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Toolbox: Life After Transplant

Learn more about what you can expect after your transplant.


Activity Precautions

For the first two or three months after a transplant you should avoid:

  • Lifting more than 10 pounds
  • Strong abdominal exercises (e.g. sit-ups)
  • Strong upper body exercises (e.g. push-ups, pull ups, pushing or pulling heavy objects)

 

This may seem like a long time, however most surgeries require at least six weeks for the incision to heal and this may take longer for transplant patients because certain anti-rejection medications can delay wound healing.

Although these activities will not damage the transplanted organ, avoiding these activities will reduce the risk of developing a hernia (incisional or abdominal). Ten pounds is not a lot of weight and depending on the patient, additional discussion may be necessary. For example, those patients with small children may forget that the lifting restriction applies to their child as well. This may require some problem solving if the patient is a parent who is caring for a young child, or if the patient lives alone and is doing their own grocery shopping.

Some patients may be concerned that they cannot take jobs involving heavy lifting. This is certainly not true as transplant patients can perform a full range of jobs, including welding and construction. They simply have to follow the same restrictions on activity that any patient would have to observe after major surgery.

When you feel that you are ready to begin more strenuous exercise and the appropriate time period has elapsed, you should discuss this with your transplant team.

Alcohol, Smoking and Recreational Drug Use

Although alcohol does not interfere directly with anti-rejection medications, it may interact with other medications you may be taking. It may also be contraindicated in some conditions such as certain types of liver disease. Speak with your transplant team for their recommendations and specific guidelines. Strict moderation of alcohol intake, if you must consume it, is important. Over-indulgence can also interfere with your medication regimen as a result of errors in judgment or missed doses. Nausea from a hangover may make it difficult to keep your medication down.

Cigarette smoking and use of recreational drugs are strongly discouraged. These activities may interfere with your transplant medications and are detrimental to your overall health. We strongly recommend that you speak to your family doctor, transplant coordinator or physician to further discuss if you are currently engaging in these activities.

Dental Care

Dental hygiene is a very important part of your health management. Eating a healthy diet will help to maintain strong healthy teeth. You should brush your teeth using a soft bristle toothbrush at least twice a day and floss once daily. Also examine the inside of your mouth for any lesions or swelling of your gums. Inform your transplant coordinator or physician of any mouth sores, swelling, or bleeding of the gums.

Visit your dentist twice a year for cleaning and examination. It is essential that you inform your dentist that you have had a transplant and that your immune system is suppressed. Some patients with certain types of heart conditions may need to take an antibiotic before having any dental procedures, including routine cleaning, in order to prevent infections.

Driving and Seat Belts

Once you are feeling strong enough and able to drive a vehicle you may resume driving. If you feel tired, or if you are experiencing any dizziness, headaches or visual disturbances you should not be driving and these symptoms should be reported to your family doctor or your transplant team. Regardless of what type of transplant you have had, you should always wear a seatbelt. If your incision remains tender, place a towel under the seatbelt to pad your incision.

Medic Alert

It is essential that you obtain a Medic Alert bracelet or necklace or update your old Medic Alert information after you have had a transplant. This bracelet or necklace could save your life and protect your transplant if you become unable to speak for yourself. Your Medic Alert identification should indicate the name of your transplant physician, the type of transplant that you have received (e.g. "kidney transplant"), and that you are "immunosuppressed."

A form will be included in your discharge package that you will receive around the time you are preparing to leave the hospital. Please ask for assistance if you need it to complete the form. You should complete the form and send it in before you leave the hospital. It will take 6 to 8 weeks to receive your Medic Alert bracelet or necklace.

If you have a Medic Alert bracelet or necklace already, it must be updated or replaced. The file number from the old bracelet or necklace, which ends with the letter "C", should be included at the top of the new form.

Your transplant coordinator can assist you with completing the form. It is your responsibility to complete the form and mail it in. Once you receive your bracelet or necklace, it should be worn at all times.

Nutritional Considerations

After your transplant, while you are in the Intensive Care Unit (ICU) or on the Multi Organ Transplant (MOT) Unit, you may be too weak or too tired to eat enough food. The doctor may decide to place a temporary tube from your nose to your stomach called a nasogastric tube. A special formula containing protein, fat, sugar and water will be put down this tube. Certain medications may also be administered through the tube.

If you have the energy and appetite, you may still be able to eat the food that comes up on your tray but check with your nurse or doctor first. If your digestive system is not working well after your transplant then another special formula of fluid (also made up of protein, fat, sugar and water) may be given to you through your intravenous line. Both of these formulas are usually used for a short time only to provide you with the extra calories you need after your surgery to help with wound healing and to rebuild a healthy body.

Some patients develop high levels of cholesterol, fat and sugar in their blood after transplant. This may be related to certain anti-rejection medications that are needed after the transplant. As well, some patients have problems with weight gain.

The anti-rejection medications you need to take may require you to adjust your food intake. You may experience one or more of the following:

  • an increase in appetite leading to excess weight gain
  • an increase in blood fat and cholesterol levels
  • an increase in your blood sugar level

 

In such cases you may be referred to a dietitian and/or a nutrition clinic that manages these nutritional issues to discuss the appropriate nutrition care for you.

Pets

A special concern for patients who are on immunosuppressive medications is the possibility of catching diseases from pets. For example, it is possible to contract a disease called toxoplasmosis from exposure to cat feces (e.g. when cleaning out a litter box). The following guidelines are very important to help decrease your chances of contracting infections from pets.

  • Wash your hands after handling your pet, especially before eating
  • Keep your pet well-groomed and clean
  • Maintain an active flea control program for your pet's health and your own
  • Minimize contact with your pet's bodily fluids (vomit, feces, urine and saliva). Clean up such fluids with a disinfectant, and have someone not at risk take care of this if possible.
  • Do not let a pet lick a wound or your face
  • Be sure that all of your pet's vaccinations are up to date
  • Have a check-up for your pet annually and if they are sick
  • Keep your pet's nails trimmed and short

 

You should speak to your transplant coordinator for more specific information related to your pet and how to protect yourself from contracting an infection

Some special considerations need to be addressed regarding care of the following animals:

  • Dogs
  • Cats
  • Birds
  • Turtles

 

Some animals have been found to be more likely to carry diseases that could spread to you. It is best to avoid them. They are:

  • Stray or wild animals
  • Animals with diarrhea
  • Exotic animals
  • Sick animals
  • Monkeys

Returning to Work

Prior to returning to work you must receive permission from your transplant physician. There are many variables that will determine when you may return to work, including the physical activity requirements of your job, your age, and the stress level of your work.

Generally, the waiting period before returning to work is 3 to 6 months after discharge from hospital. This waiting period is necessary to give you time to recover from the surgery. Also, since rejection is most likely to occur in the first three months, it is important to wait until this higher risk period has passed before returning to work. You will also be required to make frequent visits to the clinic during the first 3 months, which could result in a lot of time lost from work. In addition, if you are receiving disability benefits, these will be stopped once you return to work. In the event that you need to be re-admitted to the hospital after your return to work, it could take up to several weeks to reinstate your disability benefits.

Sexual Activity

You may resume sexual activity as soon as you feel ready – that is, once you feel physically comfortable. As with resuming any other activity, begin slowly. You may find that position changes may be necessary until your incision is fully healed; however, there are no position restrictions.

Many patients have a loss of interest in sex prior to transplant due to feeling physically unwell from their disease process. Your interest in sex should return after transplantation as a result of feeling well again. However, it is very important to discuss and understand what are safe sexual practices if you are not in a monogamous relationship.

You must always remember that your immune system is suppressed and therefore you are at greater risk for contracting an infection. Everyone has to be concerned about sexually transmitted diseases such as AIDS (Acquired Immune Deficiency Syndrome), herpes, and hepatitis A, B and C, and you must be aware of how to protect yourself. Sexually transmitted diseases are contracted through sexual activity, where there is an exchange of body secretions from one person to another. Using a latex condom along with a spermicidal contraceptive foam greatly decreases the risk of contracting a sexually transmitted disease. You can purchase latex condoms and spermicidal contraceptive foam at most local pharmacies.

For pregnancy prevention, the double barrier method is recommended and has a low failure rate if used correctly. A benefit of condoms plus contraceptive foam is that it also provides protection against sexually transmitted diseases as described above. The use of a diaphragm plus contraceptive foam is also an effective contraception method but a woman must see her gynecologist to be fitted for a diaphragm. The birth control pill may be an alternative for some patients, but you should speak to your transplant team to discuss if this is the right option for you. There is a high incidence of infection associated with the use of an IUD in transplant patients and therefore this is not recommended.

Although pregnancy in transplant recipients is not encouraged, it is possible to have children after transplantation. You should be aware that:

  • Pregnancy may be complicated, requiring hospitalization
  • The incidence of birth defects is higher in immunosuppressed patients
  • If the disease that caused your organ to fail is hereditary in nature, genetic counseling must be considered.

 

If you are considering becoming pregnant you must discuss this with your transplant team as proper planning is essential.

Sun Protection

No longer is a suntan considered a healthy look. With the depletion of the ozone layer, which filters ultraviolet (UV) light, there is an increased incidence of skin cancer in the general population. As a transplant recipient you are even more vulnerable because your immune system is suppressed. Your risk of developing skin cancer will be much greater if you do not protect yourself.

To help reduce the risk of skin cancer, always apply a sunscreen with an SPF (Sun Protection Factor) of at least 30 on all exposed skin. Wear a hat, long sleeve cotton shirt and cotton pants when you are out in the sun. Avoid the sun during the peak hours of 10 am and 3 pm.

If you notice that you have developed any kind of skin lesion that is growing or bleeding, or if a mole that you have appears different, you should inform your family doctor or your transplant team as soon as possible.

Careful attention to the following guidelines can help to further reduce your risk of developing skin cancer:

  • Apply sunscreen 40 to 60 minutes before going outside to allow it to penetrate the skin thoroughly and provide better protection
  • Pay special attention to sun-exposed areas including ears, face, scalp, neck, back of legs, shoulders and back
  • Do not forget your lips – apply a lip balm that contains sunscreen
  • Select a broad-spectrum sunscreen that blocks out the sun's shorter UVB as well as the longer UVA rays. Check the labels for products that contain oxybenzone, dioxybenzone or avobenzone.
  • Note that aminobenzoic acid (also known as PABA), a widely used sunscreen, only protects you from UVB rays but not the longer UVA rays
  • For extra protection use sunscreens that are completely opaque such as those containing titanium oxide or zinc oxide. These now come in many attractive shades and act to completely block the sun's rays.
  • If swimming or perspiring profusely, use waterproof sunscreen and reapply after drying off or if still sweating
  • Beware of cool, cloudy or overcast days as 70 to 80% of the sun's UV rays still penetrate into the atmosphere and can cause a sunburn
  • Remember that sitting in the shade or swimming underwater does not guarantee protection (UV rays penetrate through water)
  • Remember your sunscreen even in winter months if you are taking part in outside activities (e.g. skiing, skating)
  • Note that UV light is reflected from sand, concrete, snow and water. Skiers and water-lovers often sustain serious sunburns from reflected sunlight.
  • UV light may cause cataracts. Always protect your eyes with UV-filtering sunglasses.
  • Be especially vigilant at high altitudes and near the equator where solar radiation is most intense

Travel

It is strongly recommended that you do not leave the country for the first 3 to 4 months following your transplant. In some cases you may be advised against international travel for up to one year following your transplant. Please check with your transplant team for specific recommendations.

When you do plan a trip, it is very important to discuss your travel plans in advance with your transplant coordinator or physician.

Careful planning is involved before taking a trip. There are a few important things to do ahead of time in order to ensure that your holiday is as worry-free and enjoyable as possible:

  • You may require vaccination in advance of your departure when travelling to certain countries. These vaccinations can be arranged through a travel clinic. You should speak with your transplant team prior to having any vaccinations as some vaccines are contraindicated in transplant patients.
  • It is very important that you purchase out of country health insurance. Your travel agent can assist you with this.
  • It is highly recommended that you purchase airline cancellation insurance as you must consider the possibility of developing a complication that would mean having to cancel your trip
  • You should obtain a travel letter from your coordinator that includes a record of your medications, your most recent lab results, and emergency contact numbers
  • When travelling, always carry your medication with you in your carry-on luggage. NEVER check your medication with your luggage.
  • Always take along a few extra days' supply of medication in case your return is delayed
  • Be prepared to return home if you become ill while travelling

 

With careful planning you will be assured of a relaxed and worry-free holiday.

Vaccinations

After a transplant you will be taking medications that suppress your immune system. This will make you more susceptible to infections, some of which can be prevented through vaccinations.

We highly recommend that you receive the influenza vaccine each fall sometime between September and November. If you have received your transplant less than 3 months ago and this vaccine is due, you should discuss with your physician prior to having the vaccine.

If you are allergic to eggs you should not have the influenza vaccine because the vaccine has a protein base very similar to the protein found in eggs. You should make arrangements to get the flu vaccine either through your family doctor, a walk-in clinic, or at one of the local public 'Flu Shot' clinics. We cannot give the vaccine to you in the Transplant Clinic.

We also recommend that transplant recipients be vaccinated with the pneumococcal vaccine (Pneumovax®) for additional protection against pneumonia. This vaccine is best given before your transplant, however it can be given after transplant provided that you wait at least 6 months. This vaccine should be repeated every 5 years.

Your transplant team may recommend that you receive other vaccinations depending on the type of transplant you have received and your health status.

If you plan on travelling out of the country you may require vaccination against certain infectious diseases common to that area. These vaccines are given prior to departure and can be arranged through a Travel Clinic. It is very important to inform the Travel Clinic that you are a transplant patient as there are certain types of vaccines that you should not receive. You should also always discuss any travel plans with your transplant team.