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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

After a kidney transplant

In short

A working transplant means no dialysis, and more choice about what you eat than on dialysis (NIDDK). The price is anti-rejection medicines every day, on time, for as long as the kidney works (NKF). Not taking them as prescribed is linked to a high risk of rejection (KDIGO 2009 transplant, chapter 11). These medicines also raise the risk of infection and skin cancer, can raise blood glucose and potassium, and interact with grapefruit and some herbal products (Prograf label). With type 1 diabetes, expect your insulin needs to change; after a successful pancreas-kidney transplant, glucose may return to normal (ADA 2026 §9).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Blood tests for the new kidney

KDIGO recommends checking creatinine at least (KDIGO 2009 transplant, recommendation 8.3):

Time after transplant Creatinine check
First week, or until you go home daily
Weeks 2–4 2–3 times a week
Months 2–3 weekly
Months 4–6 every 2 weeks
Months 7–12 monthly
After the first year every 2–3 months

Urine protein is checked once in the first month, every 3 months in the first year, and yearly after that (recommendation 8.2). Your team also checks your anti-rejection medicine levels (Prograf label).

Other numbers

What Number Source
Fever that needs a call to the center more than 100 °F NIDDK
A1c goal with diabetes after transplant your own goal: KDIGO 2009 says to consider about 7.0–7.5 %, and not 6.0 % or lower, especially if you have lows; the newer KDIGO 2022 range is under 6.5 % to under 8.0 % KDIGO 2009, 15.2.2; KDIGO 2022, 2.2.1
Wait before trying for a baby at least 1 year, with stable kidney function and urine protein under 1 g a day KDIGO 2009, 25.2.1
Skin check by a professional once a year KDIGO 2009, 18.4
Medicare after transplant ends 36 months after the transplant if you have it only because of kidney failure; Part B-ID costs $121.60 a month in 2026 Medicare
What Number Source
Fever that needs a call to the center more than 37.8 °C NIDDK
HbA1c goal with diabetes after transplant your own goal: KDIGO 2009 says to consider about 53–58 mmol/mol, and not 42 mmol/mol or lower, especially if you have lows; the newer KDIGO 2022 range is under 48 to under 64 mmol/mol KDIGO 2009, 15.2.2; KDIGO 2022, 2.2.1
Wait before trying for a baby at least 1 year, with stable kidney function and urine protein under 1 g a day KDIGO 2009, 25.2.1
Skin check by a professional once a year KDIGO 2009, 18.4
Medicare (US only) ends 36 months after the transplant if you have it only because of kidney failure Medicare

The handbook's sample transplant menu is built around about 56–70 g of protein a day for a 70 kg adult and under 2,000 mg of sodium, with no potassium or phosphorus limit unless your blood tests need one. Your dietitian sets your own numbers.

What changes now

Medicines, every day, on time. Not taking anti-rejection medicines as prescribed is linked to a high risk of rejection and of losing the kidney (KDIGO 2009 transplant, chapter 11). Use alarms and a pill box, and never run out.

Interactions. Do not eat grapefruit or drink grapefruit juice with tacrolimus (Prograf label). Pomelos, Seville oranges and tangelos may act the same way (FDA). St John's wort lowers tacrolimus levels and can lead to rejection (Prograf label). Tell every doctor, dentist and pharmacist that you have a transplant before you take anything new.

Potassium and magnesium. Tacrolimus can raise blood potassium and lower magnesium (Prograf label). Your team may ask you to limit potassium or take magnesium; follow your blood tests, not a fixed rule.

Glucose. Tacrolimus and steroids raise glucose, especially early on and after rejection treatment (KDIGO 2009 transplant, chapter 15; Prograf label). Expect your insulin needs to change; your team sets the plan. After a successful pancreas-kidney transplant, glucose can return to normal and insulin may stop, but only your team decides that (ADA 2026 §9). Keep checking glucose until they tell you otherwise.

Infections and vaccines. Avoid live vaccines (KDIGO 2009 transplant, 12.2; Prograf label). Ask your team before any vaccine.

Sun. The risk of skin and lip cancer is very high after a transplant. Limit sun exposure for life, wear protective clothing, and use a broad-spectrum, high-factor sunscreen (KDIGO 2009 transplant, 18.1–18.2; Prograf label). Check your own skin and lips and report new spots (18.3).

Pregnancy. Wait at least a year and plan it with your transplant team (KDIGO 2009 transplant, 25.2.1). Mycophenolate can cause miscarriage and birth defects. It must be stopped or replaced before trying to get pregnant (25.2.2). Women who could get pregnant need contraception counseling and must use acceptable birth control during treatment and for 6 weeks after stopping; men taking it, or their partners, are advised to use effective contraception during treatment and for at least 90 days after (CellCept label). In July 2026 the FDA ended the mycophenolate REMS program, but these label warnings still apply (FDA; REMS). This handbook does not give pregnancy advice beyond this: see Sex, fertility and pregnancy, which refers you to specialists.

Food safety

Anti-rejection medicines make food poisoning more dangerous. The USDA and FDA advise transplant recipients (USDA–FDA; FoodSafety.gov):

Avoid Choose instead
unpasteurized (raw) milk, and soft cheeses made from it (such as some feta, brie or queso fresco) pasteurized milk; hard or processed cheeses; soft cheeses clearly labeled "made from pasteurized milk"
raw or undercooked meat, poultry, eggs and seafood (such as sashimi and some sushi) food cooked to a safe temperature: ground beef 160 °F (71 °C), poultry 165 °F (74 °C), seafood 145 °F (63 °C)
hot dogs and deli meats straight from the pack heated until steaming hot, or 165 °F (74 °C)
raw sprouts (alfalfa, bean and others) cooked sprouts
refrigerated smoked fish canned fish and seafood

Use a food thermometer: the color of meat is not a reliable sign that it is safe (USDA–FDA).

What to do

  • Take every anti-rejection dose on time; set phone alarms and use a weekly pill box.
  • Never run out: order refills a week early, and plan for travel.
  • Go to every blood test, even when you feel well.
  • Remove grapefruit, pomelo and St John's wort from your kitchen and cupboard.
  • Check with the transplant pharmacist before any new medicine, supplement or vaccine.
  • Take your temperature if you feel unwell, and call the center if it is over 100 °F (37.8 °C).
  • Use sunscreen and a hat every day you are outside, and book a yearly skin check.
  • Follow the food safety table above; buy a food thermometer.
  • Check your glucose as your team asks, and report highs and lows.
  • Update your treatment to "transplant" in the app (First setup).

Examples

A missed dose. You realize at lunch that you forgot your morning dose. Do not double up on your own. Call the transplant center or the on-call pharmacist now and do what they say. Ask for a written missed-dose plan for next time.

A cold that will not go away. It has been 10 days and you are still coughing. NIDDK lists "a cold or cough that won't go away" as a reason to call your transplant center (NIDDK).

A breakfast swap. Grapefruit halves at the hotel buffet are out. Choose berries or an apple instead.

Ask your care team

  1. What should I do if I miss or vomit a dose of an anti-rejection medicine?
  2. How often will my blood tests be, and who tells me the results?
  3. Do I need a potassium limit or a magnesium supplement?
  4. How will my insulin plan change while I take steroids?
  5. Which vaccines can I have, and when?
  6. When is it safe to plan a pregnancy, and which medicines need changing first?

Get help now if…

Call 911 (or your local emergency number)

Fever with shaking chills; chest pain; severe breathlessness; fainting; a low the person cannot treat themselves (give glucagon, then call) (ADA 2026 §6); possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath (2024 consensus). Full list: Get help now.

Call your transplant center right away

A fever over 100 °F (37.8 °C); drainage from your scar; burning when you pass urine; a cold or cough that will not go away; or you just do not feel well. Anti-rejection medicines can hide the signs of an infection (NIDDK). Also new swelling or a rise in blood pressure, which can mean the kidney is not clearing salt and fluid (NIDDK); much less urine (KDIGO 2009 transplant, 8.1); and vomiting or diarrhea that stops you keeping your medicines down, because missed doses risk rejection (KDIGO 2009 transplant, chapter 11).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06. Prices and benefit amounts as of 2026-10-06.