A Kidney Transplant Diet {According to a Renal Dietitian}

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Receiving a kidney transplant can be an incredible gift. Caring for this new kidney will be top priority to extend the life of the kidney transplant for as long as possible. Just like your diet before a transplant, a diet after kidney transplant will be important. In this article, we will cover the nutrients and foods to include in a kidney transplant diet. We will also go over foods, beverages, and supplements that need to be limited or avoided entirely to protect your kidney transplant. This information, along with your transplant team’s guidance, is sure to help you protect your kidney transplant for the years to come.

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What to Eat with after a Kidney Transplant

Once you have a kidney transplant, your diet may open to many foods previously not allowed.

In this section, we’ll cover the nutrients and diet changes after a kidney transplant.

Protein

Protein will be an important part of your diet. It will be needed in higher amounts immediately after receiving your kidney transplant.

This will be very different if you were following a stage 5 kidney diet, which is often much lower in protein.

Your doctor or dietitian may discuss continuing even higher protein intakes in some situations.

Certain transplant medications like prednisone can also cause some muscle wasting (1).

While transplant medications can be adjusted by your physician, there may be limitations to the extent in order to protect your new kidney.

Therefore, adjusting protein in your diet may be a better place to support your overall health. 

Both animal and plant proteins can be included in your kidney transplant diet. According to the Kidney Disease Improving Global Outcomes (KDIGO) nutritional guidelines, there is not enough evidence to support one type of protein over the other (2). 

Animal-Based Lean Protein Choices

Poultry

• Chicken breast (skinless)
• Turkey breast (skinless)
• Ground chicken or turkey (90% lean or higher)

Seafood

• Cod
• Tilapia
• Haddock
• Salmon
• Tuna
• Shrimp
• Scallops
• Crab
• Lobster

Dairy

• Greek yogurt (non-fat or low-fat)
• Cottage cheese (low-fat)
• Skim or low-fat milk

Eggs

• Egg whites
• Whole eggs (in moderation)

Plant-Based Lean Protein Choices

Include plant proteins as well as animal proteins. Plant proteins provide other nutrients animal proteins do not.

This can include fiber, potassium, magnesium, phytonutrients, and antioxidants.

Legumes

• Lentils
• Chickpeas
• Black beans
• Edamame
• Green peas

Tofu & Tempeh

• Tofu
• Tempeh

Seitan

• Wheat gluten-based protein

Nuts & Seeds

• Pumpkin seeds
• Hemp seeds
• Chia seeds
• Nut butters

Grains

• Quinoa
• Farro
• Amaranth

Other Plant-Based Options

• Plant-based protein powder (pea, hemp, rice protein)
• Nutritional yeast

How much protein should I eat to keep my kidney transplant?

As mentioned earlier, more protein will be needed immediately after a transplant, with a gradual reduction in protein needs as the transplant stabilizes.

A kidney transplant will still have a CKD stage diagnosis. The amount of protein to protect your kidney transplant will be based on this amount.

A lower CKD stage, like stage 4 or stage 5, may require less protein.

A mild/moderate CKD stage, like stages 1 through stage 3, will have a more “normal” protein goal.

Your diet may include anywhere from 10 – 25% of calories from protein depending on the kidney transplant function and other factors like activity, age, medical conditions (like diabetes), and medications.

Speak with your doctor or registered dietitian to get a specific protein target for your kidney transplant diet.

Should a kidney transplant diet include protein supplements?

Some kidney transplant patients may require a protein supplement if they cannot eat enough protein in their diet or have significantly higher protein needs.

This may be necessary in the initial weeks after receiving a kidney transplant while recovering.

However, as the kidney transplant stabilizes a protein supplement may not be needed or even helpful.

Discuss any protein supplement with your doctor or dietitian prior to starting to ensure it’s the right one for your needs.

Carbohydrates

A kidney transplant may mean a change in the carbohydrates you eat.

Approximately 20% of kidney transplant recipients develop type 2 diabetes after a transplant (3).

However, that doesn’t mean you shouldn’t eat carbohydrates. Instead, it’s important to focus on including whole grain carbohydrate sources.

By including nutrient-rich whole grains, fruits, and vegetables, you’ll be getting good carbohydrate sources that also provide other nutrients like fiber.

Fiber

Fiber is a very important part of an after kidney transplant diet.

Studies have shown that a higher fiber diet after kidney transplant reduces the risk of developing metabolic syndrome and cardiovascular disease (4).

A good target to aim for is at least 14 grams of fiber for every 1,000 calories you eat. Many people need at least 2,000 calories, so 28 grams of fiber per day is a healthy goal.

Choosing high-quality carbohydrates is an easy way to get the necessary fiber in your diet.

High Quality Carbohydrates to Include

Here is a list of whole grains and carbohydrate-rich foods organized by category:

Whole Grains

• Quinoa
• Brown rice
• Wild rice
• Oats (rolled, steel-cut, or whole)
• Barley
• Bulgur
• Farro
• Buckwheat
• Millet
• Amaranth
• Spelt
• Teff
• Freekeh
• Kamut
• Rye
• Sorghum
• Triticale
• Whole wheat (whole wheat flour, bread, pasta, couscous)

Carbohydrate-Rich Foods

There are other sources of carbohydrates that can be included in your diet. These foods also include other nutrients.

For example, legumes can also be a source of plant protein.

Starchy Vegetables

• Potatoes (white, red, sweet)
• Corn
• Peas
• Squash (butternut, acorn)
• Plantains
• Yams

Legumes

• Lentils
• Chickpeas
• Black beans
• Kidney beans
• Pinto beans
• Navy beans

Fruits

• Bananas
• Apples
• Oranges
• Grapes
• Pears
• Mangoes
• Pineapples
• Dates
• Figs

Other Carbohydrate Sources

• Whole grain bread
• Whole grain pasta
• Legume-based pasta
• Whole grain crackers
• Brown rice cakes
• Granola (whole grain, low sugar)
• Popcorn (air-popped)
• Dehydrated or baked legumes (like Harvest Snaps*)

Healthy Fats

Kidney transplant patients are at a higher risk of cardiovascular disease and high cholesterol levels. 

The KDIGO guidelines encourage a “plant-based ‘Mediterranean-style’ diet” to reduce cardiovascular disease risk and help with cholesterol levels (2). 

A low-fat diet that includes fats from healthy sources is good for a kidney transplant diet.

About 20 – 30% of your calories should come from healthy fats. This comes out to about 45 to 65 grams of fat per day in a 2,000 calorie diet.

Examples of Healthy Fats

Here’s a list of healthy fat sources organized by categories.

Oils

• Olive oil
• Avocado oil
• Coconut oil
• Flaxseed oil
• Walnut oil
• Sesame oil
• Canola oil
• Sunflower oil (high oleic)
• Grapeseed oil

Nuts

• Almonds
• Walnuts
• Cashews
• Pecans
• Hazelnuts
• Pistachios
• Macadamia nuts
• Brazil nuts

Seeds

• Chia seeds
• Flaxseeds (ground)
• Hemp seeds
• Pumpkin seeds
• Sunflower seeds
• Sesame seeds

Fruits

• Avocados
• Olives

Fatty Fish

• Salmon
• Mackerel
• Sardines
• Trout
• Herring
• Tuna

These sources provide a variety of monounsaturated, polyunsaturated, and some saturated fats, which are essential for a balanced and healthy diet.

Sodium

Sodium will still be a primary concern after a kidney transplant.

This is because too much sodium can increase the risk of developing uncontrolled high blood pressure.

If this happens, it causes additional strain on the new kidney.

A low-sodium diet of 1,500 to 2,300 milligrams is a best practice for a kidney transplant diet.

Remember: sodium is still an essential part of our health. It’s not a no-sodium diet; it’s a low-sodium diet.

Fluids

Before a kidney transplant, you may have been instructed to follow a fluid restriction. You will likely need to drink more water after a kidney transplant.

This is because your new kidney needs the water to help eliminate wastes.

Your doctor or dietitian will be able to give you a fluid target to aim for each day.

Make sure that the majority of fluids comes from clean, filtered water.

Hydrogen water or “pH water” is not necessary and has not been researched to show any benefits for people with kidney disease. Some animal studies have shown potential benefits, but research needs to be done on humans to confirm these benefits (5, 6)

However, other drinks that can count towards fluid intake include coffee, some teas, juices, and sodas (in moderation).

Beware that herbal teas may need to be avoided on a kidney transplant diet. More details about this will be discussed later in this article.

Phosphorus

Phosphorus is often one of the biggest concerns before a kidney transplant.

However, a kidney transplant brings back the kidneys’ ability to effectively remove phosphorus.

In fact, approximately 40% of kidney transplant recipients may have low phosphorus levels in the days and weeks after a transplant (7).

This means that a low-phosphorus diet is generally no longer required.

In fact, many kidney transplant recipients may require a high phosphorus diet.

It’s still best practice to include more foods with organic phosphorus than inorganic phosphorus (aka added phosphates).

High Phosphorus Foods

Here are some foods with higher phosphorus absorption rates to enjoy if you’re directed to increase phosphorus in your diet. (8)

• Hard cheeses like parmesan, cheddar, and pecorino
• Nuts & nut butters
• Egg yolk
• Turkey and other animal meats
• Fish & Seafood
• Cottage cheese

Foods and beverages with inorganic phosphorus may also be enjoyed after a kidney transplant.

Talk with your doctor or dietitian about your phosphorus levels and what the phosphorus in your diet should look like.

Phosphorus Supplements

In some cases, a very low phosphorus lab result may lead to a phosphorus supplement prescribed by a doctor.

This can feel very strange as many with CKD before a kidney transplant are prescribed phosphorus binders. These medications are used to lower phosphorus levels.

Your doctor or dietitian will discuss the need for any phosphorus supplements depending on your bloodwork.

Potassium

Potassium may be more liberalized in an after kidney transplant diet.

However, medications and kidney transplant function can alter the amount of potassium a transplant recipient should include in their diet.

In some cases, high potassium levels may occur with a kidney transplant that can require a low potassium diet (9, 10).

Your doctor or dietitian will be able to review your potassium levels and look at factors that can help determine the best amount of potassium you can include in your diet.

Using a food journal like Cronometer* can provide your dietitian with information to better determine if your diet is impacting your potassium blood levels.

Read more of our articles discussing potassium in foods here.

Calcium

Your dietitian or doctor may recommend increasing your calcium intake. A kidney transplant diet should generally include approximately 1,200 to 1,500 milligrams of calcium per day.

Aim to get calcium from foods such as low-fat dairy products, leafy green vegetables, canned salmon, and seeds.

What Not to Eat with a Kidney Transplant

As you can see, there are many foods that can be enjoyed after receiving a kidney transplant. However, there are some foods that should be limited or avoided entirely.

In this section, we’ll cover foods to be cautious about in your new kidney transplant diet.

Red Meat

Red meats are associated with a higher risk of developing chronic kidney disease (11, 12, 13).

Additionally, red meats contribute to high blood pressure (14).

However, some research has found that including some red meat may be protective for a kidney transplant (15). 

Red Meat to Limit or Avoid

• Beef (examples: ribeye, sirloin, tenderloin, brisket, ground beef)
• Pork (examples: tenderloin, loin chops, pork shoulder, bacon)
• Lamb
• Veal
• Goat
• Bison
• Venison
• Elk
• Mutton 
• Wild Boar
• Buffalo

Speak with your doctor or dietitian if you do want to include some red meat in your diet.

Food Safety Concerns

Kidney transplant recipients are at a higher risk of foodborne illnesses. This is due to the immune suppressing prescription medications required to keep a kidney transplant active.

Wash All Produce

Make sure fruits and vegetables are washed well before preparation or eating. Be careful with buffets and salad bars as they have a higher risk of food contamination.

Pre-packaged salad greens and cut/prepared produce should be washed prior to using, even if it’s been “pre-washed.”

Unpasteurized Foods & Beverages

Avoid unpasteurized dairy products and juices. These have bacteria that increase the risk of foodborne illness.

Cook Foods to Temp

Meats, poultry, fish and eggs need to be cooked thoroughly before eating.

Food/Food Group	Minimum Temperature
Beef, Pork, Veal & Lamb Steaks, chops, roasts	145℉ (62.8℃) + rest for at least 3 minutes
Ground Meats	160℉ (73.9℃)
Ground Poultry	165℉ (73.9℃)
Ham, fresh or smoked (uncooked)	145℉ (62.8℃) + rest for at least 3 minutes
Fully cooked ham (reheating)	165℉ (73.9℃)
Poultry	165℉ (73.9℃)
Eggs	160℉ (71.1℃)
Fish & Shellfish	145℉ (62.8℃)
Leftovers	165℉ (73.9℃)
Casseroles	165℉ (73.9℃)

Table from the USDA Food Safety and Inspection Service.

Need a food thermometer? Check out this one from Amazon.*

High-Risk Foods for Foodborne Illness

Foods that have a higher risk of developing a foodborne illness include;

Raw or Undercooked Animal Products

• Raw or undercooked poultry (chicken, turkey)
• Raw or undercooked meat (beef, pork, lamb, veal)
• Raw or undercooked seafood (fish, shellfish)
• Raw or undercooked eggs
• Unpasteurized milk and dairy products
• Unpasteurized juices (e.g., apple cider, orange juice)

Certain Produce

• Leafy greens (spinach, lettuce, kale)
• Fresh herbs (cilantro, parsley)
• Sprouts (alfalfa, bean, radish)
• Berries (strawberries, raspberries, blueberries)
• Melons (cantaloupe, honeydew, watermelon)
• Unwashed fruits and vegetables

Processed Meats

• Deli meats (ham, turkey, roast beef)
• Hot dogs (especially if not reheated properly)
• Pâtés and meat spreads
• Sausages (especially uncooked varieties like salami)

Prepared and Ready-to-Eat Foods

• Salads (egg salad, chicken salad, tuna salad)
• Premade sandwiches
• Sushi and sashimi
• Soft cheeses (feta, brie, camembert) made with unpasteurized milk
• Raw dough and batter (due to raw eggs and flour)

Other Foods

• Cooked rice and pasta (if not properly stored)
• Potatoes (especially in potato salad)
• Fermented sausages and cold cuts
• Ice cream (if made with raw eggs or unpasteurized milk)

These foods are more susceptible to contamination by bacteria, viruses, parasites, or toxins, and proper handling, cooking, and storage are crucial to minimize risks.

The United States Department of Agriculture offers a free Food Safety guide for download. You can download a copy of the USDA Food Safety guidelines for free here.

Foods That Interfere with Medications

A kidney transplant will come with new medications.

New medications required after transplant include antirejection medications and immunosuppressive medications.

Both of these medications help to ensure your body accepts and uses your new kidney.

Speak with your doctor or transplant dietitian about any of these foods and beverages prior to starting. They may be able to help you enjoy them without impacting your medications.

Grapefruit & Other Citrus

This is a common food to avoid as grapefruit interferes with many medications CKD and transplant patients have prescribed.

Medications for high cholesterol, blood pressure management, as well as immunosuppressants used for kidney transplant can be affected by grapefruit & grapefruit products (16).

This includes grapefruit-flavored sodas and waters, as well as grapefruit juice.

Pomelo, clementines, mandarin, tangelo and Seville oranges also have potential drug interactions and should be avoided (17, 18, 19).

Pomegranate & Pomegranate Juice

Pomegranate can interfere with tacrolimus, a common kidney transplant medication (20).

Green Tea

While considered a “healthy” beverage, green tea is not advised on a kidney transplant diet.

Green tea has been shown to increase levels of Tacrolimus, an immunosuppressive medication for transplant (20).

Licorice

Natural licorice has been shown to reduce effectiveness of immunosuppressant medication cyclosporine A (21).

Avoid natural licorice, which can be found as a food, tea, or supplement.

Herbal Supplements

In general, herbal supplements should be avoided with a kidney transplant diet. There is limited research with rewards related to supplements.

Supplements are not regulated by the Food and Drug Administration and therefore the ingredients, dose, and purity cannot be guaranteed.

Additionally, there is much at risk. Taking herbal supplements may cause damage to the transplanted kidney.

Below are some common supplements to be wary of. However, this is not an exhaustive list.

Do not take any supplements before getting approval from your transplant team.

St. John’s Wort

Commonly used for depression and mood, St. John’s Wort has many drug interactions. Anxiety and depression are common for kidney patients.

Treating anxiety and depression is important to protect kidney function (22).

However, it is important to avoid this supplement to ensure medications are effective and appropriate.

Speak with your doctor or healthcare professional about any mental health concerns you may have or seek resources here.

Cranberry Extracts & Supplements

While cranberry supplements are popular with kidney patients in the hopes of preventing UTIs, they are not recommended.

Cranberry extracts and supplements can interfere with medications and cause an increased risk of developing kidney stones.

They can also potentially impact medications such as Tacrolimus, a common kidney transplant medication (20). 

Turmeric

While turmeric is often thought of as a safe supplement, kidney transplant patients are wise to avoid it.

Turmeric can increase blood levels of Tacrolimus, a commonly used kidney transplant medication. (19, 20). 

Ginger

Ginger is commonly used as a supplement for nausea and vomiting. However, it is not safe for kidney transplant recipients.

Ginger can interfere with transplant medications including Tacrolimus and Cyclosporine-A (19, 23, 24). 

Work with a Dietitian

Kidney transplant recipients are eligible for dietitian services for the three years following a kidney transplant under Medicare services (25).

Your health insurance provider may also be able to give you guidance on Medical Nutrition Therapy covered with your insurance plan. Here’s what to ask them.

Working with a dietitian one-on-one is the gold standard for getting the best, most personalized kidney transplant diet recommendations.

Ask your doctor for a referral to a renal dietitian, check out these resources to find a dietitian, or learn about the dietitians at Plant-Powered Kidneys.

Summary 

A kidney transplant is a great treatment option for chronic kidney disease. It means getting a new kidney that will provide more kidney function. And more kidney function means more flexibility with a kidney transplant diet.

Focusing on lean proteins will be important to provide energy and keep a kidney transplant strong. The diet immediately after a kidney transplant will require more protein. In the months following, a kidney transplant diet has a similar protein need for a general, healthy diet.

High-quality carbohydrates are important to include in a kidney transplant diet. Including carbohydrates like whole grains, fruits, vegetables, and legumes will provide micronutrients like fiber, potassium, and even some phosphorus that a kidney transplant needs. Diabetes is a common result of kidney transplant, so limiting added sugars is helpful to protect your new kidney.

Healthy fats provide satiety, help absorb nutrients, and give more calories necessary for energy levels. Choose healthy fats like nuts, seeds, olives, avocados, fatty fish and some oils like avocado oil and olive oil.

Some foods, drinks, and supplements may need to be limited or avoided entirely. Red meats should be limited or enjoyed sparingly. Grapefruit and other citrus fruits may need to be avoided to prevent medication interactions. Do not take any herbal supplements with a kidney transplant. These have not been studied to be proven safe to include on a kidney transplant diet.

Finally, work with a transplant dietitian before and after your kidney transplant to ensure the best nutrition guidelines for your new kidney transplant.