Download Kidney and kidney/pancreas pre-op booklet - Hume

VCU Health System’s Hume-Lee Transplant Center
Welcome to the Hume-Lee Transplant
Center’s
Kidney & Kidney Pancreas
Transplantation Program
804-828-4104
1-800-762-6161, ext. 4104
Kidney Transplantation
Introduction
3
Before Your Transplant
About your Kidneys
4
Reasons for Transplant
5
What is a Kidney Transplant
7
Living Kidney Donation
8
Kidney and Pancreas Transplant Evaluation
12
Preparing for a Transplant
14
The Transplant Team
Meet the Transplant Team
16
Surgeons
17
Clinic
18
Listing for Transplant
19
Kidney Transplant Surgery
20
Medications after Transplant
25
Rejection
28
Post-Transplant Coordinators
29
Resource Directory
31
Directions
34
Parking
35
Comfort, Safety, and Security
36
Lodging
37
Fundraising Opportunities
38
Notes
39
Page 2
Introduction
Introduction
Welcome to the VCU Medical Center’s Hume-Lee Transplant Center.
The Hume-Lee Transplant Center has been performing kidney
transplants since 1967 and performs one hundred or more kidney transplants a
year. Our Center has performed more than 1800 kidney transplants, over 90
combined kidney and pancreas transplants, and 7 pancreas after kidney
transplants. The transplant team is here to assist you in your decision about
transplantation.
Kidney transplantation is not a cure for End Stage Renal Disease
(ESRD), but an alternative treatment choice for your kidney failure. The other
options include hemodialysis and peritoneal dialysis. This booklet will discuss
kidney transplantation in detail, so that you can make an informed decision if
transplantation is the right option for you.
During kidney transplant surgery, a surgeon will place a healthy human
kidney (donor kidney) from another person into your body to do the work that
your failing kidneys can no longer perform. A transplanted kidney comes from
either a recently deceased organ donor or a living donor.
Enclosed in this booklet you will find information regarding your kidney
transplant evaluation. We hope this information will help answer the many
questions you may have regarding your upcoming evaluation. This information
will be reviewed by your kidney transplant coordinator. Please write down any
questions you may have in the space provided in the booklet. This will help you
remember to discuss
them with the
members of the
transplant team.
From left to right: Daniel Maluf, MD, transplant surgeon, Marc Posner, MD, Professor &
Chairman of Transplant Surgery & Director Hume-Lee Transplant Center, Pamela Kimball, PhD,
Director HLA lab, H.M. Lee, MD, Adrian Cotterell MD, transplant surgeon, Anne King, MD, Medical Director Renal Transplant Program, Valeria Mas, PhD, and Robert A. Fisher, MD, Director
Liver Transplant Program
Page 3
About your Kidneys
What The Kidneys Do
Your kidneys are located in your back, one on each side of the spine. The lower
ribs protect the kidneys from injury. Each kidney is about the size of your fist.
The kidneys’ major jobs are to:
• Filter waste products and excess water out of the blood
• Make hormones that help regulate blood pressure and the production of red
blood cells
• Control the balance of water, salt, and acid in the body
What Happens When Kidneys Fail?
• The kidneys are not able to clean waste products from the blood
• Waste products build up in the blood causing you to feel sick
• This build up of waste products is called “uremia”
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Reasons For Transplant
Reasons for Transplant
End-stage renal disease (ESRD) occurs when kidney damage is so severe that
dialysis or a kidney transplant is needed to control symptoms and prevent
complications and death. ESRD often occurs after kidney damage has been
present for 10 years or more. Diabetes and high blood pressure (hypertension) are
the most common causes of ESRD in the United States.
Kidney failure can be measured by how well the kidneys are able to filter wastes
from the blood (glomerular filtration rate or GFR). ESRD usually occurs when the
GFR falls to 10% to 15% of normal values.
Any condition that results in end-stage renal disease includes, but is not limited
to:
Diabetes Mellitus
Hypertension
Glomerulonephritis
Pyelonephritis
Polycystic Kidney Disease
Systemic Lupus Erythematosus
Obstructive Uropathy
Congenital urinary tract defects
Alport's Disease
Reflux Nephropathy
Interstitial Nephritis
IgA Nephropathy
Goodpasture's Syndrome
Hemolytic Uremic Syndrome
Chemical Nephrotoxicity
Renal Artery Emboli
Sickle Cell Nephropathy
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Reasons For Transplant
What the Pancreas Does
• Endocrine functions and insulin. Groups of cells scattered throughout the
pancreas produce insulin; a hormone that influences the making of proteins
and certain fats, storage of certain fats, and the body's use of sugar
(glucose). Diabetes is the most common disease associated with abnormal
production of insulin and high blood sugar.
• Exocrine functions and digestion. The pancreas produces digestive juices
(enzymes), including amylase and lipase. These enzymes are emptied from
the pancreas into the small intestine through tubes called the pancreatic
ducts.
Indications for Pancreatic Transplantation
Type I (insulin-dependent) diabetes with advanced kidney disease
Those who have complications of type I (juvenile onset) diabetes and
have relatively normal kidney function
Those who have diabetes and kidney failure
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What is a Kidney Transplant
What is a Kidney Transplant
The goal of transplant is to provide you with a single functioning kidney to
perform the work that your kidneys are no longer able to do. A successful
transplant can return you to a state of good health. The kidney you will receive
may be a living gift from a member of your family or a friend. If no living donor
is available, you may receive a kidney from someone who has died and donated
their kidney (deceased kidney).
Hemodialysis or peritoneal dialysis can eliminate wastes from your body and
remove excess chemicals from your blood. But, unlike the kidneys, dialysis can’t
produce vital hormones. Through transplantation, you will get a new kidney that
performs all of these vital functions.
Purpose
Kidney transplantation is a procedure that places a healthy kidney from another
person into your body. This one new kidney does all the work that your two failed
kidneys cannot do.
How it Works
A surgeon places the new kidney inside your body in your lower abdomen. The
surgeon connects the artery and vein of the new kidney to your own artery and
vein. Your blood flows through the new kidney and makes urine, just like your
own kidneys did when they were healthy. The urine flows into the bladder through
the ureter of the kidney which is surgically attached to the bladder. The new
kidney may start working right away or may take up to a few weeks to make
urine. Your own kidneys are usually left where they are, unless they are causing
infection or high blood pressure.
The Kidney/Pancreas Transplant Program offers
Living donor kidney transplant with open or laparoscopic donor
nephrectomy
Deceased kidney transplants
Paired exchange kidney transplants
Desensitization protocol for recipients that are highly sensitive
Simultaneous pancreas-kidney (SPK) transplants
Pancreas after kidney (PAK) transplants
Pancreatic islet cell transplants
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Where Kidneys Come From
Where Kidney and Pancreas Transplants Come From:
You may receive a kidney from:
•
A family member. This is called a living related donor. These
are often the most successful transplants.
•
A spouse or very close friend. This is called a living unrelated
donor.
•
A person who has recently died. This is called a deceased
donor.
You may receive a pancreas from:
• A person who has recently died. This is called a deceased
donor.
Living Kidney Donation
Donating a kidney to a loved one who has kidney failure can be a very positive
experience for the donor, and many stories can be told about the heroic people
who gave a loved one the greatest gift possible, the gift of life.
What is living donation?
Living donation takes place when a person donates an organ to be transplanted
into a loved one in need. The donor is most often a close family member, such as
a parent, child, brother or sister. A living donor can also be a more distant family
member, spouse or friend. Anyone interested in being a donor for you can come
with you at the time of your appointment to be evaluated as a donor.
What are the advantages of living donation?
Living kidney transplantation has a number of advantages over kidney
transplantation from a deceased donor:
1. Since the living kidney donor is usually a close relative of the person getting
the transplant, there is a better chance of a good genetic match and less chance
of rejection. As a result, living donor kidneys tend to last longer. In fact, living
donor kidneys last twice as long as deceased kidneys. Lower doses of
immunosuppressive drugs can be used with fewer side effects.
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Living Kidney Donation
2. The transplant can be scheduled ahead of time, something that cannot be done
if you are on a waiting list for a deceased kidney. This allows you to plan for
absences from work, childcare, and other social concerns.
3. Kidneys that come from living donors generally begin to function immediately
after the transplant, while deceased kidneys may take several days or weeks
before they begin to function normally. The kidney usually begins to work
immediately, even in the operating room. There is a very low rate of Delayed
Graft Function (DGF) in living transplants. A deceased kidney may not work
right away for several reasons. This is known as acute tubular nephrosis
(ATN).
4. While the national waiting time can be as long as six years, patients who have
a living donor wait an average of just 88 days for their transplant! This may
help assure that you are in better health than after a long wait and declining
health.
5. Seventeen people die every day waiting for organ transplants. Living donation
helps people waiting for deceased kidneys by lowering the number of people
on the waiting list.
6. Kidneys from living donors do not need to be transported from one site to
another, so the kidney is in better condition when it’s transplanted.
Who can become a living donor?
• To qualify as a living donor, a person must be physically fit, in good health
and free from high blood pressure, diabetes, cancer, kidney disease and
heart disease. The donor is carefully evaluated by physical examination,
tests to determine kidney function and studies to show the presence of two
normal kidneys.
• Individuals considered for living donation are usually between 18-60 years
of age.
• Gender and race are not factors in determining a successful match.
• The decision about whether to accept the donor is then made by the health
care team at the transplant center.
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Living Kidney Donation
How does living donation affect the donor?
Studies have shown that one kidney is enough to keep the body healthy by
removing wastes and excess fluid from the blood. Living donation does not
change life expectancy, and after recovery from the surgery, living donors can
continue to lead normal lives. The usual recovery time after the surgery is short,
and donors can generally resume their normal home and work activities within 2
to 6 weeks.
Suppose someone decides against being a living donor?
The decision to become a living donor is voluntary and should be free from
internal or family pressures. Individuals have the right, after discussing and
considering the facts, to decide that kidney donation is not for them. Likewise,
people who have kidney failure have the right to decide that they do not want a
transplant. The patient must live with the disease, and has the right to decide what
is to be done. This decision, as well as the donor's, is respected provided it is
made after a complete discussion of the available choices and possible results.
How much does living donation cost? Who pays?
The costs of the donation, which include laboratory, x-ray and doctors' and
hospital charges, are paid by the recipient's insurance. There is no cost to the
donor. However, the donor is not paid for time off from work, or travel expenses
to or from the hospital and clinic. Some employers may allow this time to be
taken as sick leave.
Are transplants from living donors always successful?
It is important to realize that, although living related kidney transplants are highly
successful, problems may occur. Sometimes, the kidney is lost to rejection, or the
original disease that caused kidney failure may come back in the transplant,
causing it to fail.
What if I Don’t Match My Recipient?
If you are not compatible with your recipient for reasons such as blood type
incompatibility or crossmatch incompatibility, there are other options available to
both the donor and recipient.
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Living Kidney Donation
Donation to the list (Living/Deceased Donor Exchange Program)
This program allows incompatible living donors to donate a kidney to a
compatible recipient who is on the waiting list for a deceased donor kidney.
In exchange for this donation the incompatible recipient is moved to the top
of their blood group list on the deceased donor waiting list. They may
remain in this position until they find a crossmatch compatible high quality
organ. This guarantees them a shorter waiting time (usually less than 6
months) and a high quality donor organ.
Paired Kidney Exchange
Kidney paired exchange provides organs to patients who have a willing,
designated donor who is not compatible. A kidney from such a donor is
matched to, and transplanted into the recipient of a second incompatible
donor-recipient pair. The transplants are performed simultaneously. While
it is difficult to find a compatible exchange pair, the VCU team has
developed a program to identify these potential pairs.
Desensitization Protocol
About 30% of patients who are waiting for a kidney transplant are
sensitized, meaning that they have developed harmful antibodies in their
blood against foreign tissue. These antibodies can develop through previous
exposure to foreign tissue resulting from pregnancies, previous transplants,
or blood transfusions. This may cause patients to wait three or four times
longer than unsensitized patients for a compatible deceased kidney.
Many sensitized patients have living donors that are willing to give them a
kidney, but the transplant has little chance of success. The recipient’s blood,
when mixed with the donor’s blood, reacts against the donor’s cells because
of the antibodies. This is a positive crossmatch, which means that the
recipient will likely reject the kidney immediately following transplant. A
negative crossmatch is needed before a transplant can be performed.
There is a process that allows the antibodies to be removed from the
recipient’s blood called desensitization. This involves the patient
undergoing plasmapheresis treatments to help remove the harmful
antibodies from the blood. Your doctor will discuss this option in more
detail with you if it is needed.
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Kidney and Pancreas Transplant Evaluation
Laparoscopic Donor Nephrectomy
• This new procedure has greatly improved the surgical experience for the
donor. This surgery will leave the donor with 3 small scars and 1 large scar
where the kidney is removed.
• The donor will have less pain and will recover more quickly
• The length of stay for the donor has been reduced to 1-3 days
•
Many donors return to work within 2-4 weeks of the surgery
Kidney and Pancreas Transplant Evaluation
Several tests are done to be sure you are medically able to safely undergo
transplant surgery. These tests can be scheduled at VCU Medical Center or, in
some cases, at your local hospital.
I.
Evaluation Appointment:
You will meet the members of the transplant team:
Transplant Nephrologist/ Surgeon
Transplant Coordinator
Transplant Social Worker
Transplant Financial Coordinator
II.
Required Tests:
All individuals must have the following tests:
• HLA and blood typing to match a kidney to you
• Laboratory tests for infectious diseases, such as HIV, Hepatitis B,
Hepatitis C
• Chest x-ray and EKG (Electrocardiogram) to be performed at our
hospital.
• Dental clearance
• Tuberculosis skin test (PPD)
Page 12
•
Women must have a pap smear and baseline mammogram
Kidney and Pancreas Transplant Evaluation
III.
Additional Tests:
Additional tests may be required during or after the initial evaluation, depending
upon your medical history. Additional tests and images may include:
•
Ultrasound of your gallbladder may be needed to check for gallstones
•
Voiding cystourethrogram (VCUG) may be needed to see if your bladder
empties normally
•
Computerized tomography (CT) scans may be needed
•
Magnetic Resonance Imaging (MRI)
•
Doppler studies to assess blood flow
•
Heart testing such as echocardiogram, stress thallium test or cardiac
catheterization if there is a history of heart disease, any heart related
illnesses, if there is a history of diabetes or you are over age 50
•
Colonoscopy to check for cancer
Once you have completed the medical evaluation and are found to be an
acceptable candidate for transplant, your information is sent to your insurance
company for approval. Once we have obtained financial clearance, your name will
be placed on the waiting list. Your transplant coordinator will notify you and your
dialysis center or nephrologists.
Your Role in a Successful Transplant
You are receiving a gift of life with your new kidney. It is your
responsibility to care for that gift. If, after your evaluation, it has been determined
that a kidney transplant is the best treatment for your disease, there are many
considerations you should be aware of. Among the most important of these is your
commitment to change any harmful habits that may damage your new kidney. Our
program requires potential transplant recipients to be substance free for 6
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Preparing For Transplantation
months before being listed for a kidney transplant. We expect that you will
continue to avoid drugs and alcohol while you are on the list and after your
transplant. We strongly encourage smokers to quit before their transplant.
Marijuana interferes with the immunosuppressive medicines and causes them to
be inactive. It should be avoided at all costs.
Preparing For Transplantation
Waiting for a kidney to become available can take on average 4-6 years.
It is very important for you to maintain your health during that time. We strongly
encourage you to do the following:
• Maintain a healthy diet
• Exercise: If possible, stay active. You don't have to refrain from activities
you enjoy. If you have questions about whether a particular activity is right
for you, talk with your physician.
• Prepare for the Call: Be aware that the call for transplant may come at any
time. Our surgeons are available twenty four hours a day, seven days a
week, every day of the year to transplant you when a kidney becomes
available. Make sure that you have a plan for items to take with you, and
make arrangements for children or pets so you can leave with a moment’s
notice. Please bring the following things with you when you come to the
hospital for your transplant:
o A list of all the medications you are taking
o All of your diabetic medications and supplies, including glucometer
(glucose machine)
o If you are on an insulin pump, you should bring your pump and
supplies
o Loose comfortable clothes and comfortable shoes for you to wear
after your surgery
o A copy of your insurance cards
o If you are on peritoneal dialysis, you should bring enough supplies
for 3 or 4 days
o Blood Pressure cuff, if you have one
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Preparing for a Transplant
• Please inform your transplant team of any insurance or phone number
changes. This insures that the team can proceed with the transplant
when the time arrives! You must have a working telephone. Team
members also need the telephone numbers of friends, relatives and
neighbors, who can locate you when needed. Please notify us
immediately if your telephone number, insurance or address changes.
• Notify your transplant team of any health changes while you are waiting.
Notify us of any recent illness, pregnancy, blood transfusions, or infection.
• Dealing with Pre-Transplant Stress: Share your feelings if you feel
depressed or uneasy. The transplant team can answer questions, and help
alleviate fears. Stay active and spend time with family and friends.
The four most important factors during your wait time on the transplant list
are:
1. Have your monthly serum drawn at your dialysis center or your doctor’s
office
2. Notify your coordinator of telephone number or address changes
3. Annual transplant visits to ensure your medical health has not changed
4. Notify your coordinator of insurance changes
Meet The Transplant Team
During your first visit you will meet the members of the transplant team.
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The Transplant Team
I. Pre-Transplant Coordinators
• Your transplant coordinator will be one of your contacts at our Center.
• This nurse will discuss transplantation with you and your family and
answer any questions you may have during your appointment.
• Office hours are Monday through Friday 8:00am-4:30pm.
• Office phone number is 804-828-4104. If your coordinator does not
answer, please leave a voice mail message. We will return your call as
soon as possible. Please allow 24-48 hours for a response to nonemergent calls. Every call is important to us so we thank you for your
patience and cooperation.
II. Transplant Nephrologist
• Anne L. King, M.D., Professor of Medicine and Surgery is the Medical
Director of the Kidney and Pancreas Transplant Program.
• This is a kidney doctor who specializes in transplants.
• This doctor will care for you before and after transplant.
• This doctor will perform a complete physical exam and discuss with you
what tests are needed for you to have a transplant.
III. Financial Coordinators
• The financial coordinators will verify your insurance eligibility and
benefits.
• They will screen you for financial assistance, if needed.
• They can provide information regarding resources and fund raising, if
needed.
• They will discuss hospital and physician financial obligations.
• Financial clearance is necessary to place your name on the transplant list or
proceed to living donor transplantation.
• They can assist you with billing or insurance problems.
Page 16
• Please inform your transplant coordinator immediately of any
insurance changes.
• In some instances, your insurance company will require a referral from
The Transplant Team
your primary care physician before your transplant evaluation.
IV. Social Worker/Psychologist
•
The focus of the social worker is to help recipients, donors, and family
members meet and go through each step of transplantation in a way that is
manageable and healthy. The social worker can assist with psychosocial
issues during all phases of transplantation.
• The social worker/psychologist will discuss various issues such as support
systems, coping mechanisms, and past history of medical and social
problems.
V. Transplant Surgeons
• We currently have 5 kidney transplant surgeons. This is a surgeon who
specializes in performing organ transplant surgery.
1. Marc P. Posner, M.D., Professor & Chairman of Transplant Surgery,
Director, Hume-Lee Transplant Center
2. Robert A. Fisher, M.D., Director, Liver Transplant Program, Professor
of Surgery and Pediatrics
3. Adrian Cotterell, M.D., Associate Professor of Surgery
4. Daniel Maluf, M.D., Associate Professor of Surgery
5. Amit Sharma, MD, Assistant Professor of Surgery
Transplant Clinic
• Our clinic is in the Gateway Building 7th floor.
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The Transplant Clinic
• The clinic is open from 8:00AM to 4:30PM, Monday through Friday.
• If you need to schedule an appointment, please call 804-828-4104.
• If you do not have a follow up appointment, please call our office to
schedule one.
How often will you come for a clinic visit after transplant?
• The first 4-6 weeks after transplant you will visit the clinic 2-3 times a
week.
• You will be told by your post transplant coordinator if your visits will vary
from this schedule.
• After you are discharged from the hospital, clinic visits are on a set
schedule depending on how well you are doing.
• Clinic visits are by appointment only unless you are ill. In case of illness,
please call to let us know you are coming to the clinic.
• Following directions after transplantation is very important to keep your
new kidney healthy. Keep all of your appointments!
What Happens When You Are “Listed” With UNOS
• At this point your renal disease has progressed to the point that your
kidneys are no longer able to perform the normal functions of a healthy
kidney.
• Being “listed” means that you have been placed on a national waiting list
for a deceased donor kidney.
• A frequently asked question is “How long will I wait for a kidney?”
Unfortunately, we cannot determine that exactly. National waiting time is
currently as long as 4 to 6 years on average.
• Currently the United Network for Organ Sharing (UNOS) designates how
deceased organs are distributed.
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Listing for Transplant
• UNOS policy 3.2.2 allows candidates to be waitlisted at multiple transplant
centers. These transplant centers may be located within the same Organ
Procurement Organization (OPO) service area or in a different OPO
service area. With the transplant wait times increasing, many people are
going to multiple transplant centers to be multiple-center listed in hopes to
shorten their waiting time. There are some studies to suggest it shortens
waiting times, but there are no guarantees that multiple listing will shorten
your waiting time due to other factors, such as antibodies and genetics. If
you wish to be multi-listed, you should first check with your insurance
carrier to see if they will pay for additional evaluations.
• If you have accumulated time with another transplant center, you have the
option of transferring that time from center to center. You can choose to
transfer your time but remain listed at a center and begin to accumulate
time again at day one or be removed from that centers list altogether. A
written request signed by you will be submitted to UNOS regarding these
changes.
Note: Your transplant coordinator will send a letter notifying you, your
dialysis center, and your nephrologist when you have been listed.
How is a Kidney Selected?
Special tests are used to match the blood and tissue type of a donor with the blood
and tissue type of the recipient.
First, blood typing or ABO typing is performed to see if the blood typing is
compatible.
This is followed by HLA typing (tissue typing) and crossmatching. HLA
typing shows whether the donor’s antigens match those of the recipient.
Antigens are proteins found on all cells and can activate the immune system
to fight a foreign substance, such as a new kidney.
The final testing is called a crossmatch. The blood from the donor and
recipient is mixed together and evaluated for reactivity. This test is done
when a donor kidney is available. Your blood is mixed with the donor's
blood. If there is no reaction (negative crossmatch) it means you are
"compatible" with the donor. If there is a reaction (positive crossmatch), the
kidney will not work for you because it is "incompatible" and will result in
rejection.
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Kidney Transplant Surgery
If you are Blood Type
You can accept a donor with Blood
Type
O
O
A
A or O
B
B or O
AB
A, B, AB or O
For persons with a living donor, an initial HLA typing and crossmatch is
performed. Prior to transplant, a final crossmatch is performed to ensure there
have been no changes and that transplantation is safe.
If you are waiting for a deceased kidney, blood is sent in each month by the
dialysis center or nephrologist’s office. This is so that the crossmatch can be
performed on a current blood sample. It is very important our lab receives this
monthly blood sample. We will contact you if we are not receiving it.
Kidney Transplant Surgery
I. When You Are Called For Surgery
• Scheduled living donor kidney transplants report to the 5th floor of the
Gateway Building. Your family will wait on Gateway 7th floor in the transplant
clinic.
• One of the transplant coordinators may call you at any time to come to VCU
Medical Center for your transplant. We never know when a kidney will
become available, so we could call you at any time of day or night. Our
surgeons are available twenty four hours a day every day of the year, to be
ready to transplant you. To reach you quickly, the coordinator must be able
to get in touch with you!
• The kidney can be stored only for a certain amount of time. A shorter storage
time is better for the kidney. This is why you must come as quickly as you can
when you are called in for the transplant.
I. Questions the nurse coordinator will ask
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Kidney Transplant Surgery
1. Are you available for transplant?
2. When were you last dialyzed?
3. Have you had any recent illness or infection?
4. Have you recently been pregnant?
5. Have you had a recent blood transfusion?
6. How long will it take you to reach the hospital?
7. When was the last time you had anything to eat or drink?
III. When you arrive at the hospital
• You will report to Gateway Building 5th Floor where you will be
prepared for surgery.
• Do not eat or drink anything.
• Bring a list of your current medicines and insurance cards.
• Your family will wait on Gateway 7th Floor Transplant Unit while you
are in surgery.
• The nurses will get you ready for surgery. An IV will be started and
blood work drawn. Other tests that will be performed include:
o EKG
o Chest X-Ray
o Updated history and physical exam
IV. Cancellation of Surgery
• If the physician finds a medical problem such as an infection or an
incompatible crossmatch, the surgery cannot be performed, and you will be
discharged home.
V. Risk Factors A kidney transplant is major surgery. It has the same risks as
any other major surgery.
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Kidney Transplant Surgery
• Bleeding
• Infection
• Developing blood clots
• Sometimes the kidney does not work right away and needs time to
recover. If this were to occur, you would be dialyzed regularly until the
new kidney begins to work.
VI. Possible Complications of Kidney Transplantation
• Rejection of your new kidney. You will be placed on anti-rejection
medication to try to prevent this from occurring, but it can still happen.
• Typically rejection will happen within the first 6-12 months after
transplant, but it may happen even years after your transplant.
• This is why it is so important to take your medications as prescribed and
follow up with your clinic visits and labs as scheduled.
VII. What Happens During The Surgery
• Once you are have received general anesthesia and have fallen asleep,
the transplant surgeon will open the right or left side of the abdomen and
connect the kidney.
• It is not necessary to remove the old kidneys.
• The surgeon attaches the donor blood vessels to the main vessels nearby,
and the ureter is inserted into the bladder.
• During surgery, a stent will be placed in your ureter. The purpose of
placing this plastic tube is to protect the connection between the newly
transplanted kidney and the urinary bladder. The stent may be removed
approximately 6-12 weeks after your transplant. This can usually be
done in an outpatient setting with mild sedation.
• The surgery takes about 4 hours.
VIII. After Surgery
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Kidney Transplant Surgery
• You will go from the operating room to the recovery room. From the
recovery room, you will return to your room on the transplant unit. In
special circumstances, you may go to the intensive care unit.
• A tube called a foley catheter is placed in the urinary bladder during
surgery. The catheter drains urine continuously, so that the bladder does
not become too full. The catheter allows the doctors and nurses to
measure how much urine the new kidney is producing. The urine may
be blood tinged or have blood clots. This is normal after surgery. The
catheter stays in for 5 days after surgery.
• During surgery, an IV called a triple lumen IV is placed in a large vein
near the collar. This IV stays in place for several days to give IV fluids
and medicines. It also allows the doctors and nurses to measure your
heart pressures and draw blood.
• Pain medication is given through the IV. The pain medication is in a
special pump that allows you to push a button and receive a pre-set
amount of medicine. The pump is set only to deliver a certain amount of
medicine at certain times- you cannot get too much.
• Some patients will have a nasogastric tube (NG tube) placed through
their nose into the stomach. This tube is to drain the stomach and reduce
nausea and vomiting.
• After surgery, the nurses encourage you to cough and breathe deeply.
This is very important to help reduce the risk of developing pneumonia.
• The nurses will get you out of bed the evening after surgery or the
following morning. This is to reduce the risk of developing blood clots
and pneumonia. You may progress to walking the hallway the day after
surgery.
• The usual length of stay in the hospital is 5 days. Some hospital stays
may be longer, if complications arise.
• You will learn about all of your medications and why you are on them.
• While you are on the Transplant Unit please tell your family that you are
not allowed any live flowers- there is a risk of infection for you! Also no
children under the age of 12 are allowed to visit you- again because of
the risk of infection to you!
Page 23
Kidney Transplant Surgery
Survival rates
• Our adult patient and kidney graft transplant survival rates are
consistently over 94% (www.ustransplant.org) for both living and
deceased donor kidney recipients.
Page 24
Medications after Transplant
Medications After Transplant
In an attempt to prevent your body from rejecting your new kidney you must take
anti-rejection medicines daily. These are also called immunosuppressants.
Additional medications may include anti-hypertensives (blood pressure pills),
antibiotics, anti-virals, anti-fungals, and medicines to prevent stomach ulcers. You
will be on anti-rejection medications as long as you have a functioning
transplanted kidney.
You are responsible for taking the medications that have been prescribed for you.
You should talk to your physician, pharmacist, transplant nurse, and/or
coordinator to understand fully:
•
the name and purpose of each medication
•
when to take each medication
•
how to take each medication
•
how long to continue taking each medication
•
side effects of each medication
•
what to do if you forget to take a dose
•
when to order more medication so it doesn't run out
•
how to order or obtain medications
•
what to avoid while taking medications
At home, you will continue taking most of the medicines you began taking in the
hospital after the transplant surgery, especially the anti-rejection medications.
Your immune system recognizes the new kidney as foreign and will try to reject
it. Therefore, your immune system must be controlled with immunosuppressive
medications. You probably will have to take one or more of these drugs for the
rest of your life, in addition to other medications.
REMINDER: Never stop taking medication or change the dosage without a
physician's approval.
What is An Anti-Rejection Medicine?
Page 25
Medication After Transplant
Rejection is the body’s natural response against the transplanted kidney. The
anti-rejection medications prevent the immune system from working against the
kidney.
In the event of a rejection episode, more powerful medications may be required.
This may require a stay in the hospital.
If the rejection cannot be reversed, you will return to dialysis. Usually, you can
go back on the transplant list, if desired. If you have not been compliant with
your medications, re-transplantation may not be an option.
What are the Anti-Rejection Medicines?
CELLCEPT® (mycophenolate mofetil)
CELLCEPT fights rejection by decreasing the number of white blood cells the immune
system produces.
GENGRAF®, NEORAL® (cyclosporine microemulsion)
GENGRAF is used to prevent rejection of a transplanted organ. It is used for long-term
(perhaps lifetime) immunosuppression.
PROGRAF ®(tacrolimus)
PROGRAF is prescribed to prevent or treat organ rejection in people who have received
kidney transplants. It is used for long-term (perhaps lifetime) immunosuppression.
DELTASONE® (prednisone)
DELTASONE is a corticosteroid that helps prevent and treat rejection of transplanted
organs. It will be used for long-term (perhaps lifetime) immunosuppression or, in higher
doses, for treatment of rejection.
RAPAMUNE® (sirolimus)
RAPAMUNE is used to prevent or treat organ rejection in people that have received a
transplant. It is used for long-term (perhaps lifetime) immunosuppression.
These medications can be very expensive, as much as $2,500 a month.
These medications are strong and like all medicines, have side effects.
Anti-rejection medications are started at higher doses because the chance of
rejection is greater the first three months after transplant. Gradually, the doses
decrease and the chance of side effects lessens.
Page 26
Preventing Transplant Rejection
Transplant Medications and their side effects
Immunosuppressive Drug
Possible Side Effects
Cyclosporine (Gengraf®, Neoral®)
*Hyperlipidemia (high cholesterol)
*Hyperglycemia (high blood sugar)
*Hyperkalemia (high potassium)
*Stomach upset
*Swollen gums
*Kidney toxicity
*Tremors
Prevents organ rejection
Prednisone
Prevents organ rejection
CellCept® (Mycophenolate)
Prevents organ rejection
*Delayed wound healing
*Hyperlipidemia
*Hyperglycemia
*Increase in appetite/weight gain
*Skin changes
*Edema (swelling)
*Diarrhea
*Nausea and Vomiting
*CMV viremia
Rapamune® (Sirolimus)
*Nausea, vomiting, pruritus (itching)
*Hyperlipidemia
Prevents organ rejection, inhibits divid- *Thrombocytopenia
ing cells
*Neutropenia
Prograf® (Tacrolimus)
Prevents organ rejection
*Tremors
*Headaches
*Diarrhea
*High blood pressure
*Hyperglycemia
*Hyperkalemia
*Nausea, vomiting
*Kidney Toxicity
Page 27
Rejection
The greatest cause of rejection is patients not taking their medications as
prescribed. It is extremely important for you to take your medications every day
as you are directed.
Types of Rejection
1. Hyperacute: An immediate, rare type of reaction due to crossmatch or blood
type incompatibility. There is no treatment for this type of rejection.
2. Accelerated: Rejection that happens in the first few days after transplant. This
type of rejection is difficult to treat with current immunosuppressant
medications and may lead to early loss of the transplant.
3. Acute: Usually occurs with the first 3 months after transplant. This type of
rejection may be treated with pulse steroids (high doses of prednisone),
Thymoglobulin or OKT3. Acute rejection is very successfully treated.
4. Chronic: This type of rejection occurs slowly over months or years after
transplant. Treatment may include medication changes, but is a leading cause
of kidney transplant failure.
What are the Signs and Symptoms of Rejection?
The most common symptoms of rejection are:
Decrease in Urine Output
Fever over 100*F
Pain or Swelling over the Kidney
Rise in Blood Pressure
If your body begins to reject your new kidney, you may not feel ill, but your
kidney function will weaken. This can be detected by laboratory tests, which is
one of the reasons your clinic appointments are so important.
Infections
Page 28
Post– Transplant Coordinators
Immunosuppressive medications interfere with your natural immunity;
therefore, you will be more susceptible to infections after transplant
surgery.
Infections can become very serious and require immediate treatment. Please
notify your nurse or doctor as soon as possible if you have an infection.
Learn how to recognize the signs and symptoms of infections before you
leave the hospital.
Post-Transplant Coordinators
I. Inpatient Coordinator
The inpatient coordinator helps with your discharge planning, arranging for
medication orders, teaching you about your medications, and answering any
questions while you are in the hospital.
II. Post -Transplant Coordinators
• After your discharge please contact your outpatient coordinator for any
questions, concerns or illnesses. For common colds or general illnesses,
contact your primary care physician.
• In the event of an emergency after hours please call the Transplant Clinic
and a coordinator will return your call. Calls after hours are for serious
problems that cannot wait until the clinic opens. The phone number for
the transplant clinic is 804-828-4104.
• We require at least a one week notice for medication refills. It is your
responsibility to keep track of your medicines.
Page 29
UNOS Information
UNOS Information
Our Transplant Clinic works closely with LifeNet and its governing body, The
United Network for Organ Sharing (UNOS). UNOS is the organization that
oversees all transplantation services in the United States and also formulates the
rules and regulations for organ transplantation. UNOS provides a toll-free services
line to help transplant candidates, recipients and family members understand organ
allocation practices and transplantation data. You may also call this number to
discuss a problem you may be experiencing with your transplant center or the
transplantation system in general. The toll-free patient services line number is
1-888-894-6361.
Page 30
Resource Directory
Resource Directory
American Association of Kidney Patients
www.aakp.org
Air Care Alliance
www.aircareall.org
Airlifeline
www.airlifeline.org
Telephone 877-AIR-LIFE
American Diabetes Association
www.diabetes.org
American Heart Association
www.americanheart.org
Telephone 800-aha-usa1
American Medical Association Organ Donation Website:
www.ama-assn.org/ama/pub/category/1945.html
American Kidney Fund
www.akfinc.org
American Lung Association
www.lungusa.org
Telephone 212-315-8700
American Organ Transplant Association
www.a-o-t-a.org
Telephone 281-261-AOTA
Centers For Medicare & Medicaid Services [CMS]
Formerly Health Care Financing Administration [HCFA]
www.cms.hhs.gov
Governs Health & Medicare Policy
Coalition of Donation Website:
www.shareyourlife.org
Page 31
Resource Directory
Children’s Organ Transplant Association [COTA]
www.cota.org
Telephone 800-366-2682
Hume-Lee Transplant Center
www.vcuhealth.org/transplant
800-762-6161 ext. 4104
Insulin-Free World Foundation
www.insulin-free.org
LifeNet
www.lifenet.org
5809 Ward Court
Virginia Beach, VA 23455 USA
757-464-4761
Organ Procurement Organization
Living Donors
www.livingdonors.org
Living Donors Online
www.livingdonorsonline.org
Medicare
www.medicare.gov
Telephone 800-772-1213
National Foundation For Transplants [NFT]
www.transplants.org
Telephone 800-489-3863
National Kidney Foundation
www.kidney.org
National Transplant Assistance Fund [NTAF]
www.transplantfund.org
Telephone 800-642-8399
Page 32
Resource Directory
Organ Donation Website:
www.organdonor.gov
Organ Procurement & Transplantation Website:
www.geocities.com/otsfriends
Organ Transplant Support, Inc Website:
www.geocities.com/otsfriends
Pharmaceutical Research & Manufacturers Of America [PHRMA]
www.phrma.org
Telephone 202-835-3400
Drug Patient Assistance Programs
Transplant Living - Patient Services
www.patients.unos.org/101.htm
TransWeb- Transplantation & Donation
www.transweb.org
Transplant Recipients International Organization, Inc.
Phone: 800-TRIO-386
www.trioweb.org
Virginia Transplant Council
www.vatransplant.state.va.us
Social Security Administration
www.ssa.gov
Telephone 800-772-1213
United Network For Organ Sharing [UNOS]
www.unos.org
Telephone 888-894-6361
Veterans Administration
www.va.gov
Telephone 800-827-1000
Directions to the VCU Medical Center Campus
Page 33
Directions
Arriving by I-64 West - coming from Virginia Beach, Williamsburg, etc.
1. Take Exit #190 for 5th Street and Downtown/Coliseum
2. Turn left at the 4th traffic light onto Marshall Street
3. Drive six blocks and turn left onto 11th Street
4. Drive one block and turn right onto Clay Street
5. Go one and one-half blocks to the Patient and Visitor Parking Decks E & S.
Arriving by I-64 East - coming from Charlottesville, I-81, etc.
1. Follow I-64 East which merges with I-95 South
2. Remain on I-95 south to Exit #74C for West Broad Street
3. Proceed West on Broad Street and follow directions given under "arrive by I-95 North"
Arriving by I-95 North - coming from Petersburg, North Carolina, etc.
1. Take Exit #74C for West Broad Street
2. Proceed West on Broad Street for three blocks to 11th Street, take right
3. Drive two blocks to Clay Street and turn right
4. Proceed one and one-half blocks to the Patient and Visitor Parking Decks E & S.
Arriving by I-95 South - coming from Washington, Fredericksburg, etc.
1. Take Exit #74C to West Broad Street
2. Follow directions given under "arriving by I-95 North"
Arriving by U.S. Route 60 - coming from Lexington, etc.
1. Follow U.S. Route 60 which merges with 9th Street
2. Remain on 9th Street and go one block past Broad Street to Marshall Street and turn
right
3. Drive two blocks and turn left onto 11th Street
4. Drive one block and turn right onto Clay Street
5. Go one and one-half blocks to the Patient and Visitor Parking Decks E & S.
Hospitals Patient Representatives
804-628-0400
This department is available for assistance for housing and travel arrangements. Certain
Page 34
Parking
Valet parking is available for $5.00 at the entrances of the Gateway
Building, ACC and North Hospital. Parking for the Children’s Pavilion
is available in the Pavilion’s lower garage on 11th St. for $5.00.
The VCU Medical Center has a Patient and Visitor Parking Deck
located at 12th and Clay Streets. The Deck is open 24 hours daily.
There is a charge for using this facility during the week.
Reduced parking rates ($2.00 per visit) are available for patients and
visitors that obtain parking validation at the Information Desks located
on the first floor of Main Hospital, ACC, Nelson Clinic, the Children’s
Pavilion and the ground floor of the Gateway Building.
Lost parking tickets for the Patient and Visitor Parking Deck will be
charged $10.00 upon exit unless a $2.00 validation is presented.
vp Valet Parking P General Parking
Page 35
Comfort Safety and Security
Food and Vending
Cafeteria – Main Hospital, 1st Floor
Subway – Main Hospital, 1st Floor
Chick-fil-a – Main Hospital, 1st Floor
Alpine Bagels – Gateway Building, Ground Floor
McDonald’s – Gateway Building, Ground Floor
Espress Oasis Coffee – Main Hospital, 1st Floor
Vending Machines – Main Hospital, 1st Floor
Three Bears Gift Shop – Critical Care Hospital, 1st Floor
Security
Security staff is available at all times. Immediately report any
questionable situation to your health care provider. An escort service is
available to any location on the downtown campus by calling 828WALK. This service is provided free of charge at any time of the day.
Security can also assist visitors in obtaining help for car related
problems by calling 828-6595.
Telephones
Visitors are invited to use pay telephones located
throughout the medical center.
Cell Phone Usage
The use of cell phones is allowed in any area of the
medical center unless otherwise indicated.
Smoking Policy and Locations
Smoking is not allowed anywhere in the medical center and is
also prohibited in and adjacent to all entrances. Smoking is
restricted to designated outdoor smoking areas. Please check
with your health care provider for the appropriate smoking
locations.
Page 36
Lodging Near VCU Medical Center
area hotels also provide discounts if reservations are made through representatives.
Hospital Hospitality House
804-828-6901
612 E. Marshall Street
Richmond, VA 23240
This facility provides temporary lodging arrangements for visiting families of VCU Health
Systems, out-of-town patients, and patients requiring long-term treatment. Provides free shuttle
to hospital.
Days Inn- Richmond Airport
804-222-2041
5500 Williamsburg Road
Sandston, VA 23150
Holiday Inn- Central
804-559-0022
3207 North Boulevard
Richmond, VA 23230
Holiday Inn Express
804-559-0022
7441 Bell Creek Road
Mechanicsville, VA 23111
Omni Richmond Hotel
804-344-7000
100 South 12th Street
Richmond, VA 23219
Radisson Hotel
804-644-9871
301 West Franklin Street
Richmond, VA 23220
Residence Inn Richmond- West End
804-285-8200
2121 Dickens Road
Richmond, VA 23230
Richmond Marriott
804-643-3400
500 East Broad Street
Richmond, VA 23219
Provides free shuttle service to hospital
Ronald McDonald House
804-355-6517
2330 Monument Avenue
Richmond, VA 23220
Page 37
Fund Raising Opportunities for Transplant:
I. National Foundation for Transplants (NFT)
www.transplants.org
Telephone: 1-800-489-3863
Facts:
1. Do not do separate fundraising while actively fundraising
with NFT.
2. If the recipient uses NFT for active fundraising, a grant may
be available to the donor.
Policies:
1. Fundraising cannot be used for personal expenses.
2. Fundraising can be used for transplant related expenses.
II. National Transplant Assistance Fund (NTAF)
www.transplantfund.org
Telephone: 1-800-642-8399
III. American Organ Transplant Association (AOTA)
www.a-o-t-a.org
Telephone: 1-281-261-AOTA
IV. Children’s Organ Transplant Association (COTA)
www.cota.org
⇒
This is a list of resources to assist you in your fundraising efforts for
transplant. For further assistance please discuss this with either your
coordinator, financial coordinator or social worker.
Page 38
Notes
Notes
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