BEFORE TRANSPLANT
• Omega 3's Hemp seed Oil Capsules
• CMV - possible pre-transplant therapy
• Anti coagulation prevent venous thromboembolism
• Ask about which medications, supplements, and foods to stop two weeks before surgery
• Check out the paired donor exchange program through Dr. Robert Montgomery Johns Hopkins USA

FOLLOWING A TRANSPLANT
• Biopsy or what studies will follow graft rejection?
• Eyes
• Bone density
• Diabetes
• Kidney stone
• Weight gain
• Swelling of extremities

Venous Thromboembolism Rates Climb After Hospital Discharge
HAMILTON, Ontario, July 23 -- Patients are more likely to develop venous thromboembolism after hospital discharge than during their stay, and most get no prophylactic treatment. Although as many as 10% of hospital deaths can be attributed to pulmonary embolism, most cases of venous thromboembolism are diagnosed in the three months after hospital discharge. Findings emerged from a study of 1,897 patients with an episode of venous thromboembolism confirmed from medical records of in the Worcester, Mass., metropolitan area during 1999, 2001, and 2003. In all, 73.7% (1,399 patients) developed venous thromboembolism as outpatients. By comparison, only 26% (498 patients) developed the clots while hospitalized. Among 516 patients with a recent hospitalization who subsequently developed venous thromboembolism, fewer than half (42.8%) had been given anticoagulant prophylaxis during their hospitalization.

POST TRANSPLANT DIET
• Ask about an appointment with the renal dietitian
• Ask about what will increase kidney blood flow
         • Laying on your back and sleeping or resting.
         • Certain blood pressure lowering medications.
• Remain Alkaline. Should you need potassium post transplant ask about potassium citrate.
• Drink adequate water. Ask if 3 liters is a good quantity.
• Minimize dairy, animal proteins, and soy.
• Enjoy leafy vegetables, fresh fruits and many plant based foods.
• Eliminate salt, sugary, starches, and combining starches with proteins.
          • These will increase body weight. Some starches and proteins are sandwiches;
          • Meat and potatoes,
          • Nut breads,
          • Fish and rice,
          • Pasta and meatballs or cheese
• Eat animal proteins in small quantities. Gorging like a lion will drop your GFR filtration rate of that newly transplanted kidney.
• Diabetes can be a side effect of some of the transplant medications. One is called steroid diabetes. Tacrolimus and cyclosporin sometimes produce diabetes.

Sirolimus - treatment with the anti-rejection drug sirolimus may lead to increased risk of diabetes in kidney transplant patients, say researchers who analyzed data on about 20,000 Medicare patients who had kidney transplants between 1995 and 2003.None of the patients had diabetes before their kidney transplant. Compared to other anti-rejection drugs, sirolimus was associated with a 36 percent to 66 percent increased risk of diabetes after transplant.
Sirolimus - New-onset diabetes (NOD) is associated with transplant failure. A few single-center studies have suggested that sirolimus is associated with NOD, but this is not well established. With the use of data from the United States Renal Data System, this study evaluated the association between sirolimus use at the time of transplantation and NOD among 20,124 adult recipients of a first kidney transplant without diabetes.

Immunosuppression induced diabetes - 129 consecutive renal transplants done at St George's Hospital since 1995, with 1-year follow-up, treated with tacrolimus and prednisolone with the addition of azathioprine or mycophenolate mofetil in some cases. Our standard steroid dosing regimen is 500 mg methylprednisolone at the time of surgery, then 20 mg prednisolone per day, reducing by 5 mg every 2 weeks to a maintenance dose of 5 mg daily. Target tacrolimus whole blood 12 h post-dose (trough) concentrations were 15–20 ng/ml for the first week, 10–15 ng/ml for the first 3months, then 8–10 ng/ml until the end of the first year.

Reversal of corticosteroid-induced diabetes mellitus with supplemental chromium
A. Ravina*, L. Slezak*, N. Mirsky*, N. A. Bryden† and R. A. Anderson†
*Department of Diabetes, The Linn Clinic, Haifa, Department of, Biology, Oranim University of Haifa, Israel † Nutrient Requirements and Functions Laboratory, Beltsville Human Nutrition Research Center, Beltsville, MD, USA
Correspondence to: Dr Richard A. Anderson, USDA, ARS, BHNRC, NRFL, Bldg. 307, Rm. 224, BARC-East, Beltsville, MD 20705–2350, USA.

Conclusions:  These data demonstrate that corticosteroid treatment increases chromium losses and that steroid-induced diabetes can be reversed by chromium supplementation. Follow-up, double-blind studies are needed to confirm these observations.
Diabet. Med. 16, 164–167 (1999)    This is an older article and perhaps there are new current treatments available. A friend with PKD and PLD got severe diabetes from transplant medications. Eventually she needed a second transplant.