Life after a transplant: medicines, check-ups, diet and everyday life

The first weeks and months

After discharge, clinic visits are frequent – sometimes several times a week at first. Blood tests check how the organ is working, medicine levels, blood count, blood sugar and any signs of infection. If all goes well, visits gradually drop to monthly and then to a few times a year, but follow-up with your transplant centre continues for life.

The wound heals over the first weeks, so avoid heavy lifting and straining. Agree with your team when to drive and return to work. Organ-specific advice is covered in our guides to kidney, liver, heart and lung transplants.

Anti-rejection medicines

Immunosuppressants stop your immune system attacking the new organ. Several groups are usually combined – calcineurin inhibitors, antiproliferative agents, mTOR inhibitors and/or corticosteroids. The regimen and doses are set by the transplant team and adjusted according to blood levels.

• Take them at the same times every day; a phone alarm and a pill organiser help.
• Never stop or change the dose yourself, even if you feel perfectly well.
• Check with your transplant doctor before taking any new medicine, including over-the-counter products, herbal remedies such as St John's wort and supplements – some change immunosuppressant levels. Grapefruit and grapefruit juice are usually avoided.
• If you miss a dose or vomit soon after taking it, follow your centre's instructions or call them.
• Order repeat prescriptions in good time so you never run out.

Signs of rejection and infection

Rejection often causes no symptoms and is found on blood tests, which is why check-ups matter so much. Still, look out for:

• fever, shivering or feeling generally unwell;
• kidney – less urine, swelling, rapid weight gain, pain over the kidney;
• liver – yellow skin or eyes, dark urine, pale stools, abdominal pain;
• heart – breathlessness, swelling, palpitations, feeling faint;
• lung – increasing breathlessness, cough, a fall in home spirometry readings.

If you notice any of these, contact your transplant centre straight away rather than waiting for your next appointment.

Protecting yourself from infection

The infection risk is highest in the first months, when immunosuppressant doses are at their highest. Simple measures help: wash your hands often, keep away from people who are unwell, follow good food hygiene (well-cooked meat and eggs, pasteurised dairy, washed fruit and vegetables) and wear gloves for gardening or cleaning up after pets.

Vaccines. Live vaccines are usually avoided after a transplant. The yearly flu jab and other recommended vaccines – such as pneumococcal and COVID-19 – are given on a schedule agreed with your team. Vaccinating the people you live with also helps protect you.

Heart health, metabolism and cancer prevention

Some immunosuppressants raise blood pressure, blood sugar and cholesterol, and can strain the kidneys. Looking after your heart is therefore a core part of care: control blood pressure, sugar and cholesterol, keep a healthy weight, follow a heart-healthy diet low in salt and sugar, and stay physically active.

Transplant recipients have a higher risk of some cancers, especially skin cancer. Use high-factor sunscreen, wear a hat and covering clothes, avoid sunbeds and have regular skin checks with a dermatologist. Take part in routine screening for your age as well – see our guide to cancer prevention.

Work, exercise, travel and relationships

Many people return to work a few months after their transplant. Build up activity gradually – walking, cycling, swimming once the wound has healed and your team agrees. Contact sports may need extra care, especially with a kidney sitting low in the abdomen.

Before travelling, pack enough medicine (plus spare) in your hand luggage, carry a doctor's letter and arrange insurance. Read up on food and water safety and required vaccines – some destinations call for live vaccines, which are usually not suitable for you.

Sexual activity can usually resume when you feel ready. Women should use reliable contraception and plan any pregnancy with the transplant team, because some medicines can harm an unborn baby and must be changed beforehand.

Emotional wellbeing

Feelings after a transplant are often mixed – relief and gratitude, but also fear of rejection, tiredness and mood changes (sometimes linked to medicines). Recipients of a deceased donor organ may also think a lot about the donor and their family. All of this is normal. Talking to a psychologist, a support group or other transplant recipients helps. If you notice lasting sadness or anxiety, tell your team.

Some recipients want to thank the donor's family. In many countries this is only possible anonymously, through the transplant coordinator, who can pass on a letter without personal details. The identities of donor and recipient are usually kept confidential by law. Family members and carers need support too: they often take on much of the caring in the first months and should have time to rest and know where to turn for help.

Follow-up after a transplant abroad

If you had your transplant abroad, for example at an accredited hospital in Istanbul, follow-up at home should be agreed before surgery: which doctor will see you, how results will be shared, how you will get your medicines and what to do in an emergency. Bring a full discharge summary, the operation report, your medication plan and contact details for the centre. Organisers such as New City Clinic can help with coordination and document translation, but medical responsibility stays with the treating teams. A transplant must always have been carried out legally, with no payment for the organ – see organ donation law and ethics.

When to get urgent help

Contact your transplant centre immediately, or call 112, if you have:

• a temperature above 38 °C or shivering;
• severe pain, especially over the transplanted organ;
• breathlessness, chest pain or fainting;
• vomiting or diarrhoea that stops you taking your medicines;
• a sudden change in urine, yellowing of the skin or rapid weight gain.

For an overview of the whole process, see our organ transplantation guide.