By Nikki Sclafani, MS, RD, LD

Do I need to be on a special diet after my transplant?

One of the most difficult challenges for new dialysis patients is the overwhelming amount of diet restrictions they need to follow. You may have heard at one time or another your doctor or dietitian say to you, “…limit your dairy products…take your binders…drink less fluid…stay away from potassium…” and the list goes on and on. If you are planning to have a kidney transplant or have recently had one, you are probably wondering if your diet will change. After a transplant, your diet still plays an important role. However, you will find that your transplant diet may be easier to follow and less restricted than the diet you were on during dialysis.

Good nutrition is crucial after your kidney transplant just as it was before. The right amount of protein, calories and nutrients are essential for good health. It is also important to remember that the side effects of anti-rejection medications can change your nutrition requirements. These anti-rejection medications are also known as immunosuppressive medications. Everyone who receives a transplant has to take anti-rejection medications to protect their transplant from the body’s immune system. Although the doses of anti-rejection medications may decrease over time, you will have to continue taking them in order to keep your transplant working successfully. The different side effects will vary according to the medication you take. Also, not everyone will experience the same side effects, even if they are on the same medications. The dose of any medication needs to be carefully adjusted by your doctor and needs to be taken as directed. You will be required to have regular checkups with your doctor, which will include blood tests and blood pressure monitoring. Some of the common anti-rejection medications include: 

Neoral, Sandimmune, Gengraf (cyclosporine)
Prednisone (steroid)
Imuran (azathioprine)
Prograf (tacrolimus)
CellCept (mycophenolate)

Is it true that people gain weight after a transplant?

Many people have a better appetite after they get a transplant and often gain unwanted weight. In addition, certain anti-rejection medications may cause increased appetite, weight gain and fluid retention. The average amount of weight gain after a transplant is about 20 pounds.  If you are already above your ideal body weight, additional weight gain may increase your risk for heart disease, diabetes and high blood pressure. Being overweight can also affect your cholesterol and triglyceride levels. High cholesterol and triglyceride levels may lead to heart disease. Read food labels carefully to avoid foods that are high in fat and cholesterol. In addition, there are a few things to remember when planning your meals.  

* Choose low fat or non-fat diary products.  
* Limit egg yolks to three times per week.
* Choose the leanest cuts of meat and remove all visible fat before cooking.
* Increase fiber in your diet by eating more fresh fruits, raw vegetables and whole grains.
* Reduce your total calories by eating smaller portions and avoid second helpings.
* Grill, steam, microwave or broil foods using a nonstick cooking spray.
* Include regular exercise to your daily routine.

Why is protein so important and how much do I need?  

Protein is important for many reasons after a transplant.  First, it builds and repairs muscles and tissues. Second, it helps you to heal after surgery. You also need more protein to help prevent muscle breakdown often caused by high doses of prednisone. Right after your transplant, your protein requirements will need to be higher than when you were on dialysis. Later, you can return to moderate amounts of protein. Remember to follow the recommended suggestions when choosing and cooking meats.   

What about following a low potassium diet?  

As long as your transplant is working well, you should be able to eat normal amounts of potassium from food. However, it is possible that you will have to follow restrictions. Some drugs, such as cyclosporine or Prograf, can increase the potassium level in your blood, while other drugs, such as Lasix can decrease your potassium level. When potassium is too high or too low your muscles and heart can be affected. Remember high potassium foods include, but are not limited to:   

* Fruits such as bananas, apricots, avocados, melons, dried fruits, oranges and orange juice and prunes.
* Vegetables such as tomatoes and tomato juice, potatoes, dried beans and green leafy vegetables.
* Additional foods such as nuts, chocolate, peanut butter and dairy.  

Will I still need to limit phosphorus and watch calcium?

Unless your doctor or dietitian has instructed you otherwise, you can once again enjoy dairy products and whole grains. Unlike when you were on dialysis, your phosphorus levels may actually be low after your transplant. Calcium requirements may be higher if you are taking Prednisone. Weakening of the bones, which is also known as osteoporosis, often occurs when using Prednisone. Ask your doctor or dietitian about your phosphorus and calcium levels and if a supplement is right for you. 

What about salt restriction? 

Most transplant patients still need to restrict salt. Transplant medications, especially steroids, may cause your body to retain fluid. Salt makes this problem worse by increasing fluid retention and raising your blood pressure. Your doctor will decide how much sodium is right for you.  Prednisone is one of the anti-rejection medications that can increase sodium and water retention and increase your blood pressure.

Salt contains sodium, so it is best to avoid using salt when you are cooking and remove the saltshaker from the table. High sodium foods to avoid include commercial soups, processed meats, processed vegetables, salty snack foods and vegetable juices. Also, remember to use condiments such as catsup, barbecue or chili sauce and horseradish sauce in moderation. Condiments to avoid altogether include pickle relish, olives, garlic or onion salt, monosodium glutamate (MSG), soy sauce and meat tenderizers.

Is it true that I am at a higher risk for developing diabetes?  

Steroid medications, like Prednisone, can decrease the body’s ability to use sugar for energy, which causes the sugar in your blood to rise. Even though you may not have had diabetes prior to your transplant, a condition known as steroid-induced diabetes can occur. Avoiding concentrated sugars (or carbohydrates) will help decrease the side effects of steroid medications. Concentrated sugars are found in commercially prepared snack foods and sweets in large amounts. It is important to read food labels and avoid foods with sugar, honey or corn syrup listed as a first or second ingredient.

Is there anything else I should know?  

Cyclosporine is a frequently used anti-rejection drug and has been known to reduce the amount of magnesium in the body. Your doctor may give you magnesium supplements to take, especially just after your transplant. Grapefruit and grapefruit juice can cause cyclosporine blood levels to increase, so consuming grapefruit is also not recommended.  

Remember, your healthcare team is there to help you. If you have any questions or concerns about your diet, make sure you ask your doctor or dietitian for assistance.  

Nikki Sclafani, MS, RD, LD, is a Renal Dietitian for Fresenius Medical Care in Oak Park, IL. Ms. Sclafani has worked in the nephrology field for three years.

The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.  

The answers to “Food for Thought” are based on current nutrition practice and published research as well as the writer’s own clinical experience with hemodialysis and peritoneal dialysis patients. Advice or recommendation about specific products is not meant as an endorsement of a particular product and that product may only represent a typical product in a category of foods. Further, nutritional supplements with a scientific basis in published research may be recommended though food is the preferable carrier of nutrients in most cases.

This article originally appeared in the March 2004 issue of aakpRENALIFE, Vol. 19, No. 5.

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