What to Eat After Kidney Transplant, Part 2

What to Eat after Kidney Transplant, Part 1, discussed the acute phase after kidney transplant. Now we will go into the long-term phase. In the long-term phase, transplant recipients have the same nutrition recommendations as a healthy person.¹ Calorie and protein needs are no longer increased as in the acute post-transplant phase. The main goals are to maintain weight, normal blood sugar (glucose) levels, blood lipids (fats) and blood pressure. The medications that transplant recipients take long term can increase the risk of health conditions, like obesity, new-onset diabetes after transplant, dyslipidemia and osteoporosis. Following a well-balanced diet and engaging in physical activity can help reduce your risk for these conditions.

Obesity

It is common for transplant recipients to gain 20 to 40 pounds in the 6 months post-transplant.¹ Weight gain tends to occur due to improved appetite after transplant and from the steroid medication.^1,2 To manage weight gain, it is recommended to make lifestyle changes to include diet, behavior modification and physical activity. General diet guidelines for weight management are:

• Limit high-calorie foods such as fatty foods, sweets and pastries
• Eat more foods high in fiber such as vegetables and fruits
• Eat lean meats, skinned poultry and fish
• Choose nonfat dairy products
• Drink sugar-free beverages such as water, unsweetened tea or coffee

Controlling weight may also help to decrease the risk of heart disease, diabetes and high blood pressure.²

New-Onset Diabetes after Transplant

Blood glucose levels can become elevated post-transplant due to the steroid medications.¹ It can lead to new-onset diabetes after transplant. Uncontrolled glucose levels increase the risk for infection and the risk of graft loss (transplant failing). Following a carbohydrate-controlled diet and increasing exercise can aid in controlling glucose levels. The transplant team may also prescribe oral diabetes medications and/or insulin.

Dyslipidemia

Dyslipidemia is elevated cholesterol and/or triglyceride levels.² The medications taken post-transplant may cause dyslipidemia. It is important to lower these levels as dyslipidemia increases the risk for cardiovascular disease. Lifestyle modifications are the first step in improving dyslipidemia and include weight loss, quitting smoking and reducing saturated fat, trans fat and cholesterol intake.¹ Cholesterol and triglyceride levels have also improved when people eat more high fiber foods such as whole grains, nuts, fruits and vegetables.  

Osteoporosis

Long-term steroid use affects bone formation and can lead to bone loss.¹ Steroids can decrease the absorption of calcium. Because of this, transplant recipients have increased calcium and vitamin D needs. It is recommended to consume 400 IU vitamin D per day and 1,500 mg of calcium/day. Dietary sources of calcium and vitamin D mainly come from dairy products. Two servings daily of low fat milk, cheese and/or yogurt can help meet the recommendations of calcium and vitamin D.² The transplant team may prescribe supplements to help meet increased needs.

Drug-Nutrient Interactions

Nutrition and herbal supplements can cause issues with a transplant.² It is important to discuss what herbs and supplements you currently take or are thinking of taking with your transplant team to determine if they are appropriate for you. Some nutrients in foods interact with certain medications and affect how they work in the body. Grapefruit and grapefruit juice affects the absorption of some transplant medications and should be avoided by transplant recipients. The transplant team will discuss other foods or nutrients that interact with prescribed medications that should be avoided.

In summary, there are changes that occur after a kidney transplant that may determine post-transplant dietary needs. A well-balanced diet and physical activity, plus working with the transplant care team, are an important part of treatment after receiving a transplant.

References:

1. Byham-Gray, L., Stover, J., & Wiesen, K. (2013). A clinical guide to nutrition care in kidney disease. Chicago, IL: Academy of Nutrition and Dietetics.
2. Diet and Transplantation. National Kidney Foundation. Accessed 6/25/2020. https://www.kidney.org/atoz/content/nutritrans

Additional Kidney Diet Resources

Visit DaVita.com and explore these diet and nutrition resources:

• DaVita Food Analyzer
• DaVita Dining Out Guides
• Today’s Kidney Diet Cookbooks
• DaVita Kidney-Friendly Recipes
• Diet and Nutrition Articles
• Diet and Nutrition Videos
• Kidney Smart® Virtual Classes

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.