Synopsis
Understand kidney transplant assessment and aftercare, protect graft function, and recognise rejection, infection, surgical complications and immunosuppressant toxicity without unsafe medicine interruption.
- Kidney transplantation is kidney replacement therapy, not a cure: recipients retain cardiovascular risk, need lifelong surveillance and usually require continuing immunosuppression while the graft functions.
- Suitable people should be assessed before dialysis where possible; living-donor and deceased-donor routes require consent, infection and cancer screening, cardiovascular assessment, ABO and HLA work-up and a current crossmatch strategy.
- A rising creatinine is graft dysfunction, not synonymous with rejection: dehydration, obstruction, vascular compromise, infection, calcineurin-inhibitor toxicity, recurrent disease and non-adherence must also be assessed urgently.
Key red flags
Anuria or a rapid creatinine increase after transplantation requires same-day transplant-centre assessment for vascular occlusion, obstruction, rejection, sepsis and severe volume depletion.
Investigation priorities
Detect graft dysfunction early and define tempo against the recipient's post-transplant baseline.
Management branches
Advanced CKD is likely to progress to kidney failure and transplantation could be suitable.
- Refer early for multidisciplinary assessment, explaining living and deceased donation, waiting, surgery, lifelong medicines and realistic graft outcomes in accessible language.
- Define recurrence risk and evaluate cardiovascular health, infection, malignancy, urinary tract, iliac vessels, frailty, psychosocial needs and ability to manage the regimen.
Key medicines
Immediate-release tacrolimusUse the transplant centre's weight- and level-guided oral regimen at consistent times, adjusting only against correctly timed trough concentrations.
Mycophenolate mofetilGive the centre-prescribed oral dose, commonly divided across the day, with any reduction or interruption authorised by the transplant team.