Complications Post-Transplant

While a kidney transplant can literally be a lifesaver, complications can occur after a transplant.  It’s important to keep the lines of communication open with your transplant team so they can deal with any problems you may be experiencing quickly to get you back to normal.

The transplant team should be made aware of situations involving:

  • Patient's reaction to any medications
  • Understanding medication dosing - any concern that the directions on the label of medications is not what the patient was told
  • Need to take aspirin, TYLENOL® (acetaminophen), other pain relievers, or cold remedies - check with your transplant team before taking these drugs
  • Inability to take medicines by mouth due to illness
  • Presence of a prolonged illness such as diarrhea, nausea or vomiting
  • Changed eating habits
  • Introduction of a new prescription or change in current prescription by the primary or family doctor
  • Symptoms or side effects from any related medications
  • Need for any kind of dental work

There are four main complications which can occur following a kidney transplant:   

  1. Infections
  2. High blood pressure
  3. Rejection
  4. Diabetes mellitus

1. Infections

Immunosuppressive medications help keep the body from rejecting the transplanted kidney.  However, they also reduce the function of the naturally-occurring immune system within the body.  This can make a patient more susceptible to various infections after transplant surgery. Any symptoms for any of these types of infections should be shared with your transplant team.

Some of the most common infections include:

Bacterial Infections:

Wound infections - Bacterial wound infections occur at the surgical site. Most common symptoms include fever, redness, swelling, tenderness, or drainage at the incision. A test for bacteria (wound culture) is taken, and if infection is present, an antibiotic will be prescribed.

Fungal Infections:

Candida (yeast) - Candida usually appears in the mouth and throat but may also be in the surgical wound, eyes, or respiratory and urinary tracts. Candida is most severe in the bloodstream. Infection occurring in the mouth or throat produces white, patchy raw areas, pain or tenderness, a white film on the tongue, and difficulty swallowing. Candida can also infect the esophagus or, in women, the vagina. Vaginal infections usually produce an abnormal discharge that may be yellow or white.

Viral Infections:

Cytomegalovirus (CMV)
- CMV is the most common of the viral infections in transplant patients usually occurring in the first months after transplantation. Symptoms include headaches, fatigue, aching joints, high temperature, and pneumonia.

Herpes-simplex virus type I and II
- Type I typically causes cold sores and blisters around the mouth, and type II causes genital sores. Herpes type II is an infectious disease that can be transmitted sexually.

In most cases herpes-simplex infections are mild, but they can become severe in certain cases.  Herpes can be treated, but there is no cure. Treatments are intravenous, oral or topical depending on how bad the infection is.

Symptoms of herpes include fluid-filled sores in the genital area or mouth and a feeling of weakness. Women should report any unusual vaginal discharge to the transplant team.

Herpes zoster (shingles) – Typically found on the chest, back or hip, shingles appear as a rash or small water blisters.  These may be painful.

2. High Blood Pressure

High blood pressure is a very common disorder which tends to become more frequent as you age. And while some medications can cause high blood pressure in people, other people must take medication to control their high blood pressure.

There are a host of medications to help control high blood pressure. It can take trying several different ones to find the one that works right for each patient. Your doctor or transplant team will work with you to find the one best for you.
A diuretic (water pill) may also be prescribed to lower blood pressure, increase urine output, and remove extra fluid.

3. Rejection

When you have a kidney transplant, the new kidney is “foreign” to your body. Your body’s immune system fights off or destroys (rejects) anything foreign to keep it running smooth.  Because of this, you will take immunosuppressive medications for the rest of your life to prevent your body from rejecting your kidney.

Rejection comes in several forms:

Hyperacute rejection – Because of crossmatching prior to the transplant, this is a very rare form of rejection. It is when the body immediately destroys the transplanted kidney.

Acute rejection – Usually occurrs in the first few months after transplant, but it can happen at any time after the transplant.  It is typically treated with increased doses of medication to repress the body’s desire to reject the organ.

Chronic rejection – Happening months or even years after the transplant, this form of rejection causes your new kidney to slowly stop working. There is no current medication that can stop this form of rejection.

4. Diabetes Mellitus

Diabetes means your body has difficulty in maintaining normal blood sugar levels. Medications you are taking after a transplant such as Prednisone, Prograf®, and/or Cyclosporine can cause diabetes. You may need to start taking insulin or increase your dose to help control your blood sugar.

Symptoms of diabetes may include: increased thirst, increased frequency of urination, blurred vision, and confusion.

Exercise, diet and weight loss can help reduce blood sugar levels. The doctor may also prescribe an oral diabetes drug or insulin injections.

Other complications may include:

  • Delayed function
  • Drug toxicity
  • Urologic problems

There may also be side effects from post-transplant medications. These can include:

  • Cancer (skin, organ)
  • Joint problems
  • Gastrointestinal problems
  • Cataracts
  • Weight gain
  • Acne
  • Gum overgrowth
  • Tremors
  • Hyperlipidemia



Number of kidney transplants performed in the United States. Learn More