Wisconsin Dialysis, Inc.

My Transplant Experience
Transplant Anyone?
What is a Good Diet for a Kidney Transplant?
Kidney Transplant: Who is a Candidate and What to Expect
Transplant Medications: What You Need to Know
Announcements and Upcoming Events
The Wisdom of Flow
A Special Thank You

My Transplant Experience
Glenn, former WDI patient and recent kidney recipient

On July 27, 2006 I received a transplant at the University of Wisconsin Hospital. In this article, I would like to share some of my experiences.

After three and a half years on dialysis, I was certainly ready to proceed. Some of my relatives came forward with an offer a kidney. My younger brother, Richard, was the best candidate and an excellent match.

On the 26th, my brother and I checked in for the last round of pre-surgical tests. All was well and on the 27th my brother was wheeled into surgery giving me thumbs up on the way. A few hours later I was given a sedative by IV and wheeled off. It was about 3:00 pm and that’s the last thing I remember.

About 11:30 PM I awoke on a hospital bed in the transplant ward. After the nurses checked my vitals, I fell back to sleep.

The next thing I remember is waking around 6:30 am on the 28th. I felt great, and I had been making urine since on the surgery table, as I was told. My daughter was impressed with my color and the clarity of my eyes. I was able to sit up, stand and walk to my brother’s room to see him. Richard was tired, but doing fine.

As my recovery progressed it was a bit of an inconvenience to have all of the tubes connected, especially on trips to the bath-room. The nurses continually checked my vital signs and once a day I had blood taken from the line in my arm. They were very good at keeping me up to date with the results. Soon, solid foods were added to my diet, and my medications were fine tuned.

I had many visitors. I also had to attend class daily to discuss the different aspects of adjusting to my new kidney, the diet and medications.

After 10 to 11 days I had progressed enough to get ready to leave. The doctors were very pleased with my progress. Richard had left after 5 days and returned 2 days later to his home in Memphis. He is doing great! Before leaving I met with my post transplant nephrologists, a nursing staff representative and a pharmacist. They were all very helpful.

As I checked out of the hospital I couldn’t help but think about the excellent care from the whole staff. The doctors, the nurses, the nurse’s aids and even the cleaning people were all concerned and caring. Overall, it was an incredible experience and the best part is having kidney function again. I will be forever grateful.

Transplant Anyone?
Nutrition BEFORE Transplant
Ann Mader, RD

If transplant is in your future, your physical and nutritional status is of utmost importance. Meeting with a dietitian who specializes in transplantation is something you will want to set up. This dietitian, along with your dialysis dietitian, will help you correct any nutritional deficits you may have and work with you before surgery.

All transplant candidates need to meet specific weight criteria prior to transplant. Studies show that patients who are underweight or overweight do not do as well as those at an appropriate weight for height. BMI or Body Mass Index (which is a number derived from a formula based on both your height and weight) is one measurement used to determine if you meet transplant criteria. If your BMI is less than 22 or greater 30, the transplanted kidney may not function as well and can result in a lengthier hospital stay due to poor healing. UW Hospital and Clinics, Transplant Program has set a BMI of less than 40 to help ensure a safe and healthy kidney transplant. If you are interested in knowing what your BMI is, contact your dietitian.

If your BMI is greater than 40, you need to lose weight. Meeting with the dietitian to set up a meal plan may be helpful. An exercise regimen should also be arranged to assist with the weight loss. Different programs or ways to approach weight loss is very individual. For some, joining a health club is helpful. Involving your spouse, significant other, or a friend to join you in a daily walk may be a good way to get your exercise. Work on determining what form of exercise will work for you. Keep in mind that the anti-rejection medications you will need to take after your transplant can cause weight gain and so setting up something you will enjoy before your transplant will be important to continue after surgery.

On the other hand, are you one who needs to gain weight??? There are a variety of nutritional supplements that your dietitian can help you choose from to meet your needs. The surgery itself can increase your needs for protein, in particular. Increasing your protein intake can help facilitate a faster recovery period after the transplant surgery.

Ideally the goal is to achieve an optimum nutritional status BEFORE your transplant to reduce your risks involved with the surgery and help the new kidney to work as well as possible for you.

What is a Good Diet for a Kidney Transplant?

Diet for transplant patients is less limiting than it is for dialysis patients. You may still have to cut back on some foods, though. Your diet probably will change as your medicines, blood values, weight, and blood pressure change.

You may need to count calories. Your medicine may give you a bigger appetite and cause you to gain weight.
You may have to limit eating salty foods.
Your medications may cause salt to be held in your body, leading to high blood pressure.
You may need to eat less protein. Some medications cause a higher level of wastes to build up in your bloodstream.

Kidney Transplant: Who is a Candidate and What to Expect
Brenda Muth, RN, NP
Aji Djamali, MD

The evaluation for kidney transplantation can begin when your GFR is 20ml/min or less or if you are on dialysis. This evaluation is necessary to be sure you are healthy enough to have surgery and that you will be able to tolerate the immunosuppressive medications.

The work-up includes a thorough assessment of your past medical, surgical and psychosocial history. Depending on your age, length of time on dialysis and any history of heart disease or diabetes, you may need a stress test and a cardiac catheterization to ensure your heart is healthy enough to tolerate the transplant.

Any correctable heart disease must be treated prior to transplant. However, untreated heart disease or severe heart failure would make a person ineligible for a transplant. Other conditions that would make you ineligible are an active infection, recent history of cancer, cirrhosis or advanced liver disease, active substance abuse or dependence, active psychosis and noncompliance with treatment. Obesity is relative, but could be another factor for ineligibility until sufficient weight loss occurs. There is no definite age restriction for receiving a kidney transplant.
Family support is very important to help you with adjusting to your life after receiving a transplant, especially in the first few months after transplant.

After transplant, you must attend frequent clinic visits and get frequent lab tests.

A kidney transplant can come from a living related donor, living unrelated donor or a deceased donor. Best outcomes are usually expected from living donors. These kidneys usually come from siblings, spouses or friends and they begin to function immediately after transplantation. Living donors are evaluated thoroughly to ensure that they are healthy and that minimal risks are taken. Thus, the average length of stay in the hospital after kidney transplantation is 5 to 7 days for the recipient and 3 days for the donor.

The principal complications early in the post transplant period are acute rejection, infections and cardiovascular complications. Late post transplant complications include cardiovascular complications such as heart-attacks, infections and malignancies.

If you are interested in talking with the transplant clinic about your options, ask your nephrologist about setting up an appointment.

Transplant Medications: What You Need to Know
Kim Holdener, PharmD

Receiving a kidney transplant will change a medication regimen in many ways. Several medications that are commonly taken by people on dialysis are not needed after transplant. For example, phosphorus binders like sevelamer (Renagel) and calcium acetate (PhosLo) are usually not necessary because the new kidney will remove phosphorus from the body. Likewise, there are many new medications needed to keep the new organ working well. This article will focus on some of the new medications taken after a transplant.

After a kidney transplant, all patients will take medications to prevent organ rejection. These medications are called immunosuppressants or anti-rejection medications. Anti-rejection medications work by inhibiting the immune system. The immune system is what prevents and fights off infections in the body. White blood cells, which are part of the immune system, recognize germs and bacteria as foreign organisms that invade the body.

They then attack and remove these germs to prevent infection. In someone with a normal immune system, this happens hundreds of times throughout the day. Without immunosuppressant medications the immune system would recognize the newly transplant organ as a foreign object to be attacked, like bacteria. Organ rejection occurs when the immune system attacks the transplanted kidney. Therefore, it is necessary to suppress the immune system to keep this from happening. Inhibiting the immune system also means that the body will be less able to fight off infections. Patients must be on the lookout for signs of infection at all times. For the first several months after a transplant, patients take medications to prevent infection in addition to anti-rejection medications. These medications must be taken because patients are most susceptible to infection after receiving the large doses of immuno-suppressants during the transplant operation.

There are three types of anti-rejection medications commonly taken by kidney transplant patients – steroids, such as prednisone, mycophenolate (Cellcept or Myfortic), and either cyclosporine (Neoral) or tacrolimus (Prograf). These medications each work in a different way to prevent organ rejection. In combination they are very effective. Another medication that is sometimes used is sirolimus (Rapamune). Sirolimus is usually not used immediately after transplant because it can delay wound healing. It is most commonly used by people who do not tolerate cyclosporine or tacrolimus. All of these medications can cause side effects. The side effects can typically be avoided or reduced by adjusting doses or taking other medications that can prevent side effects.

Anti-rejection medications are essential to the survival of a transplanted kidney. They must be taken for the rest of your life in most circumstances and should never be stopped unless you are instructed to do so by your physician. Changing or stopping medications can result in organ rejection if not done under the supervision of a physician. These medications are the lifeline of the transplanted kidney. Anti-rejection medications are also very expensive, so it is important to know what your insurance coverage will be before getting a transplant. Getting a transplant can be both exciting and confusing since there are many changes that occur after the operation. Educating yourself about transplant medications before receiving a transplant will help you know what to expect and help make a smooth transition into your new medication routine.

Announcements and Upcoming Events

The EASIER support group continues to meet the 2nd Wednesday of every month. Watch for flyers for information on the next topic.

Nephrology Nurse’s week was recognized September 10-16^th & October 9-14^th is Technician week. We would like to thank all the NURSES (Sharon, Helen, Sally, Theresa, Cheryl, Maria, Sherry, Sandy, Laura, Tamaria, Sherri, Carla, Kelly, Jan, Lesli, Kathleen, Therese, Karl, Carol, Jan VH, Linda, Karen, Dawn, Clare and Lila) and Technicians (Jan, Jill, Mark, Sherri, Deb, Pam, Marcia, Kelly, Emily, Cheyenne, Molly, Eric, Martha, Karen, Ashley, David, Cheryl, Mary Easton and our newest tech, Dametra). What a great list of dedicated professionals!
The Bulletin Board topic changes each month. Don’t forget to take the quiz. All participants win a prize and the Grand Prize for the month goes to the name drawn! You can be a winner each and every month!
Remember Dialysis Drive-In movies are shown every Tuesday and Wednesday. Check the marquee for updates.
October 22-28^th is Pharmacy Week. WDI is extremely fortunate, and so are you, to have a dedicated, on-site pharmacist, Kim Holdener, PharmD. Kim reviews, offers recommenda-tions, and consults with your nephrologists regarding your medication needs. Thanks Kim!
Need help over the holidays? Talk with your Social Worker about available resources.

We finalized our Third Annual Exercise Program here at WDI on August 31st. Congratulations to the 18 participants who finished the 3 month summer program! They all worked hard and were able to reap the benefits of exercise.

So, you might ask, what are these benefits? Exercise helps improve or increase:

blood pressure and cholesterol levels
blood circulation
blood sugar levels if you are diabetic
strength, energy and stronger bones
depression

Here are the names of the participants: Martha, Sandy, Ron C, Geri, Mary D, Richard, Helen, Mary G, Dee, Shirley, Anthony, Bill, Estherlene, Ramona, Mary Ann, Julia, Ron W, Roger. Great job!

The Wisdom of Flow
Penny Andrews, Chaplain

Spiritual traditions often speak of making peace with change. There is great truth in this, even if it is one of the hardest things we do.

Change is everywhere. We notice it in children’s growth, in seasons, in relationships, in health, in the political arena, even in the fall television schedule.

Grief experts say that we regularly face loss, even as we step into something happily anticipated. The order of things change and we are called to accept it and adapt.

One way l have taken to acknowledging a change l would prefer not to be facing is by saying, “This, too.” It is my way of acknowledging that in order to fully embrace life, it is important to note a place within that is touched by a passing.

Seasons changing are a good place to notice this phenomenon, and practice your own, ‘this, too’. Many of us love seasonal change; it’s why we are in Wisconsin and not living in a gentler climate. During the peak of summer’s 90 degree days, the daydreams of autumn begin.

Now, as autumn cues have started, there’s nostalgia for all that summer is. Stepping into autumn, means a good bye to summer and paying attention to feelings related to this brings a deeper awareness of feelings, and feelings keep us tuned into our deepest selves.

So as l celebrate fall, l say good bye to summer of 2006, it’s’ joys and its missed opportunities, ‘This, too’. On to autumn and its comfortable sleeping, the beauty of the leaves, the football games (for some) and natures un-avoidable next step….winter.

If change is ongoing and in all aspects of life, then it is not surprising that some experts in aging say that the key to successful aging is flexibility.

Flexibility is a willingness to embrace change and the unknown it represents, and l think, a willingness to savor life in all its complexities. As you say ‘this too’ to the changing aspects of your life, may you experience the beauty and the wisdom of flow.

A Special Thank You

At WDI our goal is to provide high-quality treatment to give patients the opportunity to maintain their quality of life. Dialysis makes it possible for many patients to continue working, spend time with their loved ones, wait for a transplant, and travel. However, some of our patients have passed away over the years. In memory of their loved ones, friends and families have generously donated money in honor of these patients. When donations are made, the money is placed in the WDI Patient Fund. This fund has been used to promote patient and family activities, such as: the EASIER support group, annual memorial service, the exercise program, prizes, educational materials and special events. Also, the fund has paid for patients to attend the Living Well with Chronic Illness workshop and pays for the publication of this newsletter. Finally, the money has helped patients who have been in financial need. The patient fund has served so many patients over the years. WDI patients and staff are grateful for each donation as it helps us continue the work that the fund was established for. WDI would like to express our sincere thanks to the families and friends who have so generously donated over the years. If you would like to learn more about the Patient Fund, contact the WDI Administrator or Social Workers.