The Rogosin Institute

Every patient meets with a nutritionist following transplantation and recommendations are made based on each individual’s needs. Rogosin’s transplant nutritionists provide patients with important dietary information and assistance. They are available to discuss questions or arrange appointments. Please call 212-746-1577.

• General Dietary Guidelines
• Dietary Guidelines for Adults After Kidney Transplant
• Dietary Guidelines for Pediatrics After Kidney Transplant
  
  

General dietary guidelines

Following transplant, patients should eat plenty of protein (8-10 oz/day) for proper healing. To avoid decreases in phosphorus levels, patients should eat dairy products, nuts and legumes.

Certain medicines such as tacrolimus or Prograf may elevate serum potassium when the dose is high. Patients may need to avoid potassium until the dose is tapered.

Weight gain is not usually a major complaint in patients receiving non-steroid immunosuppressive drugs. Fluid retention may occur in the early stages after surgery, but this can be minimized by limiting high sodium foods.

Most patients at Rogosin are part of steroid-free protocols that eliminate the need for long term use of prednisone or other steroids.  However, if prednisone is prescribed, it can be associated with a “puffy appearance” in the face and torso. 

Prednisone and some immune suppressive medicines can also cause elevated blood pressure, elevated blood glucose levels or a rise in cholesterol in some patients. As a result, patients who receive Prednisone may need to avoid very salty foods and foods high in sugar or saturated fats following transplant surgery. These Prednisone side effects are not seen in everyone, but when they are, they are commonly experienced just after surgery when the doses are highest. As the does are tapered, the side effects diminish.

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Dietary Guidelines for Adults After Kidney Transplant

The following general nutrition guidelines apply to most adults who receive a kidney transplant. Your specific dietary requirements will be discussed with you by your transplant dietitian.

Protein
In the first 6 weeks after transplantation, protein intake should be relatively high to help you heal from surgery. Prednisone, especially high doses, can also have a tendency to break down muscle protein, and a high protein diet can overcome this effect. Good sources of protein include lean meat, fish, poultry and low-fat dairy products, such as milk, yogurt and cheese.
In the first 6 weeks, include at least 8-10 ounces of lean meat, fish, chicken or substitutes each day. It is reasonable to reduce intake after the first 6 weeks to 6-8 ounces of lean meat, fish, chicken, etc.

Potassium
A potassium restriction is usually not needed after transplantation although some people can develop a high potassium level related to Prograf (K-506). It is generally safe to gradually liberalize your potassium intake unless you are otherwise advised by a member of the transplant team.

Fluid
Keeping well hydrated is very important after transplantation. Approximately 2 liters or 2 quarts of fluid should be included daily. This is a minimum guideline.

Sodium
Salt or sodium restriction is usually needed right after transplantation to minimize fluid retention and help control blood pressure. Sodium intake of about 3 grams per day is reasonable. A 3 gram sodium diet means limiting added salt to ¼ teaspoon per day and avoiding salty foods like canned soups, frozen dinners, processed meat, pickles, olives, and snack foods. A 3 gram sodium diet will help maintain a healthy blood pressure and keep the kidney healthy.

Phosphorus
Phosphorus levels may actually fall too low shortly after transplantation. Include high phosphorus foods like milk, yogurt, cheese (non-fat or low-fat) along with beans and other legumes and whole grains to help you maintain a normal phosphorus level.

Calcium
Long term use of Prednisone can contribute to osteoporosis or thinning of the bones. It is important to include adequate sources of calcium in the diet – the equivalent of 4 glasses of milk each day, preferably non-fat. If you find that you are not routinely including milk & milk products let your physician or dietitian know, as a calcium supplement may be necessary. Always check with you doctor before starting or changing your dose of calcium or any other medication or supplement.

Weight Gain
Excessive weight gain following transplantation can be a serious problem and can contribute to high blood pressure, high cholesterol, the development of diabetes and the loss of the transplanted kidney function. Excessive weight gain is avoidable! People successful in controlling their weight tend to do the following: Avoid excessive fats, sweets and second helpings, and include aerobic exercise such as brisk walking in their daily routine. Some type of regular activity, whether it is walking or eventually swimming, bicycling, jogging etc. plays a key role in maintaining the health and well-being of people with kidney transplants. Check with your doctor before starting this or any other exercise program.

Sugar
Sugar can be included in your diet after transplant, provided your blood glucose levels are well controlled. Limiting sweets, however, can be helpful in controlling weight gain, and in combination with a high protein diet in the first month after transplant, may help control the moon face that some people develop on Prednisone.

Cholesterol
Rapamune, Cyclosporine and Prednisone increase the risk for developing high blood cholesterol levels. High cholesterol levels are a known risk factor for heart disease. Therefore it is important to help control cholesterol with diet, exercise and if necessary, with medication. Limiting total fat intake, especially saturated fats (animal products) and trans fats (hydrogenated oils), can be helpful in controlling cholesterol levels. Blood cholesterol levels will be checked periodically. Further diet intervention and/or medication will be advised as needed.

Vitamins
Vitamin supplements are not usually needed after transplantation provided a well rounded intake of fruits, vegetables, grains and dairy products are included in the diet. Two specific vitamins should NOT be supplemented beyond what is available in foods: Vitamins A and C. Before starting any vitamin or mineral supplement, it is best to check with your dietitian or physician.

Alcohol
In the early post-transplant period avoiding alcoholic beverages is recommended. Later, an occasional drink should be fine for most people, but it is best to check with your dietitian or physician.

Food Safety
People on immunosuppressive medications are at higher risk of infections related to foods that are improperly prepared or stored. Make sure meat, poultry, fish and eggs are thoroughly cooked before eating. Clean technique and common sense should be used in food preparation and storage, but also when dining out. Buffets and salad bars should be avoided as these have increased risks for food contamination.

Grapefruit and Grapefruit Juice
Grapefruit, grapefruit juice and grapefruit soda may interfere with medications that you are taking. Avoid these foods and beverages.

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Dietary Guidelines for Pediatrics After Kidney Transplant 

The following general nutrition guidelines apply to most pediatric patients who receive a kidney transplant. Your specific dietary requirements will be discussed with you by your transplant dietitian.

Protein
In the first 6 weeks after transplantation, protein intake should be relatively high to help you heal from surgery. Prednisone, especially high doses, can also have a tendency to break down muscle protein, and a high protein diet can overcome this effect. Good sources of protein include lean meat, fish, poultry and low-fat dairy products, such as milk, yogurt and cheese.  In the first 6 weeks, increase your intake of these high protein foods.

Potassium
A potassium restriction is usually not needed after transplantation, although some people can develop a high potassium level related to cyclosporine or Prograf (K-506). It is generally safe to gradually liberalize your potassium intake unless you are otherwise advised by a member of the transplant team.

Fluid
Keeping well hydrated is very important after transplantation. High fluid intake should be encouraged, drinking mainly water rather than calorie-containing beverages.

Sodium
Salt or sodium restriction is usually needed right after transplantation to minimize fluid retention and help control blood pressure. Sodium intake may be restricted if you have hypertension and may be liberalized as hypertension subsides with decreases in medication.  Foods high in sodium include canned soups, frozen dinners, processed meat, pickles, olives and snack foods. You should continue to monitor your sodium intake throughout your life to help maintain blood pressure and keep your kidneys healthy.

Phosphorus
Phosphorus levels may actually fall too low shortly after transplantation. Include high phosphorus foods like milk, yogurt, cheese (non-fat or low-fat) along with beans and other legumes as well as whole grains to help maintain a normal phosphorus level.

Calcium
Long term use of Prednisone can contribute to osteoporosis or thinning of the bones. It is important to include adequate sources of calcium in the diet, such as milk and milk products.  If you find that you are not routinely including milk and milk products, let your physician or dietitian know, as a calcium supplement may be necessary. Always check with you doctor before starting or changing your dose of calcium or any other medication or supplement.

Weight Gain
Excessive weight gain following transplantation can be a serious problem and can contribute to high blood pressure, high cholesterol, the development of diabetes and the loss of the transplanted kidney function. Excessive weight gain is avoidable! People successful in controlling their weight tend to do the following: Avoid excessive fats, sweets and second helpings, and increase their daily physical activity. Some type of regular activity, whether it is walking or eventually swimming, bicycling, etc. plays a key role in maintaining the health and well-being of people with kidney transplants. Check with your doctor before starting this or any other exercise program.

Sugar
Sugar can be included in your diet after transplant, provided your blood glucose levels are well controlled. Certain medications needed during the first 6 months after transplant may increase blood sugars or cause diabetes.  Limiting simple carbohydrates (sweets, snack foods, juices, candy, sodas) is recommended during this time.  Limiting sweets can also be helpful in controlling weight gain, and in combination with a high protein diet in the first month after transplant, may help control the moon face that some people develop on Prednisone.

Fat/Cholesterol
Rapamune, Cyclosporine, and Prednisone increase the risk for developing high blood cholesterol levels. High cholesterol levels are a known risk factor for heart disease. Therefore it is important to help control cholesterol with diet, exercise, and, if necessary, medication. Limiting total fat intake, especially saturated fats (animal products) and trans fats (hydrogenated oils), can be helpful in controlling cholesterol levels. Blood cholesterol levels will be checked periodically. Further diet intervention and/or medication will be advised as needed.

Vitamins
Vitamin supplements are not usually needed after transplantation if a well-rounded intake of fruits, vegetables, grains, and dairy products are included in the diet. Two specific vitamins should NOT be supplemented beyond what is available in foods: Vitamins A and C. Before starting any vitamin or mineral supplement, it is best to check with your dietitian or physician.

Food Safety
People on immunosuppressive medications are at higher risk of infections related to foods that are improperly prepared or stored. Make sure meat, poultry, fish, and eggs are thoroughly cooked before eating. Clean technique and common sense should be used in food preparation and storage, but also when dining out. Buffets and salad bars should be avoided as these have increased risks for food contamination.

Grapefruit and Grapefruit Juice
Grapefruit, grapefruit juice and grapefruit soda may interfere with medications that you are taking. Avoid these foods and beverages

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