Healthy Eating After Your Kidney Transplant

Why is nutrition important after a kidney transplant?

Eating well after your transplant is an important part of your recovery. Making the right food choices can help with wound healing, prevent food-borne illness and ensure adequate nutrient intake. Some of the medications you will need to take after your transplant can interact with the food you eat, so you need to be cautious. Some of the issues that may occur include raised blood pressure, elevated potassium levels, elevated cholesterol, depleted magnesium, raised blood glucose levels, increased susceptibility to a food-borne illness and weight gain.

Nutritional information in this resource covers the following topics:

• Nutrition after your transplant ( first two to three months)
• Long-term nutritional considerations ( after three months)

Your kidney transplant dietitian will discuss your healthy eating plan with you.

After your transplant

Healthy eating soon after your transplant is important. In particular, you must ensure that you:

• Meet your protein needs
• Follow safe food practices to prevent food-borne illnesses
• Maintain adequate fluid intake
• Maintain adequate nutrient intake, including dietary calcium, phosphorous, magnesium and potassium
• Maintain regular eating habits to help manage blood glucose levels

Protein for wound healing

Protein is essential for growth and repair. After surgery, extra protein is needed for your body to recover and heal. Protein is also required to prevent muscle loss associated with the high-dose steroids required during the first few weeks after your transplant.

Protein-rich foods

Your dietitian will advise you on the best ways to meet your protein requirements.

• Meat
• Fish
• Chicken
• Eggs
• Milk
• Cheese
• Yoghurt
• Beans / Lentils
• Nuts
• Soya / Tofu

Saturated and trans-fat (unhealthy fats)	Mono-unsaturated fats and poly-unsaturated (healthy fats)
Butter, ghee, drippings, lard, kremelta (vegetable shortening) Fat or skin on meat Full cream milk, cream, cheese Store-bought cakes, biscuits, pastries, pies, sausage rolls	Vegetable oils, e.g. olive, rice bran, canola, sunflower, avocado, flax-seed Avocados, olives Fatty fish, e.g. salmon, deep-sea fish Nuts e.g. a lmonds, cashews, walnuts, macadamia, peanuts  Margarine spreads Spreads containing plant sterols

Drinking enough fluids

Your fluid requirements immediately after your kidney transplant will vary according to your kidney function and medical management. Ask your transplant doctor or nurse if you are unsure how much you need to drink. It is important to keep your body hydrated to help assist normal kidney function. 

Water is your best beverage choice. However, tea, coffee, milk, Milo, diluted juices or low sugar cordials are also good choices. It is best to avoid both sugary drinks and soft drinks. Please talk to your dietitian if you are having trouble drinking a sufficient amount of fluids.

If your kidney transplant is working well, previous food and fluid restrictions may be removed. Your transplant team will tell you if you need to continue following certain dietary restrictions you had prior to your transplant. However, these may only be short term.

Safe food and food hygiene

After your transplant, you will be on immunosuppresses to prevent rejection of your new kidney. Because your immune (defence) system will be suppressed, you are vulnerable to infection. In fact, infection is a major cause of complications after a transplant. Eating safe food to avoid food-borne illnesses is very important, particularly during the early period after your transplant, as well as during periods of acute illness when the likelihood of infection from food is high.

In order to decrease your risk of infection, it is recommended that you practice good hand hygiene and remember to always follow the four simple rules to keep your food safe:

1. Clean: Wash hands and surfaces often
2. Cook: Cook to safe temperatures
3. Separate: Don't cross-contaminate
4. Chill: Refrigerate promptly

Always Read the Safe Handling Label for food safety information on raw foods. Be sure to check the "sell by" and "use-by" dates. If it is past the expiration date, don't buy it.

Please refer to the food safety booklet "Food safety for transplant recipients" for more information.

During your hospital stay your nurse and dietitian will ensure you are on the appropriate diet to minimize your risk of foodborne illness.

Medications and nutrition-related side effects

You may experience some side effects of your anti-rejection medications. These side effects can alter your food intake. Your pharmacist will discuss medications with you during your stay in the hospital.

Nutrition-related instructions and possible side effects from these medications are listed below.

Mycophenolate mofetil (Cellcept„¢)

• May cause diarrhoea, constipation, heartburn, nausea and vomiting
• Small frequent snacks may be better tolerated
• Calcium supplements and aluminium or magnesium-containing antacids should be separated from mycophenolate mofetil doses by at least two hours

Tacrolimus (Prograf„¢)

• May cause increased blood sugar levels
• May increase potassium level in blood
• May cause nausea and diarrhoea
• Avoid grapefruit and grapefruit juice
• Should be taken consistently with or without food
• May cause sodium/fluid retention and increase blood pressure

Cyclosporin (Neoral„¢)

• May increase blood levels of potassium through potassium retention
• May cause diarrhoea, vomiting, stomach discomfort
• Avoid grapefruit and grapefruit juice
• Should be taken consistently with or without food
• May cause sodium/fluid retention and increase blood pressure

Prednisone

• May increase your appetite”ensure you keep to your regular meal sizes and portions to avoid over-eating
• May cause sodium/fluid retention and increase blood pressure
• Tablets are best taken with food 
• May increase your blood glucose levels
• May reduce calcium absorption and adversely affect bone turnover”ensure adequate calcium intake for long-term bone mineral health

Grapefruit and herbal medications

Grapefruit juice (and grapefruit-containing products) interferes with the way your body handles certain medications. It can increase blood levels of cyclosporin and tacrolimus. It is important that you avoid grapefruit. Please discuss any drug and nutrient interactions you are unsure about with your pharmacist.

It is recommended that you do not take any over-the-counter herbal or nutritional supplements without discussing these first with your renal pharmacist or renal transplant medical team.

High blood glucose levels

Some medications, commonly prednisone and tacrolimus, can impair your body's ability to use glucose (sugar) in your blood. This causes high blood glucose levels or hyperglycaemia. Glucose is produced when the carbohydrate in food is broken down.

Please follow the following tips to best help control your glucose levels:

• Eat regular healthy meals do not skip meals to control blood glucose levels
• Avoid consumption of large amounts of refined carbohydrate sources, such as cordials, juices, soft drinks, candy, sweets and sugar
• Ensure you are eating adequate sources of fibre choose wholemeal or wholegrain bread over white bread, and bran-based cereals over refined cereals

Long-term nutritional considerations

Healthy lifestyle

It is important to maintain a healthy, balanced diet and active lifestyle to improve, control or reduce your risk of excess weight gain, developing diabetes, heart disease and for long-term bone health.

Weight gain

You may find that your appetite improves greatly after your transplant. Your appetite may increase because you feel better and have an improved sense of wellbeing, or due to medication-related side effects.

It is important that you manage your weight. Gaining too much weight increases your risk of heart disease, blood vessel disease and diabetes. Being overweight also increases the likelihood of high blood cholesterol, high blood pressure, exacerbating chronic obstructive pulmonary disease and stroke.

If you are overweight, losing 5-10% of your body weight will substantially reduce your risk of illness and improve your management of existing conditions.

Here are some tips to avoid excess weight gain:

• Keep to regular meal times and portion sizes
• Eat plenty of fruits and vegetables
• Limit your intake of saturated fats, sugar and salt
• Increase exercise and activity levels

Diabetes

Anti-rejection medications may put you at a higher risk of developing diabetes. Around 20% of kidney transplant recipients develop diabetes by the end of the first year after their transplant. Your risk of developing diabetes is increased with age, if you have a family history of type 2 diabetes, have had hepatitis C infection or are overweight.

Eating the right food, exercising and making healthy lifestyle choices will help you manage your diabetes and keep your blood glucose levels in the normal range. Your diabetes educator and transplant team will help you manage your diabetes in the best possible way.

Heart disease

Heart disease, also known as cardiovascular disease, is ten times higher in kidney transplant recipients. Having abnormal blood lipids (e.g. cholesterol) and high blood pressure increases your risk of heart and blood vessel disease.

Abnormal blood lipids

High blood cholesterol and high blood triglycerides (fats) are another risk factor for heart and blood vessel disease. Sometimes anti-rejection medications and how well your kidney is working can increase cholesterol and triglyceride levels, but lifestyle factors, including your food choices, are also important.

Dietary fat is important for good health. However, eating too much fat can cause weight gain. Eating the wrong types of fat can increase your risk of heart and blood vessel disease. There are four types of fat in food:

• Saturated fats
• Trans-fats
• Mono-unsaturated fats
• Poly-unsaturated fats

Having a diet high in saturated and trans-fats increases the level of unhealthy cholesterol in your blood. It is particularly important for transplant patients to choose foods lower in saturated fats and include more mono-unsaturated and poly¬- unsaturated fats.

High blood pressure

Most people eat more salt than recommended. The 2015-2020 Dietary Guidelines for Americans recommends a reduction in our sodium (salt) intake to less than 2,300mg per day.

Did you know that 1 teaspoon (5g) of salt contains 2,300mg of sodium?

Having high blood pressure not only places you at risk of heart and blood vessel disease, it also affects your kidney graft survival. High blood pressure is linked to chronic kidney failure and acute rejection.

If your new kidney is working well, you should keep your blood pressure below 130/80mmHg. Some risk factors for having high blood pressure may be out of your control, for example if you are male or experience delayed graft function. High blood pressure can be linked to anti-rejection medications.

Here are some tips to help reduce your blood pressure:

• Reduce your body weight (if you are overweight or obese)
• Avoid adding salt to your food
• Read food labels aim for less than 120mg of sodium per 100g of food
• Ensure you are being as physically active as possible
• Take your prescribed anti-hypertensive medications

Bone disease or osteoporosis

The risk of bone fractures among kidney transplant recipients is four times that of the general population. Females, particularly those who are post-menopausal, are at greatest risk. Long-term use of steroids such as prednisone can lead to osteoporosis (thinning of the bones). Vitamin D and calcium are essential nutrients for maintaining strong, healthy bones. Dairy products are the best sources of dietary calcium. Calcium-fortified products with vitamin D can also help contribute to your overall dietary intake.

Ensure your diet contains calcium-rich foods to meet the recommended dietary intake for calcium of 1000mg/day (1300mg/ day post-menopause). You may also be prescribed a vitamin D supplement by your doctor.

Benefits of regular exercise

Keeping active on a regular basis is important to maintain health long term. It helps control weight, blood pressure and cholesterol, improves diabetes control, cardiovascular function and maintains muscle strength. Exercise can also help you to relieve stress and feel better.

Here are useful exercise tips:

• Ask your physiotherapist about what exercises are best for you”to help your recovery in hospital and set exercise goals when you go home
• Plan your exercise to build up to your goals”set small, achievable goals and give your body time to adjust
• Get active with someone else”encourage your friends, children, partner and family to join you, or join a club.

My checklist

First week after my transplant

• I have seen a dietitian and I am aware who to contact in case I have any questions
• I am aware of food safety
• I have informed the dietitian of any dietary concerns I might have

During the first month

• I am aware of the nutritional challenges I may encounter
• I have seen the dietitian in the transplant clinic
• I am aware of what specific food and lifestyle choices I must adopt

Changes I am going to make:

Three to six months after my transplant

• I know what a healthy long-term weight is for me
• I am aware of what my nutritional priorities are

Changes I am going to make:

One year after my transplant

• I have a follow-up appointment arranged with the dietitian to discuss my current nutritional status

Changes I am going to make:

Food and lifestyle choices are important to managing your health after your kidney transplant.