Nutrition Guidelines for Discharge Home After Transplant
When you return home after a transplant, your immune system is still functioning below normal. You may also have increased nutrient needs due to medications or loss of muscle mass. Calories, protein, fluid, vitamins and minerals are necessary for you to regain your immunity, maintain or achieve your weight goal, strengthen your muscles and feel better!
- Food safety
- Calories and body weight
- Magnesium and potassium
- Vitamin & mineral supplements
- Nutrition guidelines during prednisone treatment
- Children under 18 years of age
- Allogeneic patients should continue the Diet for Immunosuppressed Patients until off all immunosuppressive therapy (such as prednisone, tacrolimus and cyclosporine).
- Autologous patients should continue the Diet for Immunosuppressed Patients during the first three months after transplant or until off prednisone for one month.
- When you discontinue the Diet for Immunosuppressed Patients, continue to use care when purchasing foods, preparing meals and dining out. Situations where you cannot control the cleanliness of the food put you at greater risk for acquiring a foodborne illness. Examples include salad bars, smorgasbords, delicatessens, bulk food bins and free food samples offered in stores. (Review the general food-safety guidelines.)
- Continue to avoid herbal and other preparations, since they may contain harmful ingredients or infectious organisms. Herbs are not regulated for purity or for effect on health.
- If you rely on well water at home, it should be tested for coliforms and Cryptosporidium immediately prior to your return home after treatment. Future testing must be performed at least once every year and preferably more frequently. To ensure safety, boil the water for one minute prior to drinking or using in recipes. Boiled water may be stored up to three days in the refrigerator. After three days it must be thrown away. (Review the water-safety guidelines.)
- Your goal is to maintain or achieve an appropriate weight for your body size.
- It is important to consume a nutritious diet, including a variety of foods, to promote recovery of your immune system.
- If you are underweight, weight gain may be slow after transplant. Set small goals (two to four pounds or one to two kilograms per month). Eat three meals daily, plus snacks. Drink beverages with calories and protein. Use medical nutrition supplements, such as Instant Breakfast, Ensure, Boost, Scandi-Shake and Polycose. Exercise to promote muscle gain.
- If you are overweight and medically stable (as determined by your doctor and dietitian), you may lose weight gradually, meaning one pound per week (one-half to one pound per week for children). You must continue to consume a nutritious diet, following any special nutrition needs your dietitian has advised. Exercise is important to prevent muscle loss.
- Calorie needs increase with fever, infection and physical activity. Some people with graft-versus-host disease (GVHD) may require more calories to maintain or gain weight.
- Chemotherapy, surgery or illness may increase magnesium and potassium losses from your body. Cyclosporine and tacrolimus increase magnesium loss from your body. Supplementation (pill or intravenous infusion) is usually necessary. Your physician may need to adjust your magnesium or potassium dose based on your serum magnesium or potassium level.
- Magnesium-rich foods include nuts, bran cereals, brown rice and whole grain breads.
- Potassium-rich foods include fruits, vegetables and dairy products. (Your dietitian can give you a more complete list.)
- A high fluid intake helps flush your kidneys when you take medications that can impair kidney function, including Cyclosporine, tacrolimus and some antibiotics. Ask your dietitian for your fluid goal.
- Serum (blood) creatinine is a measure of kidney function. An above-normal serum creatinine means that your kidneys are working below normal.
Take a multiple vitamin/mineral supplement for one year following your transplant to ensure you get the vitamins and minerals you need while your body and immune system are recovering. A generic brand is fine. If you are considering taking any supplement (including antioxidants and herbal preparations) in addition to the vitamin/mineral supplement that has been recommended, discuss its safety with your dietitian.
When selecting a supplement, it should:
- Contain NO iron.
- Not be greater than 200 percent of the Recommended Dietary Allowance (RDA).
- Contain NO herbs or other plant materials.
Recommended supplements for adults:
- Mature Balance
- One-a-Day 50 Plus
- Centrum Silver
Recommended supplements for children (follow the dose listed on the label for the age of your child):
- Fruity Chews
- Sesame Street Vitamin Chewable Tablets
Your protein needs were higher than normal early after transplant to allow repair of cell damage caused by chemotherapy and radiation. Protein continues to be an important part of your diet to promote recovery of your immune system. Your protein requirement returns to normal two to three months after transplant, unless you have lost a large amount of muscle or are taking prednisone.
Below are some protein-rich foods. Your dietitian will tell you your daily requirement. For calorie and protein information, please ask your outpatient nutritionist for the booklet, “A Guide to Good Nutrition.”
Protein Content of Selected Foods
(oz. = ounce; Tbs. = tablespoon)
||Serving Size||Grams Protein|
|Cheese||1 oz. or 1” cube||7|
|Cheese pizza (12”)||¼||15|
thigh or drumstick
|Cocoa, instant, mixed with water||1 cup||3|
|Cooked beef, fish, lamb, pork: size of a deck of cards||3 oz.||21|
|Cottage cheese||¼ cup||7|
|Cream soup (made with milk)||1 cup||6|
|Hotdog (10 per pound) or luncheon meat||1 or 1 oz.||5|
|Ice cream or ice milk||1 cup||5|
|Macaroni and cheese: homemade or frozen
packaged or canned
|Milk (nonfat, 2%, whole, buttermilk)||1 cup||8|
|Homemade milkshake||10 oz.||9|
|Peanuts and other nuts||¼ cup||9|
|Peanut butter||2 Tbs.||8|
|Yogurt: plain, coffee, vanilla
|Ensure Plus||1 cup||13|
|Instant Breakfast (made with milk)||1 serving||15|
|Boost Plus||1 cup||14|
Calcium is essential for bone health, especially in:
- Adult females with hormonal changes
- People taking prednisone
- Children and teens
Daily Calcium Requirements After Transplant
(mg = milligram)
|Children||800 mg||1,200 mg|
|Teens||1,200 mg||1,600 mg|
|Adult Males||1,000 mg||1,500 mg|
|Adult Females||1,200 mg||1,500 mg|
Calcium Content of Selected Foods
|Food||Serving Size||Milligrams Calcium|
|Beans: baked or refried||½ cup||65|
|Calcium-fortified orange juice||1 cup||300|
|Cheese||1 oz. or 1” cube||200|
|Cheese pizza (12”)||¼||250|
|Cocoa, instant, mixed with water||1 cup||90|
|Cottage cheese||½ cup||70|
|Cream soup (made with milk)||1 cup||180|
|Ice cream or ice milk||1 cup||175|
|Macaroni and cheese: homemade or frozen
packaged or canned
|Milk (nonfat, 2%, whole, buttermilk)||1 cup||300|
|Milk, calcium fortified||1 cup||400|
|Homemade milkshake||10 oz.||320|
|Yogurt: plain, coffee, vanilla
|Ensure Plus||1 cup||165|
|Instant Breakfast (made with milk)||1 serving||500|
|Boost and Boost Plus||1 cup||200|
|Citracal + D||1||315|
|Viactiv or CalBurst||1||500|
Also see the osteoporosis nutrition guidelines.
- Protein: A protein-rich diet and exercise can help prevent muscle loss. Include a protein-rich food in every meal and consume two to three protein-rich beverages or snacks daily. Exercise can include walking, bicycling and low-impact aerobics.
- Calcium: Consume a calcium-rich diet and exercise daily to minimize bone loss. If your calcium intake is low, take a supplement of calcium carbonate (such as Caltrate or Viactiv) or calcium citrate (such as Citracal).
- Vitamin D: This vitamin helps your body absorb and utilize calcium. Children on prednisone require 400 international units (IU) of vitamin D daily. Adolescents and adults on prednisone require 400 to 800 IU daily. Vitamin D is obtained from your multiple vitamin, fortified milk and vitamin D-containing calcium supplements.
- Sugar (glucose): If your fasting blood glucose level is above normal, ask your dietitian for diet guidelines. Avoid concentrated sweets, especially sugar-containing beverages and juices. Examples of concentrated sweets are cake, cookies, candy, donuts, pie, soda pop, fruit-ade, fruit juice, sweet rolls, coffee cake, ice cream, sugar, honey and syrup.
- Potassium: You may need more potassium in your diet while taking prednisone. Some sources of potassium are salt substitute, bananas, melons, oranges, orange juice, potatoes, tomatoes, tomato juice and cream of tartar.
- Salt: A high salt intake can worsen fluid retention caused by prednisone. Avoid salt and salty foods, such as canned, instant and frozen soups and entrees; soy sauce; cured meats; and packaged sauces and seasonings. In general, processed foods contain too much salt.
Your dietitian can give you a more complete list.
Height and weight should be measured at the doctor's office every month. Record these values on the growth chart provided by the dietitian. When your child returns to the center for long-term evaluation, bring the growth chart with you.
Discuss With Your Doctor
Talk with your doctor if:
- Your weight drops more than two pounds (one kilogram) in seven days.
- You develop nausea, vomiting, diarrhea, or stomach or intestinal cramps.
- Your mouth becomes drier or sensitive or develops sores.
- You have swallowing difficulties.