In this article, you'll learn what to typically expect in the hospital right after your transplant. How long will you be in the hospital? What tests will be done? And how can you make sure your new kidney arrives in your body as gently as possible?
In Germany, approximately 2000 kidneys were transplanted in 2021. Just under a quarter of these were donated by direct relatives (=living donations). For people with kidney failure, transplantation and the time that follows are often very special and exciting milestones. At the same time, these happy moments can also be associated with uncertainty and resistance. The first step is the kidney transplant itself. But your time in the clinic is not over right after the operation. After all, you also want your new kidney to stay in your body for as long as possible.
Were you recently transplanted or are preparing for transplant and wondering what else awaits you during your time in the hospital? In this article you will learn everything about your hospital stay after transplantation and how you can best cope. As we all know, good preparation is half the battle.
What happens in the hospital after transplantation?
Great, you made it through the surgery! Did you know that inserting the new kidney into your body often takes only about 2-3 hours? In living donation procedures, the donor's organ must first be removed from their body, which takes additional time. When you wake up after the transplant, you will probably be in the intensive care unit of the transplant clinic. At first, this may sound scary, but it is standard routine after such an operation. In the intensive care unit, you and your new organ can be better monitored. This is of great advantage especially directly after the transplantation. A large team of nurses and doctors will take good care of you during this time.
For better monitoring, you will find that you have several tubes and drains in your body. These are used to monitor your kidney function, keep an eye on the surgical area, and better administer medications into your blood. These tubes include a central venous catheter (CVC), which is inserted into your large jugular vein and supplies you with fluid and medication. In addition, you will also have a bladder catheter. The urine that may already be produced by your new kidney will flow into this catheter. The amount of urine produced will give you an idea of the function of your new kidney. Isn't it great to see that your new kidney is now taking over the tasks in your body that dialysis provided in the past?
In addition, you will also have wound drains, which take fluid from your wound and bring it into a bag. The color and consistency of the wound fluid can provide your medical team with valuable information about the healing process after the operation. For example, changes in the wound fluid can help your medical team quickly detect an infection or bleeding in the surgical area. In addition, you will also usually have a ureteral stent, which is a soft rubber tube that is inserted into your ureter during surgery. This stent supports your ureter, which connects your kidney to your bladder, from the inside out.
When are tubes & drains removed after the transplant?
Directly after the operation, you will be monitored a little more closely in the recovery ward. Your excretion (=amount of urine) will be monitored via your bladder catheter. If your new kidney is working properly, this value should not deviate too much from the amount you drink. Via the central venous line, the nursing staff will supply you with fluids and medications directly into your bloodstream. Wound drains are used for regular monitoring of the surgical area.
You will usually be transferred from the recovery unit back to your regular ward on the same day as your surgery. The tubes and drains often remain in your body for a few days to monitor your health. If everything looks good, the tubes can be removed from your surgical wound after about 2 weeks. The exception is the ureteral stent. This usually remains in your body for several weeks after the transplant. But don't worry, you won't really feel the stent itself.
New medications after kidney transplant
It's important that you don't take your tacrolimus on days when you have blood drawn in the morning (even later, when you come in for an outpatient checkup), until after the blood draw.
Soon after surgery, you will begin taking a type of medication called immunosuppressants. Following the transplant, you will usually take 3 medications that fall into this category: Tacrolimus, Mycophenolate Mofetil and Prednisolone. These medications are intended to slow down your immune system and thus facilitate the uptake of your new kidney in your body. It is important that you take these medications regularly and as punctually as possible. The reason for this is that a constant level of active ingredient must be built up so that they can develop their effect. If you forget to take a dose, the concentration of the medication in your blood (=active level) can drop. As a result, your own body may reject your new kidney.
Laboratory tests are often performed in the first few days after transplantation to keep track of the levels of these drugs. On days when the level of these drugs is checked by a blood sample, you should take the drugs afterwards and only after consulting with your medical team, so as not to alter the level. This also applies to later outpatient check-ups at your transplant center. Ideally, you should discuss the procedure directly with your medical team and plan the exact procedure to avoid additional check-ups and to protect your new kidney as much as possible. If you are not sure whether your blood levels will be tested during a control visit at your nephrologist or transplant center, it is better to take all 3 drugs!
Furthermore, additional measures will be taken to protect you from unnecessary infections during the suppression of your immune system. For this reason, your medication schedule often includes antiviral and antibiotic agents for a few months after the transplant. These are used for prevent pneumonia or other common infectious diseases that can occur more frequently during immunosuppression.
The Mizu app helps you both document the intake of your medications and record the active levels of your immunosuppressants in your logbook. That way, you'll master managing your immunosuppressants post-transplant with ease!
How do you know if a kidney transplant was successful?
Your new kidney often needs some time to adjust to your body. To keep track of your new kidney's function, your care team will keep an eye on how much urine your new kidney is producing and how your lab values are trending. In addition to the onset of urine production, a decrease in the creatinine value and thus an increase in the estimated glomerular filtration rate (=eGFR) are the main indicators of good kidney function after a successful transplantation. The eGFR indicates how much blood your kidney cleans per minute. One of the factors used to calculate your eGFR is the amount of creatinine, a waste product, in your blood.
Why do I have to go back on dialysis after transplantation?
In some cases, however, it takes a while for your levels to settle back down. In these cases, dialysis may provide valuable short-term support for your new kidney to do its job. However, don't worry! If the surgery went well, you'll soon be completely off dialysis for the time being.
How long will I have to stay in the hospital after the transplant?
As a general rule, you can leave the clinic between the first and second week after the transplant. However, this depends greatly on the progression of your blood values, your wound healing and your physical condition. In the ward, you will be supported by a professional team of doctors, physiotherapists and nurses, who will do everything they can to help you get back on your feet quickly.
But when exactly you can go home again is always decided by your team of doctors. Give your body time to regain its strength. You should not rush anything, especially shortly after surgery.
How often do I need to go for follow-up after transplantation?
Especially in the first few months after transplantation, regular appointments are made in your transplant outpatient clinic. Here, laboratory and blood tests will be performed repeatedly to keep track of the function of your new kidney. In the time directly after your surgery, these checks take place weekly but the frequency will decrease to a few times a month as time goes on. In Germany, the statutory health insurance reimburses your travel costs to the outpatient clinic after a kidney transplant for three months (115a SGB V).
At the six month mark, monthly or quarterly check-ups are then recommended. The exact frequency of the check-ups will, of course, always depend on the function of your new kidney. During this time, more and more check-ups can be performed by your nephrologist and you will not need to go to the transplant center as often.
