The know-how of infection prevention

Taking immunosuppressants is vital for you after the transplant. Immunosuppressants are a group of drugs that slow down the reaction of your body's defense system (=immune system) and thus ensure that your new kidney can be accepted by your body. In other words, they ensure that your new organ is accepted and not recognized by your body's immune system as an invader and then rejected.

Why is protection against infection especially important after transplantation?

The helpful functions of your immune system are severely restricted by immunosuppressive drugs. One important task of your immune system is to recognize and repel unwanted invaders such as bacteria, viruses or fungi. Due to the immunosuppressants, your immune system has a hard time properly fighting viruses, fungi and bacteria - the triggers of infections. It is therefore all the more important that you support your body and take a few precautionary measures. Let's take a step-by-step look at exactly what you can do.

What role does your vaccination play?

With a vaccination you can prepare your immune system for certain triggers of infections (=pathogens), so that diseases do not break out in the first place. This is an enormous relief for your body. Especially after the transplant, your body needs all its energy to maintain the functionality of your new kidney. For this reason, it is especially recommended to refresh your vaccinations before the planned transplantation.

These vaccinations are available after transplantation

In order to understand which vaccinations can be safely given after transplantation, we first need to look at how vaccines work in general. In general, they can be divided into two different groups:

Inactivated vaccines

In this first group of vaccines, only inactive pathogens or parts of the pathogen are used for vaccination. This means that the pathogen itself can no longer reproduce and cannot cause any disease (=inactive vaccination).

These vaccines are also suitable for you after transplantation, as they cannot cause any infections in your body despite the immunosuppression and the weakened immune system. It is best to talk to your medical team about this. When your immune system is suppressed, vaccinations often need to be refreshed more frequently than in people with an normal immune system. Together with your medical team, you can set up a vaccination schedule. This will help you keep track of your vaccinations and know when it is time for a boost. 

Live vaccines

You should avoid the vaccines that fall into this group. With these vaccines, weakened pathogens that are still able to reproduce to a limited extent are used for the vaccination (=live vaccination).

For a healthy person this is not a problem, because their immune system is able to keep this pathogen in check and the vaccination does not cause any symptoms of disease. At the same time, the immune system produces protective antibodies. However, your immune system is not able to fight the pathogens due to immunosuppression. Thus, there is a risk that the pathogens - administered by the vaccination - will actually cause the disease in your body.

Live vaccines are used in many countries, for example, against mumps, measles, rubella and chickenpox/shingles. But don't worry, this is just for your personal information! Your nephrologist has a good overview and will recommend the right vaccinations for you.

This is the optimal time for your vaccinations

After your transplant, you should ideally wait 6 months before getting vaccinated. This is because immediately after transplantation, the dosage of immunosuppressants is particularly high, which is why vaccination is not as effective during this period.

An exception can be made for the seasonal flu vaccine. Since the timing of the transplant cannot be planned in the long term and this vaccination must be refreshed every year, a flu vaccination can be given in individual cases as early as the fifth week after the transplant. Since the effect is not yet reliable at this time, a booster vaccination should be considered after 3 to 6 months. However, your medical team knows the details best.

What other protection options are there?

As you can see, you need to protect yourself particularly well against infections after transplantation. This is because there is a risk that your body will not be able to fight the pathogens sufficiently. Medications can be used to support this. These drugs include, above all, antibiotics or antivirals, which help your body fight off bacteria and viruses.

Antibiotics are used to fight bacteria and fungi.

Antivirals, as the name implies, are medications that help your body prevent certain viruses (such as cytomegalovirus) from reproducing. Don't worry, you don't have to remember all the medical terms - your medical team is responsible for that. You can also ask them at any time if something is unclear to you.

How does proper personal hygiene help me?

A high level of personal hygiene can also help to prevent infections. And the best thing is: with a few tips and tricks, you can easily integrate it into your everyday life. Let's take a look at certain areas that can play a big role.

Practice good oral hygiene

When it comes to dental and oral hygiene, you should conscientiously follow various tips to avoid fungal infections in the oral cavity. However, the advice will not be new for you. Even people without immunosuppression should follow stay on top of their oral health.

• Make sure to brush your teeth regularly. Especially after eating and before going to bed, pick up your toothbrush and clean your teeth thoroughly with enough toothpaste for at least two minutes.
• Replace your toothbrush after three months at the latest to prevent bacteria buildup.
• Floss at least once a day, as food debris can also build up in the spaces between your teeth, promoting the formation of bacteria.
• Regular mouth rinses with mouthwash can improve your dental hygiene - without any real extra effort. Simply rinse with a little mouthwash after brushing your teeth. This will help you reach places you can't reach with a toothbrush. It also removes bacteria that have accumulated on the tongue or gums, for example.

Wash your hands

By washing your hands regularly, you can prevent pathogens from entering your body. Make sure you wash your hands thoroughly under running water before preparing food, after going to the toilet, after blowing your nose and when you get home. Also use plenty of soap.

Avoid "sick" people

Because of your weakened immune system due to immunosuppression, you are more susceptible to illness. Try to reduce contact with people who are currently suffering from an infection or are showing symptoms (e.g. cough, fever, diarrhea, etc.) during this period. Even though it may be difficult to temporarily not visit certain people - if they are ill - this will protect your organ.

And you can still support them even if you are not there in person: Call them and wish them a speedy recovery. You can also simply leave groceries for them at the door with a kind card. They will understand why you are not visiting them. After all, you all want your new kidney to last as long as possible. As soon as your acquaintances are healthy again, nothing will stand in the way of a meeting!

Conscious gardening & garbage disposal

You can also take care when working in the garden and disposing of garbage to protect yourself from unnecessary infections. The rotting process on the compost pile or in the garbage can lead to the formation of various fungi, which can be inhaled when the air is stirred up and cause serious infections in the lungs. That makes it all the more important that you take a few steps to protect yourself from this.

• Wear protective clothing on your hands and feet when gardening. This way you can protect yourself from injuries and prevent pathogens from entering your body directly.
• Be sure to open garbage cans and compost piles more slowly to avoid getting too much swirling material in your face.
• Wash your hands thoroughly after gardening and taking out the garbage.

Safe sex

After kidney transplantation, it is also important that you follow various hygiene rules during sexual intercourse to prevent the transmission of infections.

• After an organ transplant, contraception with condoms is recommended. It is possible to take oral contraceptives (=the pill). However, due to the lack of protection against STIs, a condom should still be used as additional protection - even with your long-term partner.
• Taking immunosuppressants reduces the effect of the pill. For this reason, additional contraception with a condom is also recommended.
• In addition, make sure that your partner and you practice thorough intimate hygiene.

What else can you do to protect yourself and your transplant as best as possible?

Now let's take a closer look at different areas of your everyday life and what you need to consider there.

Workplace and leisure activities

What applies to everyday life at home also applies to work. Here, too, pay attention to hygienic conditions and try to reduce the risk of infection. Workplaces with temperature fluctuations or high humidity can promote the formation of germs, which is why these workplaces are only suitable to a limited extent. Working with young children and in nursing homes or homes for the elderly may also not be the best choice due to the increased risk of infection.

As we've also learned before, you should also be cautious when dealing with trash or compost. This is especially true for jobs in composting and garbage sorting facilities. It is best to discuss these points with your employer and your nephrologist before the transplant. Together you will certainly find a solution that suits you. Often, options such as home office or training for a new position can help you stay with your employer.

You should also critically examine your leisure activities with regard to the risk of infection. If you are unsure, ask your treating medical team and find out whether your hobbies are suitable for you.

Low-bacteria diet

When it comes to nutrition, there are also various points that you can observe in order to significantly reduce your risk of infection. In general, it is important to maintain good hygiene standards, especially when handling food. Wash your hands regularly, clean your work surfaces thoroughly before and after cooking, wash out your refrigerator regularly with vinegar water and avoid storing food for long periods.

With these tips, you can already make a difference. The Mizu app can also help you choose suitable foods through the food search function. Have you also read the other articles on the topic of low-bacteria nutrition? There you will also find helpful information on this topic.

Keep fit & healthy

By living a healthy lifestyle, you can give your body strength and energy that will have a positive impact on your overall health and immune system. Keep fit by exercising regularly and make sure you get enough sleep.

Try to keep your weight in a green range. Although the newfound post-transplant freedom in terms of diet is tempting, it's important to watch your weight. You will see that a healthy weight will also have a positive effect on your general health in the long run. You should also avoid smoking for the sake of your health. You will find that you will quickly feel a difference, especially in your endurance, if you stop smoking. It would be a pity if your new kidney has a shorter life span because you do not manage to give up smoking.

Also, pay attention to your mental well-being. You have come a long way to get your new kidney. It's normal for your body to feel mentally drained at times. Give your body the rest it needs and talk to friends or family about what's bothering you. Often, connecting with like-minded people can also help you feel better. Together, you can talk about problems and experiences, for example.

So you see that you can already do a lot in different areas of your life with small tricks to lower your risk of infection and increase your health. Try to implement these tips and tricks as much as possible and do something good for your body. And always remember: no one expects you to change your life completely overnight. Some tips are quicker to implement, others require some preparation. If you encounter challenges or problems during implementation, feel free to discuss them with your nephrologist. Together, you will certainly find a solution that is tailored to you and that can be integrated into your daily routine.