My experience in a renal transplant ICU
Deepa. S1, Subathra Devi. M2, Maha Lakshmi3
1Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu
2Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu
3Nursing Superintendent, Kauvery hospital, Cantonment, Trichy, Tamil Nadu
Abstract
Renal transplantation is a lifesaving intervention for the patients with end stage renal disease. Nurses play a vital role throughout the journey from preoperative to postoperative care. This article explores the nursing challenges, responsibilities, patient education, medication, psychological support and infection prevention and is based on my personal experience as a transplant ICU nurse.
Introduction
Renal transplant offers a new life to patients with end stage renal disease. As a nurse, I have witnessed the lot of physical and emotional transformation in patients and relatives. At our unit approximately five transplants are done each month including both cadaveric and live donor transplant. Nursing care is essential throughout the journey of transplant.
Pre-operative Phase
In my professional experience, preoperative preparation for renal transplant patients involves a comprehensive approach that addresses both the recipient and, in the case of a living donor transplant, the donor as well. Once the patient is admitted to the ward, our responsibility begins with ensuring a thorough assessment, patient readiness, and emotional preparedness for surgery.
Admission and Initial assessment
Upon admission, I verify the patient’s identity, review the medical history, check preoperative investigations, and confirm that all required reports such as blood tests, imaging, and cross matching are available. Baseline vital signs are record, and a physical assessment is conducted to identify any potential concerns that may need to be address before surgery.
Preparation of the recipient
For the recipient, the preparation includes:
- Ensuring that dialysis sessions are complete as advised by the nephrology team.
- Maintaining strict infection prevention measures, including preoperative antiseptic bathing and hygiene protocols.
- Reviewing medications and stopping or adjusting drugs as per the surgical and nephrology team’s orders.
- Keeping the patient fasting as per preoperative instructions.
- Preparing the surgical site as per protocol.
Preparation of the Donor (in Living Donor Cases) in living donor transplants, the donor’s physical readiness is equally important. I ensure all preoperative investigations and clearances are in place, monitor their vital signs, and prepare them according to surgical protocols.
Physical Counselling and Guidance
I provide clear, step -by-step explanations to both the recipient and donor regarding:
- Preoperative fasting instructions.
- What to expect during the transfer to the operation theatre.
- Postoperative pain management and monitoring.
- Early mobilization and breathing exercises after surgery.
Psychological Counselling and Emotional Support
A major part of my role is offering emotional reassurance and psychological counselling. Many patients and families experience fear, anxiety, or uncertainty.
- Listen to their concerns patiently.
- Reassure them about the surgical process and the medical team’s expertise.
- Provide realistic expectations about recovery and possible outcomes.
- Encourage open communication between the patient, family, and healthcare team.
Family involvement: I actively involve family members in the preparation process—educating them on postoperative care needs, infection prevention, dietary modifications, and the importance of follow-up visits. In living donor cases, I ensure both families receive equal emotional support.
Final Preoperative Checks
- Before transfer to the operation theatre, I reconfirm
- Consent forms are completed.
- All reports are available.
- The patient is in proper preoperative attire.
- Jewelry, dentures, and other personal items are remove as per protocol.
- IV access is secured, and premedication is administered if ordered
- NPO as per the instruction.
Coordinate with the surgeon OT team and prepare the patient mentally and physically ready before transfer to OT.
The Transplant procedure
- Performed under general anesthesia
- The new kidney placed in the lower abdomen
- The recipients own kidney usually not removed unless any complications
- Blood vessels from the new kidney are connect to the patients’ vessels and ureter is attached to the bladder
Intra operative and immediate postoperative care
Once the surgeon proceeds with the renal transplant in the operation theatre, my role shifts towards active coordination and seamless communication with the ICU team to ensure that the patient receives optimal care during the critical immediate postoperative period—particularly the first 24 to 72 hr, which are crucial for graft function and patient stability.
Intraoperative Coordination: During surgery, I maintain close communication between the OT team and ICU staff regarding
- Surgical progress updates – so the ICU is ready to receive the patient promptly after the procedure.
- Patient condition alerts – informing ICU if any intraoperative complications arise that require special preparation (e.g., hemodynamic instability, excessive blood loss).
- Preparation for specialized monitoring – ensuring that necessary ICU equipment such as invasive pressure monitoring, dialysis setup (if needed), and warming devices are ready before patient arrival.
Transfer from OT to ICU: At the end of the surgery, I accompany or coordinate the safe transfer of the patient to the ICU, ensuring:
- Airway security – confirming endotracheal tube or airway status if the patient is still intubated.
- Hemodynamic stability – monitoring blood pressure, heart rate, oxygen saturation during transfer.
- Safe handover – giving a structured handover to the ICU team including surgical details, intraoperative fluid balance, medications given, blood transfusion details, urine output during surgery, and any specific postoperative concerns from the surgical team.
Immediate Postoperative Critical Care Coordination (First 24–72 hr)
In collaboration with the ICU nursing and medical team, I focus on:
Vital Signs Monitoring: Continuous monitoring of blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature to detect early signs of graft rejection, infection, or hemodynamic instability.
Intake and Output Monitoring: Accurate documentation of all IV fluids, medications, and oral intake; measuring urine output hourly to assess graft function.
Fluid and Electrolyte Balance: Close observation of serum electrolytes (particularly potassium, sodium, calcium, and bicarbonate levels) to prevent imbalances that could affect the graft and overall recovery.
Fluid Maintenance: Administering IV fluids as per the surgeon/nephrologist’s orders, adjusting for urine output and hemodynamic parameters.
Pain and Comfort Management: Coordinating with ICU staff for adequate analgesia and patient positioning to prevent discomfort and complications.
Electrolyte Imbalance Surveillance: Regular monitoring of serum potassium, sodium, calcium, and bicarbonate levels is performed as per the nephrology team’s advice. I promptly report any abnormal values to the medical team for immediate correction, preventing life-threatening complications.
Drain Status Observation: Drain output is measured, documented, and assessed for color, volume, and consistency. Any sudden increase in output or appearance of blood/clots is immediately escalated to the surgical team.
Kidney Ultrasound Coordination: I coordinate timely postoperative kidney ultrasounds as ordered, to assess graft perfusion, vascular status, and early detection of complications such as thrombosis or obstruction.
Bleeding or Hematoma Surveillance at Surgical Site: The surgical site is inspected frequently for any swelling, bruising, oozing, or signs of hematoma. Early detection allows for immediate intervention, minimizing the risk of graft compromise.
Surgical Site Wound Care: I maintain strict aseptic technique during dressing changes. The wound is kept clean, dry, and monitored for signs of infection such as redness, warmth, or discharge.
Immunosuppression Management and Education: As per consultant advice immunosuppressive medications administered to ensuring accurate timing and dosage to prevent graft rejection. I educate the patient and family about the lifelong importance of these medicines
Psychological Support to Reduce Fear of Rejection: I provide emotional reassurance, addressing concerns about rejection and recovery. Open communication helps reduce anxiety and improve patient cooperation during recovery.
Infection Prevention Measures: I strictly follow infection control protocols, including hand hygiene, use of protective equipment, and limiting unnecessary exposure to visitors.
Biopsy Coordination (If required I prepare the patient for a renal biopsy, ensuring informed consent, explaining the procedure, and assisting during and after the biopsy for monitoring bleeding or discomfort.
Family Updates and Support: I also play an important role in updating the family regarding the patient’s transfer to ICU, the plan for the immediate recovery phase, and the importance of restricted visitation during the critical monitoring period.
Renal transplant post op investigation check list
| S. No | POD | Investigation |
|---|---|---|
| 1 | Day 1 | CBC, RFT, Electrolytes, Calcium, Magnesium |
| 2 | Day 2 | CBC, RFT, Electrolytes |
| 3 | Day 3 | CBC, RFT, Electrolytes |
| 4 | Day 4 | TAC – Level, RFT, Electrolytes, Calcium, Magnesium |
| 5 | DAY 5 | CBC, RFT, Electrolytes |
| 6 | DAY 6 | CBC, RFT, Electrolytes, USG Abdomen & Renal Doppler |
| 7 | DAY 7 | CBC, RFT, Electrolytes |
Discharge preparation, Follow up, and Health education
Assessment of Discharge Readiness: Before initiating discharge, Is hemodynamically stable with normal vital signs. Maintains adequate urine output, indicating good graft function. Is tolerating oral medications and oral diet without nausea or vomiting. Has no signs of active infection, bleeding, or surgical complications.
Coordination with the Multidisciplinary Team: I confirm that all relevant investigations, such as blood tests and imaging, are satisfactory. I coordinate with the pharmacist, dietitian, and physiotherapist for patient counselling and guidance.
Patient and Family Education
Education is the cornerstone of discharge preparation to ensure long-term transplant success. I provide detailed counselling on:
- Immunosuppression Therapy: Importance of taking medications at the exact prescribed time every day. Possible side effects (e.g., swelling, increased infection risk, weight gain) and the need to report any unusual symptoms immediately. Lifelong adherence to medication to prevent graft rejection.
- Medication Adherence and Review: I review the prescription with the patient and family, together with the pharmacist, to ensure understanding of each medication’s purpose and schedule. I demonstrate how to set reminders or use medication boxes for accuracy.
- Lifestyle Modifications: Strict avoidance of smoking and alcohol. Importance of adequate hydration and balanced nutrition as per the dietitian’s plan. Diet pattern: low salt, balanced protein intake, and avoiding raw or unpasteurized foods.
- Infection Prevention: Practice proper hand hygiene techniques before eating, after using the toilet, and after contact with other people. Avoiding crowded places, especially during the first few months’ post-transplant. Wearing a mask when going out in public during the recovery phase.
- Monitoring and Follow–Up: Attending frequent follow-up visits for blood tests and check-ups to monitor kidney function and detect any complications early. Knowing the schedule for blood investigations and clinic reviews.
- Early Warning Signs to Report: Fever, decreased urine output, swelling, pain over graft site, shortness of breath, or unusual tiredness.
Final Discharge Process: I provide a discharge summary prepared by the medical team, ensuring the patient/family understands all instructions. Emergency contact numbers and follow-up appointment details are given. I confirm that the patient and caregiver feel confident in managing care at home before final discharge.
Challenges and lessons learned in nursing care
One of the major challenges in renal transplant nursing care is medication non-adherence, which poses a serious threat to transplant success. Failure to take immunosuppressive drugs as prescribed can lead to kidney graft rejection and severe complications. Additionally, the risk of infection is significantly higher in transplant patients due to their immunocompromised state. In this context, infection control techniques, especially strict hand hygiene practices, play a vital role in preventing hospital- and community-acquired infections.
Another important aspect of my role is coordinating care among multidisciplinary teams and ensuring smooth communication between surgeons, nephrologists, pharmacists, dietitians, and ICU staff. Addressing the emotional needs of patients and families is equally important, particularly when dealing with language or literacy barriers that may affect understanding of treatment plans.
Each case has taught me the value of critical thinking, empathy, clear communication, and evidence-based practice. I have learned that my role as a nurse extends beyond technical skills—it involves advocacy, education, emotional support, and proactive coordination to improve patient outcomes and ensure the long-term success of the transplant.
Conclusion
My experience in renal transplant has my respect for human resilience and the power of organ donation. Working in the renal transplant team has taught me the value of life. Renal transplant is not just a surgery, it’s a life long journey. Every successful transplant feels like a shared victory between the patient and us. We as nurses are the pillar of transplant success. Being part of a team that gives pride, each patient renewed a second life. Through thorough assessment, structured education, and emotional support, I ensure that renal transplant patients and their families leave the hospital fully prepared for a safe and healthy recovery, with a clear understanding of medication adherence, lifestyle precautions, and follow-up care. We are happy to hear patients say I`m able to live without dialysis with a smile.
