Post Operative Care
Post-operative care & recovery after transplant
Recovery from renal transplantation depends on many factors including patients’ age, overall health, severity of renal disease, infections, secondary organ dysfunction or complications before or after the operation. Good understanding of the process, moral support and encouragement from family, a positive attitude and strong will-power are important in patients’ recovery.
In the hospital
Donors wake up immediately after surgery, although they might feel drowsy for a few hours. They are able to get out of bed in 1 - 2 days and made to walk in 2 - 3 days. Various intravenous lines and catheters are removed as they recover. Generally, they can have liquid diet followed by normal diet in 2 - 3 days, shifted to the ward in 1 - 2 days and discharged in 5 - 7 days. Pain medicines are given depending on their pain threshold. Some patients prefer to take pain medicines before walking or any exercise that may trigger pain or just before going to sleep for a comfortable night. On discharge, they are generally given painkillers and vitamins. Most donors will have an uneventful recovery. After discharge, donors will be required to follow up with the treating doctors to ensure they remain healthy.
Patients (recipients) are kept on a ventilator overnight and this is removed when they are fully awake. Patients are closely monitored for any bleeding, infection or other complications. First 24 - 48 hours are critical and their condition and renal function are monitored by doing frequent blood tests. Various intra venous lines, catheters and drains are removed as they make progress/ recover over 3 - 4 days. Patients are given liquid diet followed by normal diet in 2 - 5 days. Patients are helped out of bed in 1 - 2 days; they participate in the physiotherapy program, walk in 4 - 5 days and gradually become more active. They should actively do incentive spirometry to prevent collapse of lungs, prevent lung infections and recover faster. They are shifted to the ward in 3 - 5 days and remain in hospital for about 5-7 days. At discharge, they receive anti-rejection medicines, and some other medications as required.
Recipients may require blood tests and ultrasound to monitor renal function and recovery as per standard protocol. Patients’ families are generally updated about their progress by the transplant team once a day or more often, if appropriate. While it is natural for patients and families to be anxious, questions for the transplant team should be asked during the counselling sessions or during ward rounds. Visiting hours and the number of visitors is restricted to prevent infections.
Discharge from the hospital
While the patient recovers from the operation, the family should take the opportunity to learn about precautions to be taken after discharge, understand the schedule for testing and follow-up appointments, become familiar with medicines, learn about the warning signs of potential problems and understand the mechanism to contact the renal transplant team round the clock in case of urgent problems. Counselling sessions for both the patients and the donors and the relatives are conducted on a regular basis. Attending these sessions will help in discharge planning.
At the time of discharge, patients will get a discharge summary with detailed instructions about testing and medication schedule, which should be discussed with the transplant coordinator.
After discharge, patients are required to undergo tests and visit the transplant clinic every 5 - 7 days. They should therefore stay in the vicinity of the hospital for 4 - 6 weeks after discharge. The house where the patient would be staying after discharge should be prepared.
Prevention of infections
- The house should be thoroughly cleaned with disinfectants
- The accommodation should be close to the hospital with available transportation 24 hrs a day, there should not be too many stairs and the locality should be neat and clean.
- Patients are encouraged to walk and avoid using a wheel chair
- The number of visitors should be restricted for a few weeks
- Patients should avoid meeting people who are ill and report any illnesses / fever / flu / cold / persistent cough pain in abdomen/ loose motions or transmissible infections or infectious diseases such as influenza, pneumonia, chicken pox, hepatitis etc.
- Patients should avoid contact with animals and birds to prevent infection
- For the first 2 to 3 months, patients are advised to wear a mask and avoid crowded public places like malls, cinemas, restaurants, department stores, etc. After this patients can attend social events and live a normal life.
Personal hygiene and wound care
- Frequent hand washing with soap, especially before eating, should be practiced by all family members and hand-washing with antiseptic solution after using the bathroom
- Oral hygiene should be maintained by brushing teeth daily rinsing mouth after eating
- Finger nails should be trimmed
- On the 5th day after surgery, both patients and donors are encouraged to take a daily shower
Diet and nutrition
Patients’ may have loss of appetite after surgery. The appetite slowly improves with time. However, it is important to take a high protein diet to help with wound healing. If necessary, the dietician advises supplements in diet. If patients have preference for a certain type of meal or cuisine, they should check with the dietician.
Food - how to prepare/ consume
- Food should be cooked hygienically
- Wash utensils well before cooking
- Wash and cook in clean water
- Use boiled / filtered water
- Eat small frequent meals
- Drink plenty of liquids; intake is not restricted
- Salt restriction is not necessary unless one has high blood pressure
- Eat plenty of fresh fruits and green leafy vegetables after washing well and peeling off the skin
- Consume a balanced, low-fat, high-protein diet
- Take food rich in calcium, such as skimmed milk, cheese, soya, eggs, chicken, fish
- In a few weeks, patients can resume eating as they did before the transplant
Food to avoid
- Avoid eating out and roadside food
- Avoid deep fried or greasy food
- Do not eat food left overnight
- Avoid raw eggs or mayonnaise
- Avoid partially cooked food
- Avoid red meat
- Avoid cold meat
- Avoid overripe fruits
- Do not consume expired packaged food
- If potassium is high, avoid food such as banana, coconut water, fruit juices/ pulp
- If blood sugar is high, avoid sweets and fruits such as mangoes
Activity and Exercise
- At the time of discharge, patients are generally allowed active walking and routine activities like bending or climbing stairs. Regular exercise increases energy level, strengthens muscles and makes one feel more active.
- It is common to experience weakness and mild abdominal discomfort at the site of the operation, especially with movements for the first few weeks after transplant. Do not postpone exercising because of this reason. In case one has severe discomfort with movements, talk to the transplant team.
- Perform deep breathing exercise to expand lungs and help cough out sputum.
- The physiotherapist will teach limb exercises, so that limb muscles are strengthened, blood circulation is increased and the risk of complications such as venous thrombosis is reduced.
- Speak to the physiotherapists to progressively increase the level of exercise and optimize the exercise schedule.
- Ensure adequate rest and sleep
- Avoid lifting heavy weights (> 5 kgs), including babies, or performing abdominal exercises for first 3 months to allow the scar to strengthen and prevent hernia in the long term.
- After 3 months, one can resume normal physical activities; perform any exercises, including abdominal exercises, weight training and swimming. These will help strengthen abdominal muscles and flatten the tummy.