Q: My mother is about to have a renal transplantation due to renal failure. What are the post operative precautions she needs to observe? What kind of symptoms should she report to her doctor to prevent rejection and other complications?

A:1. Be aware of the names, the intended action, the dosage, the timing and the side effects of the prescribed medications. This is important since some of these medications are highly toxic and immunosuppressive and hence, if not taken in an appropriate recommended fashion, would make one prone to infection and rejection of the transplant kidney. Rejection can happen at any time but is more often in the first 3 months of post-transplant period. 2. Be aware of the name and the schedule/timing of various recommended tests to be done once discharged from the hospital after the surgery. These tests have a specific purpose which includes keeping track of the underlying kidney function, monitoring the levels of the immunosuppressive drug levels in relation to the kidney function and checking any adverse effects of these medications on the recipients health. 3. Keep track of the patients blood pressure, weight gain and temperature since any significant changes in these parameters are indicative of underlying infection and/or rejection. Be aware of some of the simple signs and symptoms of infection and/or rejection which include: increased pain/tenderness/ local swelling/ drainage around the transplanted kidney surgical suture site over the abdominal wall, urinary symptoms of discomfort or burning sensation during voiding or signs of decreased urine output or cloudy/foul smelling urine and any difficulty in breathing or worsening cough usually productive in nature which may indicate underlying respiratory tract infection. 4. Follow special dietary restriction tailored to the specific needs of each patient. This is also intended to avoid excessive weight gain and to help manage diabetes known to be prevalent in the post transplant course arising out of steroid intake (steroid forms a part of immunosuppressive regimen). 5. Awareness about the initial timing and the degree of outdoor activity including exercise regimen and restriction on lifting heavy objects. 6. Routine screening of certain cancers known to have a high incidence in the transplant patients resulting from compromised immunity of the recipient. This includes annual pelvic examination, Pap smear and mammography in women. 7. Finally, avoid taking any over-the-counter medications including vitamin supplements without the knowledge of your transplant nephrologist.