How to Manage Kidney Transplant Patients Posttransplant

Successful kidney transplantation dramatically improves survival and quality of life for patients with end-stage renal disease (ESRD), but optimal posttransplant care requires coordinated, long-term management to preserve graft function, prevent complications, and promote patient well-being.

Primary care physicians (PCPs), nephrologists, transplant surgeons and posttransplant coordinators must work collaboratively to monitor immunosuppression, detect early signs of rejection or infection, and manage cardiovascular and metabolic comorbidities. At UPMC, we take pride in keeping the lines of communication open with patients, their families and care partners, and referring providers regarding patient status, treatments, and follow-up care.

The time between surgery and a patient being discharged from the hospital can vary among patients.

“After a patient receives a living-donor kidney, they usually are discharged from the hospital about four days after their transplant,” says Manpreet Singh, MD, medical director of the UPMC Kidney Transplant Program at UPMC Harrisburg. “For a deceased-donor kidney transplant, the discharge time depends on if they have a delayed graft function or not. Sometimes a patient may need to stay five to seven days, or sometimes they are discharged on day four as well.”

Follow-up Appointments and Testing

A patient who undergoes a kidney transplant at UPMC will need to attend their first follow-up appointment with their transplant care team a few days after they are discharged from the hospital, typically within three to four days after surgery. The patient’s follow-up appointment will include posttransplant testing, including lab work to ensure that the patient’s new kidney is working properly.

“At UPMC, our posttransplant coordinators discharge patients after their transplant,” says Dr. Singh. “Our patients will see their same posttransplant coordinator at their follow-up appointments, so there is a continuation of care. This process makes it easier for the patient, care partner, and loved ones because they are familiar with the coordinator.”

The UPMC kidney transplant team will see each patient for one month, once a week to monitor their recovery. Kidney transplant patients at UPMC are usually seen by their transplant surgeon and are required to submit bloodwork twice a week. Bloodwork will be taken at the weekly follow-up appointment and patients are required to also have bloodwork taken at a facility outside of UPMC, which can be local to their home. This process will last for four weeks.

“If there is something on the labs that we are concerned about, sometimes we bring a patient to our office twice a week,” says Dr. Singh. “Our posttransplant coordinators have a posttransplant checklist and they go over that checklist with the patient. When a patient is discharged from the hospital, their posttransplant coordinator will call them and ask how their recovery is going at home and ask if they have any questions about medications. Our posttransplant coordinators’ role is to make sure that the patient understands the recovery process and provide them with education.”

Four weeks after a patient’s transplant, the patient’s stent will be removed. During this time, the patient’s nephrologist will take over the patient’s care from the surgeon. The patient’s nephrologist will then have routine appointments with the patient every 2-4 weeks for three months. After the three month mark, the nephrologist and patient will meet every six weeks up until the six month posttransplant mark, then will have an appointment at the nine- and 12-month posttransplant mark.

“These appointments are set, unless a patient has complications,” says Dr. Singh. “At the one-year mark, we draw most of the labs that we normally do at three-month, six-month, and nine-month marks. If everything looks normal, we will then only see the patient every six months.”

Collaboration between nephrologists and transplant surgeons is essential to ensure seamless patient care, optimize transplant outcomes, and promote long-term kidney function and overall health.

“The nephrologist will be the same physician who has taken care of the patient from a nephrology perspective before their transplant,” says Dr. Singh. “The surgeon and nephrologist will meet at the four-week mark of their patient’s transplant to transfer the care over and discuss the patient’s case and will share any notes about the patient.”

The kidney transplant team at UPMC manages the patient’s antirejection medications. The patient will need to take these medications for the rest of their life. Transplant patients need lifelong antirejection medications because the body’s immune system naturally attacks transplanted organs, because it recognizes the new organ as foreign.

Collaborating with the Kidney Transplant Team at UPMC

“We send our patients’ nephrologists our notes after our each of our appointments with the patient,” says Dr. Singh. “We have goals in terms of immunosuppression for our patients that we share with their nephrologists and list out the different medications they are on, so they are aware of these goals. If the nephrologists see any labs outside of the range that we provided them with in the notes we provide, they will then call us and we will collaborate to find a solution for the patient.”

At the one-year posttransplant mark for a patient, their PCP and primary nephrologist will take over most of the medical care for the rest of their life except for immunosuppression. The kidney transplant team at UPMC will continue to manage immunosuppression for the life of the graft. The team will see their patients annually in the kidney transplant clinic.

“We recommend for our patients to see their PCP once a year for a routine checkup,” says Dr. Singh. “We also recommend our patients to see their PCP right away if they have a cold or are sick. We tell our patients that they will follow the guidance of their PCP for any cancer screenings and immunizations. Transplant patients cannot receive live vaccines, so any live vaccine that their PCP might recommend they would not be able to receive, so we make sure that their PCP knows that none of our patients can receive live vaccines.”

Transplant patients cannot receive live vaccines because their medications to prevent organ rejection suppress their immune system, which could allow the weakened live virus in the vaccine to cause the disease it is designed to prevent. This risk is highest immediately after a transplant, but live vaccines are generally avoided posttransplant to prevent potential vaccine-strain disease.

Education and Recovery

Dr. Singh says that the most important education piece for posttransplant patients is knowing the recovery process and the infectious that may come posttransplant.

“Our team makes sure that our patients understand that they shouldn’t go to any crowded places, travel too far away from home, or travel by air while they are recovering,” says Dr. Singh. “We do not recommend participating in these activities until at least three months after transplant.”

While the patient is in recovery, the patient will check their vitals three times a day and touch base with the UPMC kidney transplant team regarding the results. Elderly patients may need physical therapy after transplant, and the UPMC kidney transplant team can provide the patient with a referral for in-home or outpatient physician therapy if needed.

Diet after a kidney transplant is crucial for supporting recovery and maintaining the health of the new kidney. Transplant coordinators at UPMC will contact their patients during their recovery to ensure they are following the recommended diet.

Why Choose UPMC?

According to Dr. Singh, the care the kidney transplant team at UPMC provides is different than other centers.

“Each patient is assigned a transplant coordinator, physician nephrologist, social worker, and financial coordinator,” says Dr. Singh. “We strive to have a continuity of care for our patients with the same providers and coordinators. We are proud to know our patients very well. If a patient calls us, we will call them back within 24 hours. That’s really important for posttransplant care, especially in the early post-operative period if a patient has a problem that needs to be addressed. When a patient calls, their call will go right to their assigned coordinator who knows them and their transplant journey.”

To refer a patient, or for more information, please call 717-231-8700 or email transplanthbg@upmc.edu.