Clinic follow-up after a kidney transplant and what the tests mean

After a kidney transplant, much of your care happens in a clinic room and a blood-test chair, and the results come back in abbreviations that few people were taught to read. This page explains the usual visit pattern, the main blood and urine tests, drug level monitoring and blood pressure, and what public health bodies say the numbers broadly mean. It cannot tell you what your own results mean, because ranges are judged against your own history and practice differs between transplant centres. Your transplant team has the final word, and the last section lists questions to take along.

How clinic visits usually run

NHS Blood and Transplant says most patients are seen at least once or twice a week in the transplant clinic to start with, then less often as kidney function becomes more stable over the following weeks and months. After a year, if there are no serious problems, most patients attend only once every 3 to 4 months. An older patient leaflet from an NHS hospital trust, published on the Think Kidneys website, describes at least two or three visits a week in the early days. The difference shows how much schedules vary by centre and by person.

The same leaflet lists what usually happens at a visit: you are weighed, a mid-stream urine sample is checked for infection and protein, blood is taken to check kidney function and other measures, and your blood pressure is taken. We describe the early weeks as a whole in the first months after a kidney transplant.

Creatinine and eGFR

The blood test you will hear about most is creatinine. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in the United States explains that creatinine is a waste product from the normal breakdown of muscle, that kidneys remove it from the blood, and that providers use the amount in your blood to estimate how well your kidneys filter. As kidney disease gets worse, it says, the level of creatinine goes up.

That estimate is called the estimated glomerular filtration rate, or eGFR. The NHS says a doctor uses your creatinine result plus your age, size and gender to calculate how many millilitres of waste your kidneys should be able to filter in a minute, and that healthy kidneys should filter more than 90 ml/min. The NIDDK gives a simpler marker: a GFR of 60 or more is in the normal range, a GFR of less than 60 may mean kidney disease, and a GFR of 15 or less is called kidney failure.

eGFR bands used by the NHS to describe kidney function in chronic kidney disease

Stage	eGFR (ml/min)	NHS description
G1	Above 90	Normal eGFR, but other tests have detected signs of kidney damage
G2	60 to 89	Slightly reduced, with other signs of kidney damage
G3a	45 to 59	Defined by the eGFR range
G3b	30 to 44	Defined by the eGFR range
G4	15 to 29	Defined by the eGFR range
G5	Below 15	Kidneys have lost almost all of their function

These bands were written for chronic kidney disease in general and not for transplant recipients in particular, so a number on its own does not tell you how your transplant is doing. The NIDDK makes a related point for kidney disease generally: you cannot raise your GFR, but you can try to keep it from going lower, and a GFR that stays the same is one sign that treatment is working. Ask your team what range they consider usual for you and how often they would like to see it checked.

The Think Kidneys leaflet says blood taken at clinic is also used to check sugar levels, liver and bone measures, and red and white blood cells.

Drug level monitoring

Some immunosuppressant medicines (the transplant medicines that lower the immune system so it does not attack the new kidney) are monitored with a blood test that measures how much is in your blood. The Think Kidneys leaflet names tacrolimus and ciclosporin as examples and says the blood level is taken at a set time after your last dose. At that trust, people were asked to leave their morning dose until after the blood test and to bring it to clinic with them. Other centres may do it differently, and your own team will tell you exactly when to take your tablets on clinic days.

The same leaflet says it is quite common for a dose to be changed after blood tests, and that changes come from the transplant team, with your record card kept up to date. It is firm that nobody should change or stop a medicine unless told to by the doctor or nurse, because blood levels can be too high or too low. For more on how these medicines are used, see immunosuppressant medicines and living with them.

Urine tests

Urine tests look for two different things. The Think Kidneys leaflet says a sample is checked for infection and protein. The NIDDK describes a test for albumin, a protein that a healthy kidney does not let pass into the urine, using a urine albumin-to-creatinine ratio (UACR). It says a result of 30 mg/g or less is normal and more than 30 mg/g may be a sign of kidney disease, and that your provider may repeat the test one or two more times to confirm a raised result.

The NHS uses the same idea with different units. It calls the test the albumin:creatinine ratio, or ACR, and gives stages from A1 (less than 3 mg/mmol) to A3 (more than 30 mg/mmol). It adds that urine tests alongside eGFR give a more accurate picture of how well the kidneys are working.

Blood pressure

Blood pressure is checked at clinic, and the American Society of Transplantation explains why it matters. It says high blood pressure after a transplant can be caused by transplant medicines, changes in how the kidney is working, or too much salt in the diet, and that it often has no symptoms. The society advises checking at least once a week with a home monitor, and says consistently high readings, with the top number above 130 and the bottom number above 80, should be reported to your transplant doctors.

Those figures are one body's guide, and your team may set a different target for you. If readings stay high, the society's advice is to tell your transplant team, and not to adjust anything yourself. Long-term blood pressure care is covered in staying well long term after a transplant.

Questions to ask your transplant team

A written list helps, because clinic visits go quickly. The Think Kidneys leaflet suggests writing questions down before an appointment so you do not forget to ask. These are worth considering:

• How often will I need clinic visits and blood tests over the next three months, and then over the next year?
• Which results do you watch most closely for me, and what is my usual range for each?
• On clinic days, when should I take my morning tablets in relation to the blood test?
• Which blood pressure reading should I aim for, and should I check it at home?
• If a result changes, how will I be told, and who calls whom?
• Who do I contact in the evening or at weekends, and what symptoms should make me call?
• Can some visits be done by telephone or video, or closer to home?

The last two questions connect to the symptoms that sources say should prompt contact, which we list in signs of rejection and infection to report.

The short version

Clinic follow-up centres on a handful of checks: creatinine and eGFR to estimate how well the kidney filters, urine tests for protein or albumin, drug levels for some immunosuppressants, and blood pressure. Visits are frequent early on and spread out over time. A single number rarely tells the whole story, so ask your team what your usual range is and write your questions down before each visit.