Understanding Kidney Failure

The kidneys are a pair of bean-shaped organs in the back of the body and they perform the following functions:

Remove waste products from the body
Keep the fluid content of the body in balance
Control the amount of acid and minerals e.g. salt and potassium in the body
Produce hormones that help control blood pressure, red blood cell, and bone production
Remove drugs from the body

When kidneys are unable to perform the above functions one will suffer from end-stage kidney failure. The failure of the kidneys to perform these functions will lead to a build-up of waste products, water, acid and minerals that may result in poor appetite, weight loss, nausea/vomiting, itchiness, breathlessness, swollen limbs, high blood pressure and changes in behaviour. Failing kidneys may also cause changes in hormone production which may lead to low red blood cell count and weak bones. In the most severe cases of end-stage kidney failure, one may become unconscious, develop fits and eventually die if they do not receive treatment.

Treatment Options for Kidney Failure

Haemodialysis: also known as blood dialysis, haemodialysis is a form of dialysis that takes place outside the body with a machine where blood is drawn from the arm through catheters
Peritoneal dialysis: this is done at home through a catheter in the abdomen where a specialised fluid called dialysate is filled into the abdomen
Kidney transplant: is a surgery to place a healthy kidney from a deceased or living donor.

Compared to haemodialysis or peritoneal dialysis, kidney transplantation is the preferred treatment for patients who are assessed by their doctor to be suitable.

Consulting your healthcare team is the best way to determine the most appropriate treatment option for your specific condition.

Kidney Transplant Team and Services

Multidisciplinary Transplant Team

Our comprehensive kidney transplant programme is supported by a dedicated team of specialists, coordinators, and allied health professionals working collaboratively to deliver personalised patient care and kidney failure treatment.

Leadership Team	Transplant Program Director: Prof Terence Kee Yi Shern Deputy Director (Medical): Dr Sobhana D/O Thangaraju Director (Surgical): Dr Valerie Gan Huei Lin Transplant Program Manager: Ms Yong Jinhua
Medical Team	Transplant Physicians: Dr Ho Quan Yao, Dr Liew Ian Tatt, Dr Carolyn Tien Shan-Yeu Transplant Surgeons: A/Prof Ng Lay Guat, Dr Edwin Jonathan Aslim, Dr Lim Ee Jean Transplant Infectious Diseases Physician: Dr Jasmine Chung Transplant Endocrinologist: Dr Kek Peng Chin
Transplant Coordination Team	Living Kidney Transplant Coordinators: Ms Lee Chui Wan Constance, Ms Leah Xin Hui Chelsi Nicole, Ms Siew Li Ting, Ms Tan Jia Qin, Ms Deah Auxiel Gamayot Barrete Waitlist Kidney Transplant Coordinators: Ms Ong Zi Hui Sharel, Lee Chin Yee, Wong Ho Yan Clinical Kidney Transplant Coordinators: Ms Kwan Qian Yi Natelie, Ms He Xia, Ms Ngew Jia Ying Janelle, Ms Sheena Soh Yee Ling
Allied Health & Support Team	Specialty Nurse (APN): Sister Maslinna Binte Abdul Rahman Transplant Medical Social Workers: Ms Jackie Erh Juat Khee Ms Goh Soo Cheng, Ms Li Nianci, Ms Foo Min Chen Geraldine Charmaine, Mr Clinton Shi Zeshen, Ms Faith Wong Ming Fei Transplant Dietician Lead: Ms Tan Sheau Kang Transplant Pharmacists: Dr Lee Puay Hoon, Dr Lim Rou Wei Transplant Physiotherapy: Ms Low Wai Yan, Ms Ling Mei Qing, Ms Seet Xian Tong Transplant Administrative Support: Senior Associate Executive: Ms Tan Ai Hoon Judy, Ms Kay Xin Lin Joey Associate Executive: Ms Leong Jenny

Our Services

Our services include:

Pre-Transplant Evaluation
- Assess potential kidney transplant recipients
- Evaluate living kidney donors
Transplantation Procedures
- Deceased donor kidney transplants
- Living donor kidney transplants
- ABO-incompatible kidney transplants
- HLA-incompatible kidney transplants
- Paired kidney donor exchange transplants
Post-Transplant Care
- Diagnose and manage transplant complications
- Provide complex immunosuppression therapy
- Offer transplant-related support for non-kidney transplant recipients
Living Donor Care
- Long-term follow-up and care for living kidney donors
Patient Education and Support
- Multidisciplinary counselling services
- Comprehensive transplant education programs
Transplant Counselling Services
- Educational sessions on kidney transplantation and donation
- Available at SGH
- Support for patients and potential donors
Specialised Transplant Services
- Management of high-risk transplant cases
- Innovative transplant techniques and research
- Living kidney donor transplant for patients with Hepatitis C (HCV), Hepatitis B (HepB) and Human Immunodeficiency Virus (HIV)
Transplant Education Resources
- Informational materials on transplant process
- Support groups and peer mentoring programs

Specialties Clinics

The transplant centre runs specialties clinics to cater for the needs of the programme:

Early Post-Transplant Care Clinic
- Multidisciplinary follow-up for first 3-6 months post-transplant
- Seamless transition to long-term care with primary kidney physician
Transplant Assessment Clinic
- Comprehensive evaluation by multidisciplinary team
- Preparation for kidney transplantation
Waitlist Management Clinic
- Regular health checks for patients on deceased donor waitlist
- Ensuring readiness for transplant when organ becomes available
Living Donor Follow-Up Clinic
- Annual health monitoring for previous kidney donors
- Long-term care and support post-donation
BK Management Clinic
- Provides specialist care for the complex BK virus infection, which can cause kidney failure

Key Facilities

In order to provide patients with adequate comprehensive care to the best of our abilities, we leverage the following key facilities:

Transplant Centre: which provides a one-stop hub for our patients to receive multidisciplinary care in a seamless manner. Transplantations are conducted here where patients are served by physicians, transplant coordinators, nurses, dieticians, physiotherapists and pharmacists. The outpatient transplant centre also allows for outpatient therapies to be performed
Urology Centre: offers patients a comprehensive range of pre and post-surgical transplant assessment and care
Medical and surgical kidney transplant units: where patients with kidney transplantation are admitted for transplant surgery and cared for by dedicated multi-disciplinary team care. During their stay in these units, they will be cared for by a multidisciplinary team dedicated to inpatient kidney transplant care

Clinical Outcomes

Our kidney transplant programme consistently delivers exceptional clinical results that surpass international standards across both short-term and long-term outcomes.

	1-year			5-year
	Deceased Donor	Living Donor		Deceased Donor	Living Donor
SGH Patient Survival, 2021	100%	100%	SGH Patient Survival, 2017	93.50%	93%
International Benchmark, USRDS²	93.00%	98.10%	International Benchmark, USRDS²	75.10%	84.70%
SGH Patient Survival, 2022-2023	100%	100%	SGH Patient Survival, 2018-2019	90%	97%
International Benchmark, ANZ³	98%	99%	International Benchmark, ANZ³	88%	96%

	1-year			5-year
	Deceased Donor	Living Donor		Deceased Donor	Living Donor
SGH Graft Survival, 2021	100%	100%	SGH Graft Survival, 2017	93.50%	93%
International Benchmark, USRDS²	92.20%	97.40%	International Benchmark, USRDS²	76.10%	87.30%
SGH Graft Survival, 2022-2023	100%	100%	SGH Graft Survival, 2018-2019	90%	94%
International Benchmark, ANZ³	96%	98%	International Benchmark, ANZ³	83%	91%

*All graft survival rates reported above are not censored for death

Our Heritage & Achievements

Programme Milestones

1970 – The first deceased kidney donor transplant performed in South-East Asia at SGH
1976 – The first related living kidney donor transplant
1984 – The first successful childbirth from a female kidney transplant recipient
1988 – Introduction of cyclosporine as immunosuppression as the first mainstay immunosuppression to significantly reduce rejection
1989 – Histocompatibility laboratory transferred from SGH to a national laboratory
1990 – SGH celebrates 20 years of kidney transplantation in Singapore
1991 – The first living spousal kidney donor transplant
1992 – The first kidney transplant performed in a patient with diabetes
1994 – SGH celebrates performing its 500th kidney transplant
2003 – The first HLA incompatible living kidney donor transplant using therapeutic plasma exchange
2004 – Introduction of antibody induction agents basiliximab and thymoglobulin
2008 – Introduction of everolimus as alternative maintenance immunosuppression
2009 – Introduction of Tacrolimus and Mycophenolate as mainstay immunosuppression
2009 – The first ABO incompatible living kidney donor transplant
2009 – The first dual kidney transplant from a deceased kidney donor
2009 – The first 75-year-old living kidney donor transplant
2013 – Opening of the transplant centre at Blk 7 Level 1
2015 – The first paired living kidney donor exchange between SGH and NUH
2015 – The first outpatient kidney transplant biopsy is performed at transplant centre
2016 – First use of double filtration plasmaphresis for desensitization and treatment of antibody mediated rejection
2016 – Launch of "A New Sprout of Life " facebook community page for SGH kidney transplant recipients
2016 – First annual end of the year patient update symposium
2017 – First use of Glycosorb immunoadsorption for desensitization of ABO incompatible living kidney donor transplant recipients
2017 – Launch of National Donation After Cardiac Death pilot program
2018 – SGH performs its 1000th deceased kidney donor transplant
2018 – First ABO and HLA incompatible living kidney donor transplant
2018 – First transplant nephrology urology course
2019 – Collaboration with NKF to train dialysis centre nurses on kidney transplantation
2020 – SGH celebrates 50th years of kidney transplantation
2020 – Introduction of intraoperative thymoglobulin and tocilizumab to prevent and treat rejection
2020 – Introduction of cell-free DNA testing for non-invasive monitoring of graft injury and early detection of rejection in kidney transplant recipients
2021 – Use of telemedicine to provide continuity of ambulatory care of transplant recipients during the COVID-19 Pandemic
2022 – Introduction of SGH@Home services for transplant recipients
2022 – First Hepatitis B positive living kidney donor transplantation
2022 – Completion of National Donation After Cardiac Death pilot program
2024 - First HIV to HIV living kidney donor transplantation
2024 – First use of Bortezomib to treat antibody mediated rejection
2024 – National Donation After Cardiac Death mainstream program commences (13 February)
2024 – First internal paired kidney donor exchange at SGH (7 March)
2025 – First use of Therasorb immunoadsorption for desensitization of ABO and HLA incompatible living kidney donor transplantation
2025 – First of daratumumab to effectively treat antibody mediated rejection
2025 - Introduction of liquid biopsies and molecular microscope diagnostics in kidney transplantation

Kidney Transplant Programme Multimedia Gallery

Video Testimonies

Hit “Play” on the videos below to have a look at our department's expertise and the transplant journey through the eyes of our patients.

I am a Living Donor for Kidney Transplant

Kidney Transplant Video Collection SGH YouTube

Social Channels

Frequently Asked Questions about Kidney Transplant

Receiving a kidney transplant

Yes. Patients who are undergoing dialysis rely on dialysis machines to help filter wastes from the body. For haemodialysis, dialysis is only performed for about 12 hours per week, or peritoneal dialysis at around 10 hours per day. As a result, it may only be able to remove up to 70% of waste products from the body. Hence patients are required to continue strict fluid and dietary restrictions to prevent excessive waste accumulation.

However, a successfully transplanted kidney functions in a person’s body for 24 hours a day, hence the effectiveness in removing wastes can be like a person who does not have any kidney failure. After a successful transplant, patient will:

No longer require dialysis
Have a chance at a longer life-span
Experience an improved quality of life such as travelling, sports, return to education and/or employment
Increase their chances of having successful pregnancies; and be able to avoid the complications associated with long-term dialysis such as heart disease and nerve damage

You can undergo a kidney transplant when you:

Suffer from end-stage kidney failure, and already, or will soon require dialysis in order to maintain life and remain healthy
Have been assessed by your doctor to be medically and psychologically fit to undergo transplantation
Have a kidney available from a deceased or living donor for transplantation.

You can undergo a pre-emptive living kidney transplant when your kidneys are close to failure, before dialysis must be initiated.

If a pre-emptive transplant is not possible for you, you can start dialysis while waiting for kidney transplantation.

The fastest way to get a kidney transplant is through a living donor. If you have a willing family member or friend, we can evaluate them as a potential donor.

For deceased donor transplants, ensure you're actively registered on the National Transplant Registry System (NTRS) and keep all your medical appointments to maintain your eligibility. Stay as healthy as possible while waiting.

Surgery, risks, and recovery

Kidney transplantation is a major surgery conducted under general anaesthesia. During the surgery, a cut will be made in the lower part of the abdomen to place the donor kidney(s) into the patient’s body. The blood vessels from the donor kidney(s) are then connected to the patient’s blood vessels that supply blood to the legs. The ureter from the donor kidney(s) is/are connected to the bladder.

The patient’s own kidneys will not be removed unless there is a specific reason requiring such removal, such as an infection, or if it is necessary to make room for the new kidney(s) to be placed into the body. Besides the surgical operation, other tubes may be inserted for various purposes such as a central venous pressure (CVP) catheter into the vein of the neck to allow monitoring of fluid balance and the administration of fluids or medication, a urinary catheter into the bladder to monitor urine production, and a tube to drain fluid and blood from the operation site.

Finally, a small plastic tube (called a stent) is usually inserted into the connection between the ureter and bladder. This is removed 2 to 4 weeks after the transplant by an outpatient procedure called a cystoscopy under local anaesthesia.

Kidney failure and dialysis can affect the kidney patient’s physical function. Before transplantation, there is a window of opportunity to increase the success rate of their kidney transplantation through prehabilitation.

If the doctor assesses a patient to be frail or to have problems with mobility, they may require an assessment by a physiotherapist. The physiotherapist will work closely with the patient to prescribe an individualized exercise programme to improve their function to help with their recovery after surgery.

Kidney transplant surgery has no higher risk than other major surgery. However, as with all surgical procedures, complications can occur. The risk of death is less than 1%. Other possible risks of surgery include reactions to anaesthetic drug, blood clots, rejection of new kidney, bleeding and infection. We prioritise patient’s safety and do our best to manage these risks.

After completion of the transplant surgery, the patient generally stays in the hospital for one week. Some patients may require dialysis for a period of time if the newly transplanted kidney does not work immediately.

Prior to your discharge, you will be counselled and educated on various aspects of living and caring for your newly transplanted kidney. Upon discharge, it is extremely important that you take the medication as prescribed, undergo the tests that are ordered for you and attend your appointments with your doctor or transplant coordinator.

The incision for a kidney transplant is typically made in the lower abdomen, often extending from just above the pubic bone to one side of the lower abdomen. The exact location and size can vary depending on the surgeon's technique and the patient's body type.

Key points about kidney transplant scars:

Size: The scar is usually about 6 to 8 inches (15 to 20 cm) long
Appearance: Initially, the scar will be red and raised, but over time it usually fades and flattens
Healing: The scar healing process varies from person to person. It can take several months to a year for the scar to fully heal and fade
Scar care: Proper care of the incision site, as directed by your healthcare team, can help minimise the appearance of the scar
Individual variation: The appearance of the scar can vary based on factors like skin type, age, and overall health

Patients who do not have a living donor can be registered on the National Transplant Registry System (NTRS) if he/she fulfils the eligibility criteria to receive a DDKT.

Your kidney doctor will recommend registration on NTRS if you are medially eligible and willing. You are also encouraged to initiate and check with your doctor on your suitability for registration. A referral will be sent to the transplant team; after which you will be contacted by transplant coordinators to proceed with further screening tests to confirm your eligibility for registration.

These tests may include:

Metabolic screening
Cardiovascular screening
Infectious disease screening
Cancer screening

The criteria to be placed on the waiting list are stricter than the criteria to receive a living kidney donor transplant. This is because patients need to remain healthy and ready at any time to undergo kidney transplant surgery after a longer wait time. Patients who are NOT suitable to be placed on the waiting list include those with:

Poor heart function
History of stroke
Active untreated infection
History of untreated or treated cancers (except small kidney cancers that have been removed)
Ongoing psychiatric illness or drug addiction
Severely obese patients (body mass index 35 kg/m2 or more) who are unable to lose weight to decrease their BMI to < 35
Any other organ disease which is likely to worsen while waiting for a kidney transplant or increase the risk of a poor outcome after kidney transplantation

One may develop complications while on dialysis that may render them unfit to receive a kidney transplant. Some complications like infections can be treated but require a temporary suspension on the waiting list.

During this period, one will not be called for DDKT even if there is a suitable donor available. If one remains medically eligible, they will no longer be suspended once the complications are treated adequately. A suspension does not increase the waiting time as wait time starts from your date of first dialysis.

However, some complications may result in a permanent ineligibility remain on the waitlist to receive a DDKT. Hence, one would need to remain on dialysis if a living kidney transplant is not available.

Yes: the differences are:

Aspect	Living Donor Kidney Transplant (LDKT)	Deceased Donor Kidney Transplant (DDKT)
Transplant Outcomes	Better outcomes	Good outcomes, but generally not as good as LDKT
Kidney Longevity	Usually last longer	May not last as long as living donor kidneys
Average Waiting Time	Approximately 6 months or longer	9 years or more
Consideration	Considered the best treatment option	Good option, but longer wait times

Life after kidney transplant

Life expectancy after a kidney transplant varies greatly depending on factors like your overall health, age, and how well you adhere to your post-transplant care regimen.

During the immediate post-surgical period, you may feel tired easily, loss of appetite, swelling around the ankles and legs, difficulty in breathing and shortness of breath which could lead to physical inactivity. In addition, side effects of medications such as steroids may include weight gain, osteoporosis (loss of bone mass/decrease bone strength) and sarcopenia (loss of muscle mass).

You will need to take long term medications (anti-rejection drugs) to suppress the immune system and be monitored routinely by the medical team after transplant. For best outcomes for you and the kidney, you will be advised to live a healthy lifestyle. The transplant team will provide step-by-step guidance as you embark on your new life with a kidney transplant.

Before you return home, the ward clerk would have arranged for your follow-up appointment to see your kidney specialist. In the first year after transplant, you will need to attend frequent clinic visits so that your kidney specialist can review your tests results, adjust your medications and monitor for signs and symptoms of rejection and infection.

A typical schedule of outpatient clinic reviews:

For the first 3 months – 1-2 times a week
4th to 5th month – Every 2 - 3 weeks
6th to 9th month – Every 4 weeks
10th to 12th month – Every 2 months
After the 1st year – Every 3 months

However, patients with complications may require more frequent reviews.

The Importance of Clinic Reviews

Your clinic reviews are crucial for the long-term success of your kidney transplant. These appointments allow us to monitor your progress, adjust your treatment as needed, and address any concerns you may have.

Please note that review times may vary depending on individual patient needs, and some patients may require more extensive consultations. As a result, appointment schedules may occasionally shift to accommodate complex cases. We appreciate your understanding and patience. Your dedicated healthcare team is committed to providing thorough and personalized care to every patient.

To make the most of your visit, consider bringing a book or device for entertainment, having a light snack before your appointment, staying hydrated, and using waiting time to review any questions you have for your healthcare team.

Your consistent attendance and active participation contribute significantly to your overall health and the success of your transplant.

Blood and Urine Tests

Schedule tests 1-3 days before your clinic visit
Location: Transplant Centre (SGH Block 7, Level 1) or Specialist Outpatient Clinic Laboratory (SGH Block 3, Level 1)
Bring laboratory request forms given to you in the ward
Avoid testing on the day of your appointment
For immunosuppressive drug level tests (e.g., Prograf), draw blood before taking your morning dose

Items to Bring

Your current medications
List of prescribed medicines
Monitoring book (weight, blood pressure, heart rate, intake, output, blood sugar if diabetic)
Virus screening file
Face mask
Snack and drink

Arrival Time

Arrive at least one hour before your appointment for registration and coordinator consultation

During Your Visit

Meet with transplant coordinator for record review and counselling
Possible consultation with transplant pharmacist
Doctor consultation: Discuss concerns and understand any changes to your treatment plan

After Your Visit

Collect next appointment details, laboratory forms, and prescription slip
Confirm medication delivery service if needed

Blood Testing Without a Visit

For tests without a doctor's appointment, contact your transplant coordinator for results and follow-up instructions

Always take your medications as prescribed unless instructed otherwise by your healthcare team.

To get the best long-term results, you will need to take a combination of medications. There are two important groups of medications:

Immunosuppressive drugs which prevent rejection of the transplanted kidney, and
Prophylaxis (antibiotics and anti-viral drugs) to prevent infections.

It is important to take these medications every day, according to your doctor’s instructions.

Immunosuppressive Drugs

Your immune system protects you from infections by recognizing and attacking foreign substances. However, it also sees your new kidney as foreign. Immunosuppressive drugs partially suppress your immune system, allowing your body to accept the transplanted kidney.

Importance of Immunosuppressive Drugs:

These medications are crucial in preventing rejection of your new kidney. Stopping them can lead to severe rejection, potentially resulting in kidney failure or even death. It's vital to take them every day as prescribed.

Key Guidelines for Taking Immunosuppressive Drugs:

Take them daily at the right dose and time.
If you miss a dose, take it as soon as you remember, unless it's been more than 8 hours. In that case, skip the missed dose and resume your regular schedule. You should inform the transplant coordinator as you may need to have blood levels of the immunosuppressive drug checked.
Never double dose to make up for a missed one.
If you're on Diltiazem, don't miss it as it helps maintain proper levels of immunosuppressants.
Consult your healthcare team before taking any new medications (including traditional medications) or supplements.
Inform all healthcare providers that you're a transplant recipient.
Alert your transplant coordinator if you can't take your medications for any reason, e.g. vomiting or medication supply running out
Keep medications away from children and pets.
If planning pregnancy or pregnant, inform your kidney specialist immediately.
Attend regular blood tests to monitor immunosuppressant levels.

Prophylaxis Drugs:

Due to your suppressed immune system, you'll also be prescribed medications to prevent infections. These typically include Co-Trimoxazole (Bactrim), Valganciclovir, and Valacyclovir. Take these as prescribed to protect yourself from potential infections.

Remember, your healthcare team is here to support you. Don't hesitate to ask questions or seek clarification about your medication regimen.

Different immunosuppressant drugs require specific timing for blood tests to accurately measure their levels in your system. Here's a simplified guide:

Trough Level Tests (0 hour):

For these tests, come to the lab before taking your morning dose of medication (acceptable window: up to 15 minutes before your scheduled dose time). Take your medication after the blood test is done.

FK 506 (Prograf or Advagraf)
Cyclosporine A (Trough)
Mycophenolic Acid
Everolimus
Sirolimus

Peak Level Test (2 hours):

Cyclosporine A (Peak): This test is done 2 hours after taking your morning dose of medication.

For the Cyclosporine A peak test, take your medication as usual and note the time. Come to the lab exactly 2 hours later for the blood draw (acceptable window: 1 hour 45 minutes to 2 hours 15 minutes). Always bring your medications with you to the lab so you can take them immediately after trough level tests.

Before your kidney transplant, you were restricted to certain types of foods and drinks because of your kidney disease. However, this changes after transplant.

Before discharge, a dietitian will advise you of a post-transplant nutritional plan. This plan will be tailored to your eating habits, weight, laboratory tests, kidney function and medications.

To promote healing after transplant surgery, you should eat adequate protein-rich foods such as lean meat, poultry, fish, eggs, milk, beans and legumes, and its products. You should also include a variety of grains, fruits and vegetables for adequate calories, vitamins and minerals.

Fad diets, diet supplements and herbal products should be avoided.

Post-transplant physiotherapy is crucial to address various challenges and medication side effects after the surgery. Key aspects include:

Early Mobilization: To combat post-surgical fatigue and physical inactivity.
Weight Management: Regular moderate-intensity exercise (30 minutes most days) to counteract potential weight gain from medications and dietary changes.
Bone Health: Weight-bearing and core strengthening exercises (at least 30 minutes, three times per week) to combat osteoporosis risk.
Muscle Strength: Progressive resistance training targeting large muscle groups, 2-3 times a week for at least 8-12 weeks, to prevent sarcopenia.
Cardiovascular Health: Aerobic exercises to improve fitness and reduce risks of stroke and heart attacks.

Your physiotherapist will assess your needs regularly, providing an individualized, progressive exercise program. This program will be adjusted as you recover, aiming to improve overall physical function, manage medication side effects, and enhance long-term health outcomes. Start slow and gradually increase both duration and intensity of exercises under professional guidance.

Action plan

For Individuals with Kidney Failure:

Identify your support network: Consider who, besides your medical team, you want to involve in your treatment decisions
Family discussions: Share your medical condition and treatment options with your family and loved ones
Seek expert advice: Consult a kidney transplant coordinator for more detailed information

For Family Members and Friends:

Open dialogue: Discuss available treatment options with your loved one facing kidney failure
Offer encouragement: Support and motivate your loved one to consider kidney transplantation
Spread awareness: Share information about kidney transplantation within your social circles. This could potentially lead to finding a donor
Get informed: Speak with a kidney transplant coordinator to learn more about the transplantation and donation process

Several resources are available to support your kidney transplant journey:

Live On: A webpage by the National Organ Transplant Unit offering education and support on organ transplantation in Singapore
Online tools: Such as the Body Mass Index (BMI) calculator for adults to monitor your health
Hospital resources SGH provides:
- Transplant education materials and programs
- Support groups and peer mentoring
- Multidisciplinary counselling services
- Educational sessions on kidney transplantation and donation for patients and potential donors

Your transplant team can guide you to the most relevant resources for your specific needs. Don't hesitate to ask your doctor, nurse, or transplant coordinator for assistance in accessing these supports.

Cancer in kidney transplant patients

As a transplant recipient, you'll receive immunosuppressive medications to prevent organ rejection. While crucial for your transplant's success, these medications can increase your cancer risk. Here's what you need to know:

Understanding the Risk

Immunosuppression reduces your body's ability to identify and destroy abnormal cell
Transplant recipients have a higher risk of certain cancers, especially those associated with virus infections e.g. lymphoma.
Cancer is among the top 3 causes of death in transplant recipients

Prevention Strategies

Vaccinations: Consider HPV vaccine for cervical cancer prevention and Hepatitis B vaccine for liver cancer prevention as advised by your doctor
Treatment of underlying conditions: For example, treating Hepatitis C can prevent related liver cancer
Lifestyle choices: Avoid smoking, tobacco chewing, and excessive sun exposure

Early Detection

Regular screenings: Your follow-up visits will include cancer screenings such as abdominal ultrasounds, stool tests, mammograms, and pap smears as appropriate
Self-examination: Check your skin monthly for unusual moles, spots, rashes, or non-healing ulcers
Sun protection: Use SPF 50 sunscreen, avoid prolonged sun exposure, and wear protective clothing
Breast self-exams: Check for new lumps or skin changes

Treatment Approach

If cancer is diagnosed, your treatment will be personalised:

Anti-cancer treatments will be administered as appropriate.
Anti-rejection medications may be adjusted to allow your immune system to fight the cancer.
In some cases, particularly with blood cancers, stopping anti-rejection medications may help, but this carries a risk of organ rejection.
Your nephrologist and oncologist will work together to balance anti-rejection medication and cancer treatment.

Early detection is key. Stay vigilant, attend all follow-up appointments, and communicate any concerns to your healthcare team promptly.

Infection in kidney transplant

As a kidney transplant recipient, you're more vulnerable to infections due to your kidney disease history and the immunosuppressive medications you're taking. Here's what you need to know:

Increased Susceptibility: Your suppressed immune system makes you more prone to infections and at risk of developing more severe complications
Types of Infections: You may experience common infections like pneumonia, urinary tract infections, gastroenteritis, and soft tissue infections. You're also at risk for opportunistic infections that don't typically affect healthy individuals
Causes: Infections can come from various sources, including other people, animals, the environment, or even from microorganisms already present in your body that become overactive
Symptoms: Watch for signs like fever, breathlessness, and diarrhoea. These could indicate an infection
Potential Complications: Infections can lead to serious issues such as organ injury (including damage to your new kidney or lungs) and, in severe cases, can be life-threatening
Importance of Vigilance: It's crucial to learn how to recognize signs of infection early and take preventive measures

If you suspect an infection, contact your transplant team immediately.

Healthy lifestyle

Take a healthy balanced diet as recommended by our dieticians
Exercise regularly as recommended by our physiotherapists
Drink adequate fluids as discussed with your doctor
Get adequate rest and sleep

Safe practices & personal hygiene

Avoid crowded places
Wear a face mask when in public
Avoid close contact with people who are sick
Wash your hands frequently with water and soap or other cleansing solutions
Wear gloves when coming in contact with soil/ gardening
Avoid high-risk behaviour such as casual sex and abusing drugs

Food safety (to prevent intestinal infections

Avoid raw or partially cooked food (e.g. salad, sushi, soft-boiled eggs)
Avoid food that have been left overnight or out in the open
Eat freshly peeled fruits (instead of cut fruits left in the fridge for some time)
Avoid food that may have been prepared in an unhygienic fashion (e.g. unlicensed street-side store)

Preventing urinary tract infections

Avoid holding your urine
Drink adequate fluids
Pass urine after sexual intercourse
For women
- Wipe from front to back when cleaning your private area
- After menopause, if your private area feels persistently dry or itchy, you may have vaginal dryness which can increase your risk of urinary tract infections. Discuss with your doctor for the necessary treatment.

Medications

Kidney transplant recipients usually receive medications that help them prevent infections for a defined period of time
It is important that you take these medications as prescribed to help you prevent infections. If you have any issues with the medications, please discuss with your doctor.

Vaccinations

Kidney transplant recipients are recommended to receive vaccinations ideally before and regularly after transplant.
In general, vaccinations are only administered when you are stable about 6 months to 1 year after your transplant.
Vaccines “train” your immune system to remember how to fight certain infections the next time it is exposed to the germ
Common vaccinations include
- Influenza vaccine
- Pneumococcal vaccine
- Shingles vaccine (Shingrix®)
- Other vaccinations that may be recommended by your doctor include vaccines for hepatitis viruses, tetanus/diphtheria/pertussis, meningococcus, Hemophilus depending on your condition
However, some vaccinations (such as vaccines which are composed of live viruses) may not be suitable kidney transplant recipients
Vaccinations will not be able to prevent all infections. Therefore, good personal hygiene and infection prevention measures remain important

These restrictions may cause inconveniences and impede your newfound freedom and independence after being dialysis-free. However, it is important to prevent infection in an immunocompromised state to maintain your health and avoid complications.