The aftercare

After an organ transplant, quality assurance through aftercare is essential. At the beginning of every transplantation there is a humanly generous decision: the consent of the relatives to donate organs in the case of cadaveric kidney transplantation or the personal sacrifice in the case of living kidney transplantation. In addition, the organization of donation is complex, complicated and expensive. The long-term outcome of the transplant and therefore the patient's quality of life ultimately depends on the quality of aftercare. For this reason, the legislator has given special weight to post-transplant care in the Transplantation Act and made it essentially the responsibility of the Transplant Centre. The transplant center is responsible for providing the transplanted patient with the best medication according to the current state of knowledge. This is only possible if the transplant patient remains in contact with the Transplant Centre even years later.

Life after the transplant

Discharge after a successful kidney transplant requires a massive change in the transplant patient's life situation. Although the dialysis treatment, which usually lasts for years, has come to an end, the patient is not healthy, but must take regular medication in the long term, the effects and side effects of which must be monitored, as must the function of the transplanted kidney.

In the first year

For follow-up care after transplantation, the patient regularly visits the nephrologist or general practitioner close to home and also the transplant outpatient clinic. In the first year after transplantation, the transplant outpatient clinic accounts for the largest proportion of visits, especially as rejection reactions are most frequent in the early phase (first weekly, then fortnightly, later several weeks). After the first year, routine consultations every three to six months are common, occasionally every year. Issues relating to rejection and the relevant medication settings are usually determined by the transplant outpatient clinic. The treating nephrologist or general practitioner receives a report from each visit to the transplant outpatient clinic, if necessary with treatment suggestions.

Regular punctures

In order to better assess the transplant and detect early rejections, kidney punctures are routinely carried out on an outpatient basis in Hanover in the first six months, namely after six weeks and after three and six months. The respective result has a direct influence on further treatment, in particular the anti-rejection medication is then controlled and possibly changed. In 20 percent of cases, changes are discovered that indicate rejection of the transplant that would otherwise not have been detected by a blood test.

After one year

After the first year, the nephrologist or family physician close to the patient's home usually takes over the main part of regular care, supplemented by less frequent visits to the transplant outpatient clinic. In the long-term phase, it is important that the Transplant Centre is contacted again and again outside of the agreed appointments in the event of illness, deterioration in kidney function, fever, pain or drug intolerance. Deterioration of kidney function, fever, pain, shortness of breath, gastrointestinal illnesses or other events may necessitate inpatient treatment at the Medical School. Here, too, inpatient admission is usually organized via the transplant outpatient clinic or, in an emergency, via the MHH emergency department.

The adjustment of blood pressure, which is usually elevated in transplant patients, and the lipid metabolism disorder that is often present, as well as questions of drug intolerance and interactions, must be discussed repeatedly. One of the main concerns in the late phase of care is the problem of chronic changes in the transplant, which almost always occur for reasons that are still unclear and shorten the functional life of the transplant. In order to avoid an unnecessarily early loss of the transplant, the therapy must occasionally be changed at a later stage.