Safe living after transplantation

Living with a lowered immune system as a result of transplant medications means making simple adjustments to your lifestyle to protect your new organ.

From how to reignite sexual desire post-surgery; how much alcohol recipients can drink; how to enjoy life and maintain peace of mind with simple hygiene and screening schedules – this section covers it all.

Lifestyle

Clean hands protect you

To minimise the spread of organisms, wash your hands with soap and water:

  • Before preparing food and before eating
  • Before and after touching catheters and wounds (whether or not gloves are used)
  • After touching body fluids, excretions or items that might have had contact with human or animal fluids like clothing and toilets
  • After going to a public place
  • After removing gloves
  • After collecting or depositing garbage

Avoiding the common cold

In the initial months following a transplant, when you’re on high doses of immunesuppressants, you can socialise gradually. You will be able to do normal things once the doses of the immune medicines have reduced and stabilised. Try to stay away from crowded areas such as shopping malls, subways and elevators, where close contact with people with respiratory illness is likely.

Avoid close contact with people with colds or respiratory illnesses. Wear a surgical mask if contact with a person with flu or respiratory illness is unavoidable. Ideally both the infected person and the transplant recipient should wear a standard surgical mask.

Food safety

It’s important to reduce risk of getting foodborne infections by taking these simple precautions:

  • wash your fruitsIdeally, eat only freshly cooked food. However, leftovers can be eaten if they are refrigerated promptly and kept no longer than a day. It’s important not to eat food if there’s any doubt about its hygienic preparation or storage
  • Wash and dry raw fruit and vegetables well
  • Thoroughly cook all raw meat, chicken and fish
  • Reheat food until it is steaming hot
  • If you are keeping food hot, keep it very hot (60°C or hotter). Keep cold food cold (5°C or colder). Don’t leave foods to cool on the bench or stove top. Put them in the refrigerator after the steam has gone
  • Keep your refrigerator clean and operate it below 5°C
  • Keep stored foods covered
  • Store raw meat separately from cooked and ready-to-eat food. Store it below other foods so that there’s no chance it will drip onto other foods
  • Thaw ready-to-eat frozen food in the refrigerator or microwave – don’t thaw at room temperature
  • Thoroughly wash and dry hands before preparing food
  • Wash knives, cutting boards and kitchen appliances, and dry after handling raw food to prevent contamination of cooked and ready-to-eat foods
  • Choose and consume foods well within their ‘use by’ or ‘best before’ date

Foods that are steaming hot are safe to eat. While eating out, choose menu items that are cooked to order and served hot. Do not eat food that is served lukewarm. Ready-to-eat foods from salad bars may have been prepared and refrigerated some time before they are put on display. Listeria bacteria may have grown in these foods so they are best avoided. For more on food safety click here.

In particular, watch out for bacteria which may be found in shellfish. Eat shellfish like prawns and crabs that are well cooked.  

Bacteria found in soil, water and some animals – including poultry and cattle – can be present in raw milk and foods made from raw milk. It can also contaminate a variety of processed meats and can be killed by cooking and pasteurization.

Smoking and alcohol

Smoking increases the risk of chronic rejection, cancer and heart disease. It’s strongly recommended that you stop ASAP. 

Alcohol in moderation (one standard drink per day) is usually acceptable, but you need to discuss this with your dietitian and transplant nurse. Know your limits and work with them.

Regularly drinking alcohol above the maximum recommended amounts can raise blood pressure. This can be dangerous for your new organ, and also cause weight gain.

Each of these is one standard drink. A standard drink contains approximately 10 gms of pure alcohol.

Adapted from the NSW government alcohol fact sheet.

 Recommended limits for alcohol intake

Type of organ transplanted
Male
Female
Kidney, Pancreas, Islet 
2 standard drinks per day
1 standard drink per day
Heart, Lung 
2 standard drinks per day
2 standard drinks per day
Liver 
Alcohol should be avoided for the first year after your liver transplant under any circumstances. Moderate alcohol consumption may damage the new liver.
You may have an alcoholic beverage to celebrate special occasions. Remember to limit your intake to one to two glasses of wine or champagne, or one to two glasses of beer.
People whose liver disease was caused by alcohol should never drink alcohol again.

Water / swimming safety

  • If you are traveling to countries with poor sanitation, avoid tap water or ice cubes or inadvertently ingesting water during showers
  • Swimming in chlorinated pools is safe, as is swimming in the ocean. If you incur abrasions, clean the wound thoroughly with soap and uncontaminated water (not the water you were swimming in) to reduce risk of infection, and refrain from swallowing water during swimming
  • Stay away from water that’s likely to be contaminated with human or animal waste
  • Swimming in fresh water lakes, unchlorinated pools, ponds, rivers and creeks can be risky for transplant recipients as they contain bacteria

Outdoor activity and pets

  • Wear gloves whenever handling heavily contaminated materials such as soil, moss or manure
  • Ensure you’re well covered, wearing shoes, socks, long pants and long-sleeved shirts while doing gardening, yard work or being in parks and wooded areas
  • Consider waiting to acquire a new pet until you’re stable with immune suppression (at least 6–12 months after transplantation)
  • Maintain hygiene after touching or cleaning up after pets and animals
  • Seek veterinary help at the first signs of illness in a pet
  • Avoid cleaning birdcages, bird feeders, aquariums, litter boxes and handling animal faeces. If this is not possible, disposable gloves and a standard surgical mask should be used
  • Avoid stray animals

Additional precautions for children who have been transplanted

  • Wash hard plastic toys and games regularly in the dishwasher or with hot soapy water
  • Hand-wash or wash soft toys on delicate cycle in washing machine

kids-toys

  • Keep your child away from bath toys that retain water like rubber ducks or toys that can squirt water
  • Avoid toys and games that cannot be washed or cleaned like toys with electronic parts or holes that can retain water

Sex after transplantation

After a transplant you can start doing the things you enjoyed before, including having sex. Sexual activity will not harm your transplanted organ.

Practicing safe sex is important for everyone, but especially for those with a transplant.

What is safe?

If you’re single or starting a new relationship, be aware that recipients can catch infections easily due to a low immune system. Remember to follow safe sexual health practices to reduce the risk of sexually transmitted diseases.

Condoms, diaphragms and spermicidal jellies are safe to use, as are some contraceptive pills, but you must clarify the brand with your transplant doctor. Unsafe sex may put you at risk of STIs such as chlamydia, gonorrhoea, syphilis, or hepatitis B, or may result in an unplanned pregnancy.

Consider using latex condoms during sexual activity with long-term monogamous partners during periods of increased immunosuppression. Monogamous relationships/decreasing the number of sexual partners will help reduce the risk from infections.

It’s important to discuss sexual preferences and practices with your doctor to ensure you’re protected.

Beware – kissing people with cold sores could put you at risk of herpes.

Report genital rashes, sores, unusual discharge or yeast infections immediately.

Women on immunosuppressants are more prone to urinary tract infections than men. Emptying your bladder before and after sexual activity helps get rid of bacteria in the urethra and reduce this risk. Infections can develop within the first 24 hours after having sex.

Screening for safety

All recipients are encouraged to have regular Pap smears and anal smears.

Homosexual men must have their HIV screening and STI screening as per national protocols.

STI screens can also be carried out for those who have had unprotected sex and are not aware of the status of their partner.

Sexual desire and pregnancy after transplant

Fertility and libido returns quickly after transplantation and many recipients have successfully become parents. While some recipients find an increase in sexual function and desire, others can experience a loss of libido or feel differently about their body after the transplant.

Transplant medications can cause weight gain, acne, bruising and increased body hair causing recipients to feel unattractive and less interested in sex. Speak to your doctor as they can suggest alternative medications to reduce these side effects.

Women are encouraged to use double contraception unless she has had a tubal ligation or her male partner is known to have had a vasectomy. Intra-uterine devices (IUD) such as Mirena is also recommended. If the Oral Contractive Pill (OCP) is the choice, it should be a full pill not the mini pill. It’s safe for recipients to use barrier methods such as condoms or diaphragms with the pill.

There is a risk of organ rejection in the initial years of transplant. For female recipients, it’s recommended that you wait for a period of at least 2 years before considering pregnancy. To keep yourself safe from unplanned pregnancies, use contraceptives.

Talk to your doctor if you’re planning on becoming a parent because the side effects from transplant medications can be unsafe for the fetus. Many recipients have had successful pregnancies wherein their doctors have adjusted the transplant medications to minimise hazards to them and their unborn child. It’s vital that your transplant doctor, gynecologist and obstetrician are all in contact whilst managing your pregnancy.

This resource discusses how to recover your libido, and pregnancy post-transplant.

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Acknowledgements

Transplant Australia gratefully acknowledges the contribution of A/Prof Germaine Wong, Transplant Nephrologist at Westmead Hospital in reviewing this material.