In the first three to six months after your transplant, you will likely make a lot of trips back to the hospital. You might sometimes be re-admitted overnight. This is not easy, but it is very important to have follow-up visits to make sure you and your new organ are healthy.
You might visit the hospital every day (even on weekends) for up to four weeks after transplant.
Common tests and visits once you leave the hospital
- You may receive IV medicines through a CVL either at home (for example ganciclovir) or at the hospital.
- A home care nurse will visit you at home to check your IV line, do dressing and cap changes and possibly give you medicine through the IV.
- Your CVL or PICC line will be taken out anytime between six weeks and three months after surgery. Ask your team when yours can come out.
- If you have a “stent” (a small tube in the ureter to keep it open and let urine flow through), it will be removed about six to eight weeks after your transplant. This is done during a short operation – there is no “cut” and the tube will be gently removed through your bladder. Your transplant team might do a biopsy (see below) at the same time.
- If you have had a stent removed, you will have an ultrasound about a week later to make sure there are no drainage problems with the kidney.
- Your team may do a biopsy, normally about six weeks after surgery, to check how well your kidney is doing. They may also do one if there are concerns about rejection or if your blood is positive for BK virus. You can get more information about biopsies on the next page.
- You may need to have ultrasound scans of your kidneys. These are usually done if your creatinine level is increasing.
- You will also make specific visits to the transplant clinic (see below).
Transplant clinic visits
At a typical clinic visit you will have blood drawn for testing and then be seen by different members of your transplant team, including your nurse, doctor or nurse practitioner, dietitian, social worker, physiotherapist and adolescent medicine specialist.
They will all ask you questions and check different things to make sure you are healthy.
The table below shows how often you need to come for clinic visits.
| If your transplant was... | You will come to the clinic... |
|---|---|
| 0 to 3 months ago | At least once a week |
| 3 to 6 months ago | At least once every two weeks |
| 6 to 12 months ago | At least once a month |
| Over 1 year ago | At least once every three months |
*These are guidelines only. Your visits may change depending on how you are doing.
Blood work after transplant
How often you have blood work depends on when you had your transplant surgery. Have a look at the table below for more information.
| If your transplant was... | You will have blood work... |
|---|---|
| 0 to 4 weeks ago | Every day or every other day |
| 5 to 12 weeks ago | At least twice a week |
| 3 to 6 months ago | At least once a week |
| 6 to 12 months ago | At least once every two weeks |
| Over a year ago | At least once a month |
If your team is concerned about any blood test results, they will bring you back to have blood work more frequently. For example, if you’re having your blood work twice a week and your creatinine level is up on one of these days, your team will likely ask you to come back the next day to check it again.
All this follow-up at the hospital might seem like a lot, but regular blood tests and check-ups are the only way we can know that you and your transplant are healthy. If your body is rejecting your kidney, you will probably not have any symptoms for a long time. Similarly, if you have an infection, your team often finds signs in the blood or urine long before you start to have symptoms.
Other tests
Later on after your transplant you will have a set of tests and appointments that are part of the normal follow-up. These tests include:
- renal ultrasound (a year after transplant and then once a year)
- echo (a year after transplant and then once a year)
- renal (kidney) biopsy (see below).
Your transplant team might order other tests such as a renal scan or bone age scan if they think you need them.
Kidney biopsy
If your team sees signs in the blood work that your creatinine is increasing, they may do a biopsy of the kidney.
Biopsies do not always mean something is wrong. Many transplant teams do routine biopsies, for example at six weeks, six months and a year after transplant.
What happens during and after the biopsy?
A biopsy involves inserting a needle through your abdomen (belly) to take out a tiny piece of your new kidney so it can be studied under a microscope. You will receive medicine to help you relax, known as sedation, and/or have a local anaesthetic to numb the area so you won’t feel any pain when the needle goes in.
After the biopsy, you will have to lie flat in hospital for six to eight hours with a sandbag over the site of the biopsy to help prevent any bleeding. You may see some blood in your urine up to a day after. If this happens, call your transplant team.
What happens if the biopsy results are abnormal?
If your biopsy shows that you have signs of rejection in your kidney, you may be admitted to hospital to receive medicines to treat the rejection or be given extra medicine to take at home.