Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
By Janelle Gonyea, RD, LD
Receiving a transplant requires a surgical procedure, creating an incision that will need to heal properly to get you back on your feet again as soon as possible. To promote healing after the transplant procedure, it is important for you to do the following: maintain good nutritional stores prior to transplant, achieve and maintain a reasonable body weight prior to transplant and eat well-balanced meals after the procedure. Without all of these in place, there is concern for delayed wound healing which can lead to infections and the need for additional surgery to correct the problem.
In general, the surgical wound should be healed in approximately 3 weeks. The wound is considered to be healed if by that time, the stitches or staples have been removed, the incision remains closed and there is no drainage from the wound. Any wound that opens up, drains fluid or becomes infected after 3 weeks is unhealed and considered to be delayed wound healing.1
Maintaining good nutritional stores prior to transplant can be helpful to the healing process, but quite likely easier said than done. While organ function is declining, it can be difficult to eat properly due to decreased appetite and/or symptoms of nausea and vomiting. Pre-transplant, kidney dialysis patients have particular challenges. Vital nutrients such as protein and vitamins are lost in the dialysis process, increasing nutrient needs even further. Also, restriction of key nutrients such as sodium, potassium and phosphorus significantly restrict food choices and thus limit your ability to eat properly. All of these difficulties place you at significant risk for malnutrition. Malnutrition can make it more difficult to heal after a kidney transplant. Following your albumin levels closely during this time is very important as they offer you a glimpse of your nutritional status and how well you are maintaining it over time.
It is extremely important for you to achieve and maintain a reasonable body weight prior to transplant, as being overweight will make you more prone to delayed wound healing and wound infections.2 Your goal weight is one that places you in the healthy body mass index (BMI) range of 18.5 to 24.9. This is important as every one point increase above this goal increases your risk of wound problems.3 Extra body fat makes it more difficult for healing to occur and places stress on an incision trying to close, thus increasing the possibility that it will open again.
The BMI is calculated via a mathematical equation using your weight and height measurements. You can calculate your BMI using one of the following equations or going to www.nhlbisupport.com/bmi,4 which will calculate this for you. The BMI is calculated a bit differently depending on whether you are using the metric system or the English system.
The formula when using the metric system is: Weight in kilograms divided by the square of the height in meters. Since height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters before you use the formula.
An example of calculating BMI using the body mass index formula:
Weight = 68 kg
Height = 165 cm (1.65 m)
BMI Calculation: 68 Ã· (1.65)2 = 24.98
The formula when using the English system is: weight in pounds (lbs) divided by height in inches (in) squared and multiplied by a conversion factor of 703.
An example of calculating BMI using the body mass index formula:
Weight = 150 lbs
Height = 5'5" (65 inches)
BMI Calculation: [150 Ã· (65)2] x 703 = 24.96
Even though you have calculated your BMI to determine if you are at risk for delayed wound healing, it is important to talk with your health care provider to determine what a “healthy” weight range is for you. BMI is a tool that can be used to indirectly measure body fat, but it has its limitations and there are other factors that play into determining the healthiest weight for you. As discussed above, it is very important for you to maintain good nutritional status to keep you in the best possible health as you proceed to transplant, so sometimes it is a matter of striking a balance between good nutritional status and weight loss goals. Improper calorie restriction that promotes weight loss, but leads to depletion of protein stores is not a good trade off. Visit routinely with your registered dietitian who can give you strategies for controlling calories to allow you to achieve and maintain a desired body weight while maintaining good nutritional status.
To promote weight loss, it is typically advised that you control calories by limiting your intake of high fat foods and sweets as these foods supply lots of calories while providing little to no protein or vitamin benefit. Another necessary lifestyle change is increased physical activity. Participating in a regular exercise program is key to your success. Your goal is to be as active as you possibly can on most days of the week. Be sure to talk to your health care provider before starting a new exercise program. If you haven't exercised for quite some time, be sure to start slow and gradually, increasing both the duration and intensity of your exercise program over time.
Finally, after the surgery, it is important to eat well from a wide variety of foods to ensure that all the building blocks are in place to promote healing. You will need adequate calorie, protein and vitamin intake to heal as quickly as you can. You may be advised to continue with a standard multivitamin during the initial phase after transplant when your vitamin needs remain a bit higher. Talk to your health care provider regarding how long you should remain on this vitamin supplement.
In summary, wound healing problems can be a significant complication after transplant. Obesity increases the risk, so achieving and maintaining your goal body weight is extremely important. Additionally, it is important to eat adequate amounts of highly nutritious foods to ensure that you have all the building blocks in place to optimize healing.
1. Tiong HY, Flechner SM, Zhou L, Wee A, et al: A Systematic Approach to Minimizing Wound Problems for De Novo Sirolimus-Treated Kidney Transplant Recipients. Transplantation 2009. 87(2): 296 – 302.
2. Jindal RM, Zawada ET: Obesity and Kidney Transplantation. Am J of Kidney Diseases. 43(6): 943 – 952.
3. Dean PG, Lund WJ, Larson TS, Prieto M, et al: Wound-Healing Complications after Kidney Transplantation: A Prospective, Randomized Comparison of Sirolimus and Tacrolimus. Transplantation 2004. 77(10):1555-1561.
4. National Heart Blood and Lung Institute. Calculate Body Mass Index. Accessed August 1, 2009. http://www.nhlbisupport.com/bmi/