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Dietary Advice after a Kidney Transplant

Date issued: April 2021

Review date: April 2023

Ref: C-239/Dietetics/CT/Healthy eating after your kidney transplant v5

PDF:  Dietary Advice after a Kidney Transplant April 2021 v5.pdf[pdf] 762KB


Dietary Advice after a Kidney Transplant

Now that you have had a kidney transplant you can enjoy a much wider choice of food and drinks. This is because your new kidney is clearing any excess potassium, phosphate, salt and fluid that the body does not need.

What you eat and your lifestyle is still important because after your transplant you may have:

  • A larger appetite which can lead to unwanted weight gain

  • Increased levels of cholesterol in your blood

  • Increased levels of sugar in the blood which may lead to post transplant diabetes

  • Risk of bone problems

  • Increased risk of heart disease

A healthy diet and regular exercise can help you manage these problems and will help you reduce your risk.

You also need to be careful about food hygiene because your immune system (which normally fights infections) is being suppressed by the new drugs you are taking.

Food safety

Following your transplant you will be started on medication to prevent your immune system rejecting your new kidney. This medication suppresses your immune system, increasing your risk of food poisoning, therefore, it is a good idea to follow food hygiene and safety practices.

The following food hygiene practices will minimise your risk of food poisoning and should continue for the lifetime of the transplant as the immune system will remain suppressed:


Food hygiene practices


Wash your hands before preparing, handling and eating food.

Keep worktops, chopping boards and utensils clean at all times using hot soapy water, especially after contact with raw food.

Change dish clothes and tea towels regularly and wash at 60ºC. Use a separate towel for drying hands.

Never handle food if you are ill with diarrhoea and vomiting, and do not allow others with these symptoms to handle your food.


Always ensure that food is cooked thoroughly and as per the manufacturer’s instructions.

When reheating food always check that it is piping hot. Do not reheat more than once.

Eat cooked foods within an hour of cooking.

Always follow the cooking instructions on the label.

Do not eat food past its ‘Use-by’ date.




Maintain your fridge and freezer at the correct temperatures.


Fridge:      between 0-5°C

Freezer:    -18°C or lower

A cool bag maybe useful when shopping to keep things cold until getting home.

Do not overload your fridge or freezer and avoid buying foods from freezers and fridges which are overloaded.

Cool cooked food as quickly as possible and then put in the fridge or freezer.

Keep chilled food out of the fridge for the shortest time possible during preparation.

Cross contamination

Cross contamination is when bacteria spread between food, surfaces and equipment. It is most likely to happen when raw food touches or drips onto ready to eat food, equipment or surfaces.

Clean and disinfect work surfaces, chopping boards and equipment prior to preparing food and after you have prepared raw food.


Always cover raw meat/fish/ poultry and store at the bottom of the fridge.



Food safety: High risk foods to avoid and safe alternatives

Following food safety guidance is important for all those with a transplant, but is particularly important when high doses of immunosuppressive medication are recommended or when dose adjustments are being made.  This is likely to be the case within the first six months after transplantation but this will vary for each person.

You may want to discuss your level of immunity with your doctor and whether it is possible to reintroduce some of the higher risk foods. There is little evidence to guide when this is safe and you may or may not decide to do this.

This table should help you quickly identify which foods you should avoid and safe alternatives you can enjoy:


Food to avoid and safe alternatives


High risk, should be avoided


Have instead:


All unpasteurised milks.

All pasteurised milk or ultra-heat treated (UHT). 


This includes cow’s milk, goats, sheep milk, soya, rice, oat and nut-based milks.



Yoghurt which is described on the label as ‘bio’ or ‘probiotic’.

Any plain/natural, sour cream, Greek, fruit yogurt or lassi which does not describe itself as bio or probiotic.

Large sharing pots of yoghurt.


Small single serving pots.

Homemade yoghurts and cultured milks such as Kefir.



Probiotics and prebiotics

Probiotic drinking yogurts such as Yakult®, Actimel®, Supermaket own versions.



Prebiotic yoghurt/product (these contain substances which promote the growth of healthy bacteria.  They do not contain any live bacteria themselves).




High risk, should be avoided


Have instead:


Cheese from the deli counter


Best to buy pre-wrapped cheese


All pasteurised hard cheese


Red Leicester



Stilton (white)



Hard goats’ cheese


All unpasteurised soft cheese unless cooked until piping hot

Pasteurised soft cheese (check the label)

Cottage cheese



Cream cheese

Paneer, labnah



Processed cheese such as cheese spreads (eg Dairylea®)


Soft cheese – mould-ripened (white rind) Brie, Camembert and certain goats cheese eg Chevre.


Blue-veined cheese eg Stilton, Danish Blue, Gorgonzola Roquefort and Dolcelatte.


Homemade cheeses eg labnah/paneer.


Mould-ripened (white rind) and blue-veined cheese if cooked until piping hot.








Fish and Shellfish

* Fresh fish and shellfish from fishmongers or deli counters


* Pre-packaged fish, shellfish and smoked fish.  Eat within 24 hours of opening if eaten cold or cooked until piping hot.

Raw fish and shellfish eg sashimi, oysters and caviar.

Raw fish and shellfish should be cooked until piping hot


* There is no evidence to support this advice. This has been recommended as the safest possible option.  If you prefer to buy fish from a fishmonger, then to reduce the risk of food borne illness it is best eaten at the earliest opportunity.


Meat and poultry

Raw, rare and undercooked meat and poultry.



Cooked meat and poultry served piping hot.

Under-cooked BBQ meat.

Ensure BBQ meat is thoroughly cooked and served piping hot

Deli counter meat and poultry.


Sealed pre-packed meat and poultry.

Rotisserie chickens.


Cooked and sealed chicken from the chilled cabinet.

Cured meat*.


Safe to use in cooking if cooked thoroughly and piping hot.   Purchase in sealed packets only.

* To reduce the risk of food borne bacteria cured meat can be eaten if frozen after purchasing (ideally pre-packaged), for four day before consumption.  The meat should be defrosted thoroughly in the fridge for 24 hours before eating and leftovers discarded.

Please note: There have recently been a few cases where people who are immunosuppressed after a transplant have been infected with Hepatitis E Virus (HEV).  This was possibly due to eating under-cooked pork or pork products (such as sausages, bacon, cured meats and offal).  Cook all meat thoroughly and take particular care with barbequed meat as this can sometimes be undercooked. Try baking it first, then finish cooking it on the barbeque for added flavour.



High risk, should be avoided

Have instead:


Uncooked eggs or partially cooked egg.



Thoroughly cooked lion-stamped eggs.


Store in the fridge.

Sauces or desserts that may contain raw or undercooked eggs eg mayonnaise or chewy meringue.


Raw cookie dough or cake batter.


Mayonnaise or salad cream made with pasteurised egg.


Meat and vegetable pate.


Pasteurised pate and paste in tins and jars that do not need to be refrigerated.


Homemade vegetarian pate


Rice from a take-away.


Cook your own rice at home when ordering a take-away


Reheated rice.

Rice should be served hot and eaten immediately after it is first cooked


Homemade sushi


Ask your dietitian for further advice if you wish to eat home-made sushi.


Shop bought sushi


Check the use by date

Buy from the chiller cabinet and ensure packaging intact.

Store in fridge until eaten.



Fruit, vegetables and salad

Unwashed fruit, vegetables and salad.


All other fruit, vegetables and salad providing they are washed thoroughly to remove all traces of soil and visible dirt.


Raw sprouted seeds e.g. beansprouts.

Cooked sprouted seeds and beansprouts


Unpasteurised fruit juice or smoothies.


Pasteurised fruit juice and smoothies.


Slush puppies.

Homemade juices and smoothies if all fruit and vegetables thoroughly washed before use.




High risk, should be avoided


Have instead

Pre-packed sandwiches or take away freshly made sandwiches

Avoid high risk fillings eg unpasteurised cheese and cured meats.

Pre-packaged sandwiches.

Eat within the use by date.

Toasted sandwiches must be served piping hot.




Ice cream




Whipped ice-cream from an ice cream van.


All other purchased ice cream.

Caution should be taken to ensure ice-cream is not thawed and re-frozen.

Homemade ice-cream with raw egg.

Homemade ice cream with a pasteurised egg substitute.


Unpasteurised or ‘farm fresh’ honey and honeycomb.

Pasteurised or heat-treated honey, and ideally use individual sachets or portions

Food safety: Eating out and takeaways

Eating out or consuming takeaways within the first 6-8 weeks after transplantation should be avoided. After this period, eating out can be enjoyed when following these basic principles:

  • Check the eating area is clean and tidy.

  • Avoid all high risk foods on the menu.

  • Try to order a plated meal that is cooked fresh to order rather than a carvery, salad bars or buffet.

  • Ensure your meal is piping hot and thoroughly cooked when it arrives.

  • Avoid rice that has already been cooked; ask for it to be cooked fresh or choose another option such as potato, pasta, chips, chapatti or noodles.

  • Beef burgers should be well done, even if they are freshly made.

  • If you need to eat from a buffet it is recommended you try to be the first in the queue and not to go back for further servings as there is a risk the food may have been contaminated by other diners.

  • Caution should be taken when eating food from a street vendor. The food may have been stored at incorrect temperatures allowing the perfect environment for the growth of food borne bacteria.

  • Consider the previous advice about raw egg in sauces, desserts and other foods as previously listed

The Food Standards Agency website (http://ratings.food.gov.uk) provides information with regard to the overall cleanliness of a business and whether it is a suitable place to eat at.  You can also look up the hygiene rating for all restaurants.  Where possible, try to go for 5 star establishments.

Food safety: Eating and drinking abroad/foreign countries

It is especially important to be very vigilant with food safety when eating abroad. The following tips will help reduce risk of food poisoning:


  • Avoid drinking tap water outside the UK, ice and beverages made from tap water and fresh fruit juice.

  • Drink bottled or canned beverages.

  • Boil tap water if it is to be used.

  • Some people may prefer to brush their teeth with bottled or cooled boiled water to prevent any risk of contamination.


  • Hot food should be served piping hot.

  • Avoid any foods that may have been washed in tap water such as salads and fruit.

  • Select vegetables and fruit that can be peeled.

  • Caution should be taken with hotels offering buffet style restaurants as described in the ‘Eating out and Takeaways’ section.

Dietary restrictions

Before your transplant you may have been advised to cut down on foods and drinks high in potassium and phosphate as well as limit your fluid. Once your new kidney is working well many of these restrictions may be relaxed.

High potassium and phosphate levels:

Although unlikely, it is important to be aware that some people may need to continue a potassium or phosphate restriction after their transplant. This would normally be in the first few days or weeks post-transplant. Speak to your dietitian, consultant or specialist nurse if you are unsure.

Low phosphate levels:

Occasionally, after a transplant people may experience low phosphate levels. It is unclear whether this can be alleviated with higher phosphate foods and often this has to be replaced with medication. However, if you wish to try to increase your levels in your diet ask to speak to your dietitian.

Salt :

It’s still really important to continue following a low salt diet, eating no more than 6g of salt a day, which is about a teaspoon. Much of the salt in our diet comes from processed foods. It’s not just in ready meals, soups and sauces, though – keep an eye on everyday foods such as breads and cereals, as well as sweet foods.  Read food labels to make sure that you are making low-salt choices, or use the free health app, FoodSwitch, which tells you which foods are less salty.


It is important to keep your new kidney healthy, the doctors will tell you how much to drink each day.

  • Water, tea, coffee and herbal teas without added sugar are the best options.

  • It’s advisable you limit your intake of sugary drinks or high fat drink e.g. milk shakes.

Foods that interact with your new medications

Some foods and herbal remedies can interact with immunosuppressive medications and reduce their ability to function. It is not recommended to take any ‘alternative’ medicines (e.g. herbal or homeopathic) or high dose vitamins without first discussing it with the transplant team.

Grapefruit and grapefruit juice, pomelo, pomelo juice and star fruit can affect the level of medication in your blood and therefore these should be avoided.

Bone health

Following your renal transplant you may be at increased risk of diseases which affect your bones. Steroid therapy and some immunosuppression can also weaken bones. It is therefore important to minimise the risk of your bones thinning and of fractures by ensuring that you have an adequate intake of calcium and vitamin D. The list below contains foods that are rich in calcium. Aim to have a minimum of 3 - 4 portions of calcium rich foods each day.

High sources of Calcium

High sources of Calcium

Milk: if choosing non-dairy milk such as soya or rice milk check the labels to make sure that they are fortified with calcium.


Yoghurt and yoghurt drinks


Tinned fish especially sardines, pilchards and salmon (if the bones are eaten)

Sesame seeds and tahini (sesame seed based paste)

Ready Brek® or own brand hot oat cereal fortified with calcium

Moderate sources of Calcium

Cottage cheese

Pulses especially baked beans, soya beans, broad beans, red

kidney beans and chick peas

Nuts, almonds, brazil nuts, hazel nuts

Dried figs

White bread and white flour products

Fortified breakfast cereals

If you are struggling to meet the recommended amount of calcium through diet alone, a calcium supplement may be appropriate , your dietitian will advise.

Vitamin D

Vitamin D helps you to absorb calcium from your food. The main dietary sources of vitamin D are:

Skimmed milk powder (with added vitamin D)

Margarine and low fat spread

Oily fish such as mackerel

Fortified breakfast cereals


The best source of vitamin D is safe sun exposure. However, transplant patients need to be careful as the immunosuppression medication you take can increase the risk of skin cancer. If you are concerned then your vitamin D level can be measured and a supplement can be prescribed by your doctor if required.

Lifestyle and bone health

Incorporating the following healthy lifestyle habits can also have a positive effect on your bone health:

  • Maintaining a healthy body weight (BMI 20-25kg/m2).

  • Weight bearing, high impact and strengthening exercises (eg walking, tennis, dancing, weight training).

  • Not smoking.

  • Drinking less alcohol. Current guidance is no more than 14 units of alcohol per week for both men and women.  

Example of units in alcoholic drinks:

Alcoholic drinks

1 unit

  • 1 single shot (25ml) of spirit
  • Or ½ pint low-strength (3.6%) lager, beer or cider

2 units

  • 1 pint of low-strength (3.6%) lager, beer or cider
  • Or 1 glass (175ml) of 12% wine


3 units

  • 1 pint higher-strength (5.2%) lager, beer or cider
  • Oor 1 large glass (250ml) of 12% wine


Healthy eating after a transplant

Once your kidney transplant is working well, looking after your diet and lifestyle are important. This is because some people develop side effects from their medication, such as:

  • Increased appetite

  • Weight gain

  • Increased blood cholesterol

  • Increased blood sugars

  • These can all increase your risk of heart disease or developing diabetes known as Post Transplant Diabetes Mellitus (PTDM)

If you would like further dietary advice regarding healthy eating, weight reduction or diabetes, please speak to your dietitian or ask your doctor to refer to a dietitian.

Reducing your risk of heart disease and developing post-transplant diabetes

Dietary and lifestyle changes can help reduce your risk of heart disease and diabetes, these include:

  • Achieving and maintaining a healthy weight (BMI within 20-25kg/m2).

  • Performing physical activity within the NHS guidance.

  • Stop smoking.

  • Healthy eating, following the ‘Eat Well Guide’.

What is healthy eating?   Healthy eating is often described using’ The Eatwell Guide’, shown here, and your diet should consist of the following groups:

What is healthy eating

Fruit and vegetables:  Eat plenty of fruits and vegetables, aiming for at least 5 portions of a variety every day. Choose from fresh, frozen or canned.  Dried are also included (up to 30g a day) as is fruit juice (up to 150ml a day).

Potatoes, bread, rice, pasta and other starchy carbohydrates:  Starchy food should make up just over a third of the food we eat.  Choose higher-fibre, wholegrain varieties such as wholemeal bread, whole-wheat pasta, brown rice or simply leaving the skins on potatoes.

Beans, pulses, fish, eggs, meat and other proteins:  These foods are high in protein, eat from this group twice daily.

  • Beans, peas and lentils (which are all types of pulses) are good alternatives to meat because they’re naturally low in fat, and high in fibre, protein and vitamins and minerals.
  • Choose lean cuts of meat or trim off any excess fat or skin from your meat.
  • Aim for at least two portions (2x140g) of fish a week, including oily fish.
  • Limit your intake of fatty processed meat products such as sausages, pies and burgers.

Dairy and alternatives:  Include diary or diary alternatives in your diet.  Choose lower fat options when possible.  For products like yoghurt, go for ones lower in fat and sugar.

Oils and spread:  Use these products sparingly as they are high in fat.  Cutting down on these types of foods could help to control your weight as they are high in calories.

Eat less sugar:  Too much sugar in your diet can increase your risk of becoming overweight and having high blood glucose levels. This includes sugar that has been added to food, as well as sugar naturally present in honey, syrup and fruit juices. The sugars that occur naturally in foods such as whole fresh fruit and milk should still be included as part of a healthy diet.

Eat less salt:  Much of the salt in our diets come from processed foods; therefore less processed ready prepared foods and more home cooked foods will help you to reduce your salt intake.

  • Limit salty food e.g. sausages, ham, ready meals, crisps and salted nuts, smoked and tinned meat and fish.
  • Check the labels and try to choose lower salt options. Where available, use the ‘Traffic Light’ guidance on the front of food packaging. Aim for green (low salt) or amber (moderate salt), and limit the red (high salt).
  • A little salt in cooking is OK, but try not to add any to your food at the table.
  • Try to use alternatives e.g. herbs, spices, lemon juice, garlic, vinegar or mustard for flavouring food. 
  • AVOID: Salt substitutes e.g. Losalt®, Solo, Saxa So-low® and supermarket own brands.

Alcohol guidance:

  • Men and women are advised not to regularly drink more than 14 units a week.
  • If you drink as much as 14 units a week, you should spread your drinking over three days or more days and have several alcohol-free days each week. For information about alcohol units see page 12.


Tips to cope with hunger

  • Have regular meals, including breakfast every day.

  • Avoid eating between meals.

  • If you are hungry, low sugar, low fat drinks can be used to fill you up, such as tea, coffee, reduced sugar squash and cordial, diet fizzy drinks or low calorie soups.

  • Avoid shopping when you are hungry.

  • At meals try to focus on high fibre foods as much as possible. Fibre can be found in vegetables, salads, fruit, beans, pulse, lentils and all the wholegrain varieties of starchy foods such as granary bread, brown rice and whole-wheat pasta.

  • Wait at least 10-20 minutes after you finish eating before you decide whether to have second helpings.

  • If having puddings, opt for fruit and low fat, low sugar yoghurt.

  • Before you eat check whether you are really hungry or just eating out of habit or boredom.

Useful websites


Bone health

Eating out

Food Safety

  • National Health Service NHS) – www.nhs.uk

  • Food Standards Agency – www.food.gov.uk

Health eating/lipid lowering/lifestyle

  • Consensus Action on Salt and Health – www.actiononsalt.org.uk

  • Action on Sugar - www.actiononsugar.org

  • British Nutrition Foundation – www.nutrition.org.uk

  • The Cholesterol charity – www.heartUK.org.uk    

  • Diabetes UK – www.diabetes.org.uk

  • National Health Service (NHS) –

  • British Heart Foundation –

Renal transplant support groups

  • National Kidney Federation (NKF) – www.kidney.org.uk

  • National Kidney Patient Association – www.kidney.org.uk/kpa

  • British Kidney Patient Association – www.britishkidney-pa.co.uk

  • Kidney Research UK – www.kidneyresearchuk.org

  • Kidney Care UK – www. kidneycareuk.org (Includes ‘Kidney Kitchen’ with lots of recipes)

Skin Health

Smoking cessation

Travelling abroad

  • National Travel Health Network and Centre (NATHNAC)

Weight loss

  • NHS Choices Weight Loss Guide www.nhs.uk/livewell/weight-loss-guide/Pages/weight-loss-guide.aspx

  • British Dietetic Association Weight Wise eating plan http://bdaweightwise.com/

  • The British Heart Foundation produce a booklet called ‘Eat Better’ https://www.bhf.org.uk/informationsupport/support/healthy-living/managing-your-weight

Written information cannot replace personalised recommendation. For further advice please seek a dietetic referral from your consultant or GP

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