Creatinine Post Transplant

[MatthewC]

My brother's creatinine dropped to 140 by a few days after the transplant. He has just told me that last Friday (16 days post tx) it was at 154, then 174 on Monday, 178 on Tuesday and down to 163 this morning. The worrying thing is that, despite a biopsy yesterday, they are unable to explain this rise and fall. He is not dehydrated (no ADN, whatever that is) and no rejection. Does anyone know if this is normal or something to be worried about?

[bigbuzzard]

It's not necessarily something to worry about, unless there's an underlying tendency in the wrong direction over weeks/months - though you need to keep a close eye on it, hence the 3x/week blood test regime in the weeks after transplant. It can bounce around all over the place until it, hopefully, settles at a relatively stable level.

[Tibbs]

From what they told me, it's pretty normal for your creatinine to bounce around for the first year or so post transplant.

My creatinine has a baseline of 250, but can be anywhere from 220 to 280 without undue concern.

[MidgeMan90]

I think it is pretty normal. After my transplant it bounced around and was as low as 74 and went as high as 154 but seems to have now settled at around 130. I had two biopsies to make sure and they picked up nothing, so hang in there.

[rheaybou]

I have seen mine bounce about by 10% up and down. I raised the question about this in my last transplant clinic 4 weeks ago and the response was...."we could test the same blood sample in the same lab, with the same lab tech 3 or 4 times and get a variance like this, its best to look at the averages"

As Bigbuzzard and Tibbs have highlighted, a tred of dropping values will always be the indicator that something needs to be looked at. It is early days so i hope it settles.

[MatthewC]

Thanks for the above - my brother was reassured by the view that this is fairly normal in the early days, and the hospital staff agreed when he asked about this that they would be more worried if it was 6 or 12 months later.

His creatinine is back down to 153 and it is reckoned that possibly he was being given too much anti-rejection drugs (Tacrolimus I think). I guess this is all part of the early days roller-coaster until they can set the dose more accurately. Anyway, he was much encouraged this morning so it's looking good.

[Tibbs]

The Anti-Rejection drugs are a real balancing act, especially the Tacrolimus.

It's actually poisonous to the kidney (nephrotoxic) in high doses, so too much Tacro = rising creatinine due to kidney damage, too little Tacro = rising creatinine due to rejection. The Therapeutic index (the gap between when a drug is effective and when it become poisonous) is really small with Tacro and other anti-rejection drugs. This is where the real skill comes in, but hey, this is what the doctors do for a living!

I'm glad he's feeling better - a rollercoaster is a really apt description for what happens post transplant. You wake up thinking "right, I'm better now, let's get on with things" and then you're presented with a whole load of other problems that you hadn't thought of! Once you get over them, that's when life kicks off again.