Kidney Transplant

Kidney transplantation is the definitive treatment for end-stage renal disease, offering superior survival and quality of life compared to dialysis. The transplanted kidney is placed in the iliac fossa (not the native kidney location), and the client will have a surgical incision in the lower abdomen. Post-operatively, urine output is the most critical indicator of graft function — expect large volumes initially due to osmotic diuresis, then monitor for sudden decreases suggesting rejection or vascular complications. Acute rejection is the primary threat and can occur within days to months. Signs include fever, graft tenderness over the iliac fossa, decreased urine output, rising serum creatinine, hypertension, and weight gain from fluid retention. Any sustained rise in creatinine from baseline is significant and warrants prompt evaluation. Lifelong immunosuppression with agents like tacrolimus, mycophenolate, and corticosteroids is non-negotiable — missing even a few doses can trigger rejection. The nursing priority triad: strict I&O monitoring, infection prevention (immunosuppressed clients are profoundly vulnerable), and immunosuppressant adherence with trough-level monitoring. Tacrolimus trough levels are typically maintained at 8–12 ng/mL early post-transplant, then 5–8 ng/mL during maintenance.