Staying Well Long Term After a Transplant

Once the first months are behind you, life with a kidney transplant settles into something closer to routine, but the risks do not all disappear. A common worry is what, exactly, you are meant to keep an eye on for the years to come. This page sets out what public bodies such as NHS Blood and Transplant, Kidney Care UK and the US National Kidney Foundation say about infection, skin cancer, blood pressure, weight, diabetes, bone health, screening and kidney function. Practice differs between transplant centres, and your own transplant team has the final word on what applies to you.

What changes after the first months

NHS Blood and Transplant (NHSBT) describes a gradual shift. Once the first few months have passed, kidney function is likely to be stable and you will not need to come to clinic as often. After the first 3 to 6 months the risk of rejection is lower and your immune-suppressing medicines will reduce, though some will be needed for the lifetime of the kidney. If you want the detail of that early period, our page on the first months after a kidney transplant covers it.

The same NHSBT page is frank that the story does not end there. It says the risk of complications falls over time but does not reach zero, that long-term risks differ from person to person, and that staying as fit and healthy as you can helps reduce them (NHS Blood and Transplant). That is the thread running through everything below.

The US National Kidney Foundation puts a kidney transplant's long-term care into three jobs: take your anti-rejection medicines as prescribed, keep in touch with your transplant team and get your blood tests done on schedule, and follow a healthy lifestyle. It adds that a transplant does not cure kidney disease (National Kidney Foundation). The medicines themselves are explained on our page about immunosuppressant medicines and living with them.

Infection prevention in everyday life

Infections remain part of the picture for years. NHSBT says they are very common even many months or years after a kidney transplant, that chest and urine infections are the usual ones, and that these are normally straightforward to treat with antibiotic tablets. It also notes that all immunosuppressants increase the risk of infection (NHS Blood and Transplant).

The National Kidney Foundation says that finding and treating infections early is the best way to keep both you and the transplanted kidney healthy. For everyday protection it lists washing hands often or using hand gel during cold and flu season, wearing a mask in crowded places or near sick people, and staying away from people who are unwell and from children who have recently had a live vaccine. It also says to get the vaccines your transplant team recommends (National Kidney Foundation). Which vaccines are involved, and why live ones need care, is the subject of our page on travel and vaccines after a transplant.

Knowing when to pick up the phone matters as much as prevention. NHSBT asks people to contact their transplant team for a high temperature of 38C or above, feeling hot and shivery, a severe headache, diarrhoea, vomiting, shortness of breath, new chest pain, fatigue or generally feeling rough, or little or no urine (NHS Blood and Transplant). Your centre will have its own instructions for out-of-hours and emergency contact, and those take priority. Our page on signs of rejection and infection to report goes through the same ground.

Skin cancer and sun protection

Skin is where the immune-lowering effect of the medicines shows up most clearly. NHSBT says cancers, especially skin cancers, are more common after a kidney transplant, and advises avoiding long spells in the sun and wearing factor 50 sunblock, long-sleeved shirts and a hat when outdoors (NHS Blood and Transplant).

Kidney Care UK goes further on detail. It recommends factor 50 suncream all year round, avoiding sunbathing and sunbeds at all times, covering up with clothing, and wearing a hat, which it flags as especially important if you have a bald head. It quotes a consultant dermatologist who says transplant patients are at 100 times greater risk of squamous cell skin cancer, and that people on immunosuppressants are also more at risk of skin cancers spreading, so changes should be dealt with quickly. Fair skin, earlier skin cancers and sun damage raise the risk further (Kidney Care UK).

The practical habit Kidney Care UK suggests elsewhere is a monthly check of all your skin for new marks, scabbed spots or changing moles, with a friend or relative looking at places you cannot see, such as the ears and back. Concerns should go to your doctor promptly (Kidney Care UK).

Other cancers and routine screening

Skin is not the only area. NHSBT lists lymphomas as more common after a kidney transplant, and Kidney Care UK adds lung, kidney and bowel cancers to the list of types seen more often in people with transplants, because the immune system that normally finds and destroys abnormal cells is dampened (Kidney Care UK).

The advice on screening is consistent across both UK sources. NHSBT says it is strongly recommended that you attend invitations for tests such as mammograms, cervical screening and bowel cancer screening. Kidney Care UK says the NHS screening schedule is the same as for people without a transplant. NHSBT also asks you to tell your team about a lump, something unusual on your skin or anything else that worries you.

Blood pressure, weight, cholesterol and heart health

Weight gain is common after a transplant, especially in the first year. NHSBT links this partly to medicines, partly to a less restricted diet and partly to a better appetite, and warns that too much weight strains the heart and blood vessels. It suggests at least 5 portions of fruit and vegetables a day, plenty of wholegrain foods, and cutting back on sugar, saturated fat and salt. On blood pressure it stresses that exercise, a balanced diet and a healthy weight all matter alongside any tablets (NHS Blood and Transplant).

The longer-term page is direct about why this matters. Heart problems and strokes can occur many months or years after a transplant, and NHSBT lists stopping smoking, regular exercise, a healthy body weight and good control of blood sugar and blood pressure as the main ways to lower that risk. It also notes that steroid medicines such as prednisolone can raise blood pressure (NHS Blood and Transplant). The National Kidney Foundation groups heart disease, high blood pressure and high cholesterol together as the problems a healthy lifestyle can help lessen (National Kidney Foundation).

The pages we opened give no cholesterol targets or testing intervals, so we give none. Whether and how often yours is checked is a question for your team or GP. Our pages on diet and fluids and exercise cover the lifestyle side in more depth.

Diabetes risk

Some anti-rejection medicines can push blood sugar up. NHSBT names tacrolimus and steroids as medicines that can raise blood sugars (NHS Blood and Transplant), and the National Kidney Foundation lists new-onset diabetes after transplant among the complications to know about, adding that gaining too much weight raises the risk (National Kidney Foundation). NHSBT adds that a low-sugar diet is particularly important for managing diabetes.

Whether blood sugar is checked, how often, and what to do about a raised reading are decisions for your transplant team and GP.

Bone health

Bones are easy to forget because nothing hurts until something goes wrong. A National Kidney Foundation article by a nephrologist describes substantial bone loss in the first year after transplant, linked to steroid treatment, vitamin D deficiency, continuing overactivity of the parathyroid glands and reduced activity. It estimates the risk of fracture conservatively at 2 to 3 percent of patients per year, and says a bone density scan is advisable in the early period for some people, with further scans every couple of years in those whose kidney function allows. Regular physical activity is described as necessary for healthy bones, and the article is open that evidence for treatment is limited and that interpreting results belongs with your nephrologist (National Kidney Foundation).

NHSBT says the same in plain terms: you may need bone scans to check for thinning, and you may be advised to change your lifestyle or be given medicines if there is a problem (NHS Blood and Transplant).

Keeping an eye on kidney function

The thread that ties the long-term picture together is regular monitoring. The National Kidney Foundation explains that the standard way to estimate how well kidneys filter is a blood test measuring creatinine, a waste product from protein in food and from muscle breakdown, which is fed into a formula to produce the estimated glomerular filtration rate, or eGFR. It notes that a past solid organ transplant is one of several factors that can affect how accurate an eGFR estimate is, and that looking at results over time is often more helpful than a single number (National Kidney Foundation).

The National Kidney Foundation says there are sometimes no symptoms of rejection at all, and that chronic rejection tends to develop slowly over a long period, which is why bloods and follow-up visits are the safety net. Its short rule is "when in doubt, reach out" (National Kidney Foundation). We do not interpret individual results here; the detail of what each test measures is on our page about clinic follow-up and what the tests mean.

Hot weather deserves a mention. Kidney Care UK quotes a consultant nephrologist who explains that a donor kidney does not have the nerve supply that normally helps the kidneys balance fluid loss, so heavy sweating can reduce blood flow to the kidney. The advice given is to stay out of the sun at the hottest times, sit in the shade, wear a hat and keep replenishing fluids even if you do not feel thirsty (Kidney Care UK). Your own fluid advice from your team applies first.

Dental, eye and routine appointments

Living with a transplant also means looking after the rest of the body. The National Kidney Foundation notes that anti-rejection medicines can raise the risk of eye problems, skin cancer and problems with the mouth or teeth. It suggests seeing your regular doctor, kidney doctor, skin doctor, dentist and eye doctor at least once a year, together with sun safety, not smoking and getting screenings on time (National Kidney Foundation). That list comes from a US organisation, so NHS arrangements will differ.

Stopping smoking comes up in several of the sources above. NHSBT says smoking increases the risk of strokes, heart and lung problems and hernias in transplant patients, and that your transplant team can help with stopping. Most people can drink alcohol in moderation, according to the same page. If low mood, tiredness or worry are part of the long haul for you, our page on mental wellbeing and fatigue after transplant is a good next stop.

Frequently asked questions

How often will I be seen by the transplant team years after the operation?

NHSBT says clinic visits become less frequent once kidney function has stabilised after the first few months, but it does not give a fixed schedule. The National Kidney Foundation asks readers to keep up with appointments and blood draws on the schedule their team sets. How often that is differs between centres and between people.

Do I really need sunscreen all year round?

Kidney Care UK recommends a high factor 50 suncream all year round for transplant recipients, along with avoiding sunbeds and covering up. The reason it gives is that anti-rejection medicines weaken the body's ability to spot and repair skin damage, and that people who are immunosuppressed are more at risk of skin cancers spreading.

Do I still need national cancer screening if I see a transplant team?

Yes. NHSBT strongly recommends attending any screening you are invited to, and Kidney Care UK says the schedule is the same as for people without a transplant. Screening looks for early signs in people without symptoms, so it covers ground that clinic bloods do not.

Can I exercise and still protect the kidney?

NHSBT says most sports and activities are possible, with moderate exercise such as walking, jogging, swimming or cycling usually encouraged as recovery goes well. It advises avoiding heavy contact sports such as rugby, martial arts and boxing because they risk damaging the transplanted kidney. Your team can tell you what suits you.

The short version

Long-term health after a kidney transplant rests on a few repeating habits: protect your skin, take infection seriously, attend screening and blood tests, and look after blood pressure, weight and blood sugar. Public bodies agree the risks are real but fall over time and respond to ordinary healthy living. Your transplant team decides what is right for you.