Renal transplantation is considered to offer the patients with ESRD (end stage renal disease) the best chance of rehabilitation and good quality of life, writes Mrinal Pandit, Chief Dietician, NephroPlus, for Elets News Network (ENN).

The positive effects of transplantation are to relieve the patients from dietary and other lifestyle restrictions imposed by dialysis. Moreover, the most important thing is they no longer have to go through the exhaustive process of dialysis.

Ten important aspects transplant recipients need to take care of for a speedy and successful recovery

Nutrition care should be the same as for any post-surgical patient: monitoring biochemistry and urine output, ensuring the return of normal gut function and appetite and meeting the requirement with supplements, if necessary.

Calories: The calorie requirement will increase, as the body has to overcome the post-operative stress. Calorie requirement can be 2,000-2,300 Kcal per day. It might take few days to regain appetite post-surgery.

Diet protocol after surgery–

Day 1-Patient will be NBM (Nothing by mouth)

Day 2- Sips of water progressing to clear liquids.

Day 3- Clear liquid to full liquid diet and gradually semi-solid diet.

Day 4- Soft diet to full diet as per patients tolerance and doctors advice.

The change in the consistency and the texture of the food will vary on the bowel movement, nausea, abdominal distension and clinical parameters.

Food safety and hygiene: Immunosuppressive therapy, which is used to prolong the life of the transplanted kidney, suppresses immunity and makes patient more susceptible to infection; special care should be taken to avoid food contamination.

1. Avoid uncooked food that can lead to growth of unwanted microorganism
2. Always wash hands well with soap and water. In addition, dry your hands thoroughly before eating, before, and after handling foods.
3. Storage of the food-Separate raw and cooked foods while purchasing, storing, preparing foods
4. Serving temperature of the food to be maintained at 60 degree Celsius and above

Monitor potassium levels for first 24 hrs:

The rate at which biochemistry and urine output return to the normal can vary and needs to be monitored closely. Some medicine post-transplant can increase potassium levels while others can reduce it.

Avoid taking high potassium foods immediately after surgery like coconut water, fruit juices, barley water etc. Your nutritionist will advise you about when it is acceptable to start adding high potassium foods back into your diet.

Fluids recommended should be like rice kanji, rawa kanji, buttermilk, weak black tea, sago kanji, dal water etc.

Fluid output:

Treatment varies from fluid and electrolyte to intravenous support. The urine output is monitored and maintained to 5- 6 litres per day. Initially only intravenous fluid is given and later, oral fluids are encouraged more with gradual decrease in the intravenous fluids. Dehydration at this stage can lead to kidney damage.

Manage protein:

For the first 4- 6 weeks of the transplant you may need increase in the protein intake to build up the muscle tissue that is broken down by the large doses of corticosteroids. Later it can return to normal serving size depending upon the recovery.

Diet rich in proteins helps:

-Faster healing of wound post-transplant

-Wear and tear of tissue and muscle.

Eat good sources of proteins like lean chicken, fish, soya products and low fat dairy products. When cooking, try to bake, grill or steam instead of deep-frying.

Monitor blood glucose levels:

Some medications can decrease the body’s ability to use its blood sugar for energy. This can cause increased blood sugar (glucose). This condition is called hyperglycaemia or steroid-induced diabetes. This effect can last for few days to months. Regular follow up with the doctor can help to manage sugar and understand the line of treatment and progression of diabetes.

Avoiding concentrated carbohydrates like sugar syrup, canned juices, honey, jaggery etc. as it will help decrease the side effects of steroid medications.

Salt intake:

Salt restriction is usually needed post transplantation for most of the people, as transplant medicines, especially steroids, may cause your body to hold on to fluids. Increase fluid in the body may raise your blood pressure. Restricting salt intake to 3 grams per day is reasonable. Your Doctors can guide you better considering your serum sodium values.

Avoid foods rich in salts and preservatives like pickles, papad and processed foods.

Weight management:

Many people develop better appetite after transplant that leads unwanted weight gain. Monitor your body weight often and adhere to your ideal body weight. Controlled weight can lower the risks of unwanted complication like heart disease, diabetes, blood pressure and deranged lipid levels.

-Restrict the carbohydrate serving to 5 per day.

-Avoid simple carbohydrates like sugar, molasses, jam, cold drinks etc.

-Include food rich in fibres

Life style modification:

Healthy and balanced eating habit should be encouraged. Patients who have been initially on potassium restriction diet may be reluctant to first increase intake of all sorts of fruits and vegetables and other cardio protective foods. Conversely, there may be a temptation to overcome some of the previously restricted foods such as alcohol, chips. Dairy products, fruit juices, nuts chocolate etc. contributing to rapid increase in body fat.

Regular follow up with the renal physician, nutritionist, and physiotherapist can help you overcome these barriers and lead healthy life style.

Physiotherapy:

Your nephrologist may ask you to take physiotherapy session at the time of hospitalisation. It helps to improve peristalsis and bowel motility. Regular light exercise as per physiotherapist guidance can improve appetite and encourage post-transplant patients to move around actively with confidence.

Summary of the dietary guidelines

• Have 4- 6 small frequent meals per day.
• Include high protein foods in the meals.
• Avoid simple sugars and restrict the complex carbohydrate serving to 4-5 per day.
• Encourage food rich in fibre.
• Include 4-5 servings of fruits and green vegetables in the meal.
• Restrict the usage of fats and oil.
• Avoid preserved and packed food.
• Follow balanced and healthy diet.
• Indulge in regular physical activity
• Have a regular follow up with your Nephrologist/ Nutritionist.
• Beware of good food hygiene practices.
• Monitor biochemistry, especially blood cholesterol, triglycerides, glucose, potassium and blood pressure.
• Plenty of fluids to be encouraged.

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