Dietary advice following a kidney/kidney-pancreas transplant

Enjoy a more varied diet after a kidney transplant

Potassium

Successful transplants should mean that your previous potassium restriction is relaxed. Your dietitian can advise you about how to reintroduce high-potassium foods, such as bananas, coffee, nuts and chocolate. When you have been advised that you can reintroduce potassium-containing foods, be sure to do this gradually, for example one new item a day in small portions – not everything all at once.

In some cases, it might be necessary to continue with a low-potassium diet if you are experiencing delayed graft function. This is usually only in the short-term for most people. If you have any concerns, please ask your dietitian.

Phosphate

Phosphate binders are stopped after a kidney transplant and you should no longer need to follow a phosphate restriction.

Salt

Continuing to follow a no added salt diet is recommended to help prevent high blood pressure. Avoid adding salt when cooking or at the table. Suitable alternatives include pepper, herbs, spices, lemon juice and vinegar.

Calcium

Long term steroid use can weaken your bones and increase the risk of fractures. Sufficient calcium intake may help to prevent this. Good sources of calcium include milk, cheese, yoghurt, tofu and calcium-enriched soya products (choose lower-fat options if you are conscious of your weight). You should aim for three to four portions a day. A portion is 125g yoghurt, 25g cheese (small matchbox size), 75g cottage cheese, 200ml milk.

Grapefruit, pomegranate and Seville oranges

After transplant, you should avoid eating grapefruit, pomegranate and Seville oranges or drinking the juice of these fruits because they interfere with the levels of the anti-rejection medication. You should also check things which may contain grapefruit, pomegranate and Seville oranges such as mixed fruit juices. This includes pink grapefruits and star fruit.

Food hygiene advice post-transplant

After your kidney transplant you will have to take immunosuppressive medication, for example tacrolimus, ciclosporin, mycophenolate mofetil or azathioprine. These reduce the activity of your immune system to help prevent your new kidney from being rejected. Your immune system protects your body by fighting infections.

When the level of your immune function is reduced, you will be more likely to catch infections, including food-borne infections. There is a risk of catching a food borne infection such as listeria, Salmonella or E.coli. You may not realise that you have Listeria, as some people have no symptoms. Others develop mild flu-like symptoms such as headache, temperature, sore throat and diarrhoea. More serious complications, for example vomiting, can occur if the Listeria infection develops further within your body.

Vomiting can mean you are at higher risk of rejecting the new kidney due to an inability to take or keep down the immunosuppressive medication, reducing the concentration of the medication in the blood. In rare circumstances, and where you are not able to fight the infection, the medical team may choose to lower the dose of immunosuppressive medication sooner than planned, which also places you at a higher risk of rejection. It is therefore recommended that you use good food hygiene principles and avoid certain high risk foods. Following the advice below will reduce the risk of getting a food-borne infection.

Some guidelines to help reduce your risk of infection from food and drinks:

Shopping

• Only eat food that is still within its use-by or best-before date.
• Purchase pre-packaged meat and fish – avoid deli counters and counters where foods are exposed and unwrapped.
• Once purchased, put fresh foods into the fridge or freezer as soon as possible.

Preparation

• Keep pets out of the kitchen.
• Wash your hands properly and protect cuts and wounds before handling food.
• Wash and dry utensils (for example knives) and work surfaces (for example chopping boards) between preparation of raw and cooked food. This is to avoid cross-contamination. Ideally, use separate chopping boards.
• Wash all fruit and vegetables before preparation.

Cooking

• Thaw meat, fish and poultry in the fridge for 24 hours, not at room temperature.
• Cook meat, fish and poultry thoroughly.
• When reheating food, ensure it is piping hot.
• Never reheat food more than once. It is advised not to reheat rice at all.
• When using a microwave, follow the cooking and standing times and know the power rating.

Storing food

• Regularly check the fridge/ freezer temperatures. Ensure that the fridge is 5°C or lower and freezer -18°C or lower.
• After cooking, once food has cooled, place in the fridge immediately.
• Never refreeze thawed food.
• Cover all food in the fridge.
• Store raw and cooked foods separately. Keep cooked food at the top of the fridge and raw goods at the bottom of the fridge.

Eating out

• Eating out or consuming takeaways should be avoided within the first six to eight weeks after transplantation.
• When eating out or having a takeaway, ensure that food is fresh and well-cooked.
• Buffets should be avoided avoided if possible – if unavoidable and eating at buffets, ensure that food is served fresh and piping hot. Try to be the first in the buffet queue and avoid going back for further servings. This is because there is a risk that food might have been contaminated by other diners and might not have been kept at the correct temperature.
• Ensure BBQ meat is thoroughly cooked and not left for long periods between cooking and eating.
• Rotisserie-style cooking methods should be avoided, as there is a higher risk of uneven cooking.
• Avoid high-risk foods and choose eateries that have a rating of 5 on the Food Hygiene Scale. Use the Food Standards Agency app or website to check the rating.

Don’t be afraid to liaise with the chef or catering staff at restaurants when eating out.

Eating abroad

Take extra care when abroad, as food hygiene standards may be poorer. The following tips will help reduce the risk of food poisoning.

Drinks

• Drink bottled, canned and processed beverages only.
• Avoid tap water, ice and drinks made from tap water and fresh fruit juice. If drinking tapwater, boil it first.
• Some people might prefer to brush their teeth with bottled or cooled boiled water to reduce the risk of contamination.
• Avoid street food and markets.

Food

• Ensure that hot foods are served piping hot.
• Try to use only reputable restaurants and eateries, and avoid food sold on streets or markets.
• Avoid foods which might have been washed in tapwater – for example, fruit and salad.
• Opt for vegetables and fruit that can be peeled.

Specific foods and drinks to avoid, to help reduce your risk of food borne infections

The below list of foods should be avoided by all transplant patients to minimise the risk of poisoning (Listeria or Salmonella infection).

The foods in the table below should be avoided strictly for the first six months. After six months, if your kidney function is good, the medical team is happy and you have not had any increases in your anti-rejection medication, you will no longer need to avoid the high-risk foods. However, basic food safety principles should continue for the lifetime of the transplant as your immune system will remain suppressed, particularly if there are changes to the anti-rejection medications. Your team can further advise you about this if you have any queries.

Weight gain

In the first few weeks post-transplant, weight gain is likely to be due to fluid retention after the transplant operation. However, many patients gain weight in the long term after their kidney transplant. This can be caused by:

• steroids, for example prednisolone – these can increase your appetite and make you eat more
• relaxation of previous dietary restrictions – this enables you to eat more freely, which can cause weight gain
• reduced activity levels immediately after transplant – this can promote unwanted weight gain

If you are concerned about your weight, please ask your GP for weight management services.

Body mass index (BMI)

Your BMI indicates whether you are a healthy weight for your height. You can calculate your BMI using the formula BMI = weight (kg) / height² (m).

Maintaining a healthy weight reduces the risk of developing new-onset diabetes after transplant (NODAT). The anti-rejection medication and steroids may cause your blood sugars to rise – often this is temporary but it may become permanent, leading to diabetes.

Healthy balanced lifestyle

A healthy, balanced diet combined with exercise will help to prevent unwanted weight gain and/or help with weight loss, helping to keep you fit and healthy.

The Eatwell Guide below shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet. You do not need to achieve this with every meal, but should try to get the balance right over a day or even a week.

Fruit and vegetables

Your potassium restrictions are most likely relaxed following your transplant. You should therefore be able to enjoy a wider variety of fruits and vegetables in your diet. They are naturally low in fat and high in fibre so can help fill you up and prevent snacking on other high fat/ high sugar foods. Most people do not eat enough fruit and vegetables; you should aim to eat at least five portions a day.

Protein

Protein is important for wound healing and recovery following your transplant. Pulses (beans, peas and lentils) are good alternatives to meat as they are lower in fat and higher in fibre and protein. Choose lean cuts of meat where possible and reduce your intake of red and processed meats (bacon, ham and sausages). Fish is also a good source of protein – you should aim to eat at least two portions of fish a week; one should be oily.

Dairy and alternatives

Milk, cheese and yoghurt are good sources of protein. They are also rich in calcium which is required while you are on steroids. Try to opt for lows-fat dairy products where possible, unless you have problems with poor appetite.

Fat

There are two main types of fat: saturated and unsaturated. They both contain the same amount of calories (energy), so have only small amounts of fat in your diet.

• Saturated: animal fats such as fat in milk, cheese, cream, coconut oil and fat on meat.
  Try to limit the amount of saturated fats in your diet as these can increase your cholesterol levels, which may increase your risk of heart disease and stroke.
• Unsaturated: These are better types of fat and are preferable to saturated fats. There are two types of unsaturated fat:
  • monounsaturated, eg olive oil
  • polyunsaturated, eg sunflower oil, omega-3 fish oils.

Saturated and unsaturated fats contain the same amount of calories (energy). Therefore only use small amounts of fat in your diet. Saturated fats can increase your cholesterol levels, which may increase your risk of heart disease and stroke. Unsaturated fats will not increase your cholesterol levels and so should be used in place of saturated fats wherever possible.

The following tips might be useful for reducing your fat intake:

• trim the fat off meat
• grill, bake or steam foods and avoid frying
• choose unsaturated fat spreads eg olive oil spreads instead of butter
• choose semi-skimmed milk or reduced fat produce

Starchy carbohydrates

Starchy carbohydrates should be about a third of your diet. They are a good source of energy and fibre. Try to opt for wholegrain varieties as these are higher in fibre eg whole wheat pasta/ rice.

Sugar

Sugar provides energy and if it not used, it will be converted into fat and stored in the body. Foods high in fat include chocolate, biscuits, cakes, sugary soft drinks, butter, ghee and ice cream. If you are conscious of your weight, foods high in fat, salt and sugar should be eaten less often and in small amounts. Choosing low calorie and sugar-free drinks are better options.

Contact details

If you have any queries, please do not hesitate to contact your renal transplant dietitian on 01223 216655 (or via the Contact Centre (01223 245151) and ask for extension 2655.