Special considerations for transplant patients
Travel after a transplant
Generally, domestic travel is fine from about 3 months following your transplant. You will need to ensure you have a medication plan so you don’t run out of medication while you are away from home.
International travel may involve some additional precautions and preparation so be sure to speak to your medical team when planning travel.
Fertility and pregnancy after a kidney transplant
Fertility (the ability to fall pregnant) improves quickly after transplantation for both female and male transplant recipients. Some common transplant medications are not safe in pregnancy or may affect your sperm, so it is important to use effective contraception after your transplant.
Many patients are able to have a successful pregnancy after transplantation. The outcomes are better if pregnancy is planned, so that your medications can be adjusted to drugs that are safe in pregnancy.
Talk to your kidney specialist for more information.
Information for female transplant recipients
Fertility (the ability to fall pregnant) is reduced in patients with severe kidney failure or who are receiving dialysis. Receiving a kidney transplant usually improves fertility rapidly, as well as increasing the chance of having a successful pregnancy. However, the chance of getting pregnant after a kidney transplant remains a little lower than the general population.
Medication safety in pregnancy
Some of the tablets that you will be prescribed after a kidney transplant can cause problems in pregnancy. This means that it is really important to use effective contraception after your transplant, and to talk to your doctor early if you are thinking about pregnancy so that they can discuss the options for changing your medications with you.
Transplant medications in pregnancy
| Usually safe to continue while pregnant | Not safe in pregnancy |
|---|---|
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Never stop taking any of your medications without talking to your doctor, as this could result in rejection—which may damage your kidney and make it more complicated to have a pregnancy in the future.
Contraception after kidney transplantation
Most forms of contraception are suitable after a transplant—the most effective are the ones that you cannot forget to use! Common recommendations include:
- Mirena device—intrauterine device (IUD) containing levonorgestrel that is inserted into the womb by a doctor; effective for 5 years but can be removed if you want to become pregnant
- Implanon—a soft plastic stick containing Etonogestrel that is inserted under the skin by a doctor; effective for 3 years but can be removed if you want to become pregnant
- Progesterone depo intramuscular injection—effective, but needs to be repeated every 12 weeks
The oral contraceptive pill is safe to use from 1 month after transplant but has a failure rate of 0.3-9% per year depending on how regularly they are taken. Patients who have had a thrombosis (blood clot) in a leg (deep vein thrombosis) or lung (pulmonary embolus) should avoid taking the oral contraceptive pill.
Condoms provide additional protection from sexually transmitted infections as well as contraception but have a high failure rate for pregnancy (2-18% per year).
Your kidney specialist can discuss which contraception options would be best suited to you and refer you to a GP or specialist if necessary.
When is it safe to get pregnant after a kidney transplant?
The risk of rejection and other problems is highest in the first 3 to 6 months after a transplant. It is best to wait until your transplant and general health are stable before trying to get pregnant. This is so that you have the best chance of having a successful pregnancy, and to minimise the risk of problems with your transplant during the pregnancy.
The usual advice is to wait at least 1 year after transplant, and 6 months after any treatment for rejection. It is also important to delay pregnancy if you have cytomegalovirus (CMV) infection, as this can affect the developing baby.
How successful are pregnancies in kidney transplant patients?
The chance of having a good outcome from pregnancy depends on how well your kidney transplant is functioning, as well as your general health. In kidney transplant patients with good kidney function, the likelihood of a successful pregnancy is similar to the general population. However, the chance of experiencing problems during pregnancy is higher if you have a transplant, including an increased risk of:
- Early miscarriage
- High blood pressure during pregnancy
- Pre-eclampsia
- Having a baby that is born early, or has a low birth weight
- Needing a caesarean section to deliver the baby
- Getting urine infections during pregnancy
The risk of some problems in pregnancy can be reduced. For instance by taking a low dose of aspirin during pregnancy. Your kidney specialist can discuss your personal risk factors with you and may refer you to a pregnancy specialist (Obstetric Physician) for further advice and counselling.
There are a small number of kidney transplant patients who would be at high risk of having a bad outcome from a pregnancy. This may mean that they are at high risk of developing other health problems during pregnancy, or that the chance of a successful pregnancy would be extremely low. In this situation your medical team may advise you against getting pregnant.
Will pregnancy affect my kidney transplant?
If your kidney transplant is functioning well, pregnancy does not seem to reduce transplant survival compared to other kidney transplant patients. However, your transplant kidney does have to work harder during pregnancy, and some patients may experience a fall in their kidney function after pregnancy, which may be permanent. The chance of this happening is increased if your transplant function is reduced (i.e. your creatinine results are high), you have high blood pressure, or there is an increased level of protein in your urine.
Information for male transplant recipients
Men who have had a kidney transplant usually experience an improvement in sexual function. Sperm counts and libido increase, and the chance of experiencing erectile dysfunction goes down. If you continue to experience problems with achieving or maintaining an erection let your kidney specialist know, there are treatment options (e.g. Sildenafil / Viagra) that are usually very effective.
Is it safe for my partner to get pregnant if I have had a transplant?
Some of the medications you may be prescribed after a transplant can affect your sperm, so it is important for male transplant patients and their partners to use effective contraception after transplantation:
- Valganciclovir (Valcyte)—you will usually take this for the first 3 to 6 months after transplant, and should use contraception until you have stopped taking it for at least 90 days.
- Sirolimus (Rapamycin) and Everolimus (Certican)—these medications can reduce your sperm count. If you are thinking about starting a family, talk to your kidney specialist about the risks and benefits of changing to an alternative medication
- Mycophenolate (Myfortic / Cellcept)—there is a very small chance that this medication could affect sperm, so some patients choose to switch to an alternative medication if their partner is intending to get pregnant. However, this risk must be balanced against the increased chance of experiencing rejection if you change medications. For most transplant patients, it is likely to be better to continue to take mycophenolate—discuss with your kidney specialist.
Sexuality and Kidney Transplantation
Kidney Failure and its associated symptoms and side effects, in both men and women, can significantly affect sexual function.
Transplantation and the subsequent restoration of health can improve sexual function. Fertility can improve in both male and female post-transplant patients.
Pregnancy is possible, but not recommended within the year post-transplant.
More information
Employment
Some patients need to stop working for a while, others can continue at a full or reduced level. Your employment may be affected by:
- Medical appointments
- Your kidney condition
- A requirement to relocate to be listed for transplant
- The post-transplant recovery period (3 months recommended)
- Your ability to physically undertake your job
It is helpful for patients and their partner or family to discuss your employment situation with your medical team. If changes are required, for example work is to stop or reduce for a certain timeframe, relevant support letters or medical certificates can be provided.
Income support might be available through employers, Centrelink, superannuation disability payments, or other streams. Contact the social worker for assistance or to discuss your individual situation.
If you need to re-train or decide to pursue a different career see Education and Training
Teens and Young Adults
Until approximately end of secondary school age, younger Queensland patients are managed at the Queensland Children’s Hospital (QCH). Their parents or guardians are involved with their care whilst being treated through the QCH.
The treating doctors at the QCH discuss with patients and parents/guardians when might be the best time to transfer to the adults’ hospital for their medical management. The Queensland Kidney Transplant Service is based at the Princess Alexandra Hospital (PAH) in Brisbane. If the patient moves away from Queensland, the patient’s care can be transferred to a kidney transplant unit nearest to where they are living.
Support is available to assist young people learn about the adult hospitals and the transplant programs. There is support also through the Mater Hospital Adolescent Transplant Clinic.
If you need help or someone to talk to, you are welcome to contact a Queensland Kidney Transplant Service Social Worker on 07 3176 2610.
Useful websites
Online forums
Transplant Buddies is an online forum open to anyone to join. It has neither affiliation nor responsibilities with or to Queensland Health. You may find the site useful for sharing your experience with others.