vegetables are edible and which are not.
Vitamins and Nutrients Most transplant centers recommend that you take multivitamins every day to ensure that vitamins and trace elements meet the recommended daily intake standards. It is forbidden to take Chinese herbal nutrition because it has potential interaction with anti-rejection drugs.
Exercise has many benefits, such as lowering blood pressure, controlling blood sugar, losing weight, strengthening bones and muscles and improving blood lipid level. Exercise can also regulate mood, because exercise can release amine polyphenols (pleasant chemicals in the brain). If you haven't exercised regularly before, you should exercise your endurance and perseverance slowly and step by step. If you have anemia, you should correct it before you start exercising. Once the doctor makes it clear that you can exercise, you should start from 30 minutes every day. Weight training (walking, jogging and weightlifting) is the best exercise method to prevent osteoporosis and bone loss.
As we discussed in the drug section, the main side effect of these drugs is weakened immune system. The common consequence of taking immunosuppressants after renal transplantation is infection. Prevention and treatment of infection has become the main challenge for doctors and patients after transplantation. In the first few months after kidney transplantation, because of taking large doses of immunosuppressants, it is usually necessary to take some drugs to prevent infection. In the future, with the gradual reduction of the dosage of immunosuppressants, the autoimmune system will also be improved. You know, as long as the transplanted kidney is still working, it is very important that you can't completely stop using immunosuppressants. In order to prevent the infection of fungi, bacteria and viruses, you may need to change some living habits.
Maintain good personal hygiene every day. Don't use personal items with others, such as towels, combs, shaving blades, tableware, etc. At the same time, pay attention to the physical environment, and don't stay in places that may be moldy, such as the basement that has been soaked recently and the attic that is not ventilated. Fungi in the air can cause serious lung infections. Wash your hands frequently (three minutes at a time), and don't rub your eyes, nose and mouth before washing your hands, which can avoid many infectious diseases.
Separate the chopping board for cutting raw meat from other ingredients. Don't eat raw or undercooked poultry, meat and fish. In order to thoroughly cook the meat and reach a safe temperature, the center of the meat should turn light brown instead of pink. Put the leftover food in the refrigerator immediately. Soak the fruit in 1% bleach for 5 minutes, then wash it before eating. Travel to countries with poor sanitation, don't drink tap water directly, and don't eat fruits and vegetables washed with taps. You should boil fruits and vegetables and peel them before eating.
If you have pets, cats and dogs, to be on the safe side, let others take care of the cat ash. Fish tanks should also be cleaned and replaced by others. Birds and reptiles are not recommended because birds, fish and reptiles may carry many bacteria and viruses.
If you have to undergo some invasive treatment, such as tooth cleaning or removal of ureteral stent, you should take antibiotics in advance, even a few days after treatment. In addition, be sure to let the doctor who treats you know that you are a transplant patient who is taking immunosuppressants.
If you accidentally cut yourself, wash the wound with running water and the area around the wound with soap. If the wound is not deep, it will be exposed after hemostasis without dressing. If the wound turns red and feels pain, call your transplant doctor. If the wound is deep, go to the emergency department of the hospital immediately.
It is necessary for transplant patients to keep good vaccination records. You need to get an annual flu shot; Vaccinate pneumonia vaccine once every five years; Give tetanus vaccine every ten years. When the titer of hepatitis B antibody is too low, you should get a booster shot. When you plan to travel abroad, you should be vaccinated against hepatitis A. Remember, you can't get any live vaccine, such as smallpox vaccine, yellow fever vaccine, nasal flu vaccine, etc. Transplant patients can only get "inactivated vaccine". Before getting the vaccine, check with your doctor whether the vaccine is inactivated. ) 。 Traveling outside the United States, ask the local medical staff what vaccines they can recommend. You can also go to the US Centers for Disease Control and Prevention to check the list of recommended vaccinations in various countries. Please consult your transplant doctor before vaccination to ensure that the vaccine is safe.
Here are just some suggestions to help you stay healthy and how to avoid infection. In addition to this article, there are many good living habits that can help you prevent infection. Immunosuppressants make the immune system fragile, so we should make reasonable judgments and protect ourselves from invisible enemies around us: bacteria, viruses and fungi. Remember, if you have any questions, you should always communicate with your transplant doctor.