A Roundup of Anti-Rejection Medications for the Kidney Transplant Patient

By M. Roy First, MD

Anti-Rejection Medications for the Kidney Transplant Patient

As a result of the high success rate of kidney, heart, liver, and other organ transplantation, hundreds of thousands of people worldwide have been able to lead healthier lives. The recipient of an organ transplant has received a valuable gift, the “Gift of Life.”

Fighting Foreign Invaders
Your body’s immune system protects you against foreign invaders such as bacteria and viruses. The problem is that the immune system also recognizes the transplanted organ as a foreign invader and will try to reject it. For this reason, you will be prescribed anti-rejection drugs, also called immunosuppressive agents, in an attempt to dampen down your body’s natural immune response.

The goal of these medications is to keep your transplanted kidney or other organ healthy. Therefore, even though you may experience certain side effects from these drugs, it is important that you take your medications as prescribed by your transplant team. It is also important to discuss with them any problems that you might be having with these medications.

Adherence and Rejection
Unfortunately, failure to adhere to the medications as prescribed is an important cause of rejection and possible loss of the transplanted organ. To ensure that you take your drugs in the prescribed fashion, you may consider using a treatment diary to keep track of the medications. You can also use a pillbox to organize the medications. And always remember to refill your prescriptions before you run out.

It is also important that you have a healthy diet and exercise on a regular basis. Discuss these aspects with the transplant team dietitian and your doctor. And be sure to remember this: Do not take any new medications prescribed by other doctors without first checking with your transplant team. This also applies to certain over-the-counter medicines. Even grapefruit juice may have an effect on some of the anti-rejection agents. Excessive weight gain and smoking also need to be avoided.

Common Immunosuppressive Drugs
You may be on a combination of anti-rejection drugs. By dampening down the immune system, all immunosuppressive drugs, while they keep your body from rejecting your transplanted organ, also come with certain side effects you need to discuss with your doctor. Not everyone will have the same side effects, and some patients will experience only mild effects from these medications. The most commonly used drugs, with their most frequent side effects, are described below.

  • Prednisone. This medication is usually given twice a day in the period immediately following the transplant, but is converted to a once daily dose, usually in the morning, soon after the transplant. The main side effects include increased appetite and weight gain; fat deposits; swelling; increased facial hair growth; acne; bone, muscle, and eye problems; increased blood sugar (glucose) levels; delayed wound healing; and growth problems in children.
  • Imuran (azathioprine). Imuran is usually taken once daily following a transplant. It was widely used in the early years of transplantation, but, with the development of newer agents, is currently used far less frequently. Adverse events include hair loss, low white blood cell count, loss of appetite, diarrhea, and pancreas problems.
  • Cellcept (mycophenolate mofetil, or MMF). MMF is taken twice a day and comes in capsule, tablet, and liquid forms. The main side effects are stomach problems, diarrhea, low red blood cell count (anemia) and white blood cell count, and low platelet count.
  • Myfortic (mycophemolic acid). This anti-rejection drug is similar to MMF. It is taken as a tablet twice a day. Side effects are similar to those with MMF.
  • Rapamune (sirolimus). This once-a-day agent is given as a capsule or liquid mixed with water or orange juice. Among the side effects are a high cholesterol level; skin rash; stomach problems; low white blood cell, red blood cell, and platelet counts; delayed wound healing; swelling of the legs; and ulcers in the mouth.
  • Neoral (cyclosporine). Cyclosporine is given as a liquid or capsule, usually taken twice a day. It is important to take the drug at the same time each day, taking each dose approximately 12 hours apart. The downside includes a high blood cholesterol level, high blood pressure, swelling and bleeding of the gums, increased facial hair growth, tremors, headaches, reduced kidney function, and high blood glucose levels. There are a number of generic versions of cyclosporine available. You should immediately contact your physician if you notice that you are given a different form of cyclosporine from that originally prescribed by your transplant team.
  • Prograf (tacrolimus). This immunosuppressive is taken as a capsule twice a day, and, like cyclosporine, it should be taken at the same time each day. The major side effects encountered with this drug include shakiness, tremors, headache, high blood pressure, decreased kidney function, hair loss, and high blood sugar level. Recently, a new formulation, Prograf-XL, has been developed for once daily use in the morning.

Conclusion
As mentioned earlier, the immunosuppressive drugs that you might be on after your transplant may be highly  varied and complex. Always take your medicines exactly as prescribed by the transplant team and discuss any potential problems or difficulties you encounter with them. It is also important to take your medication exactly as prescribed even when you are feeling good.

Remember that it is these medications that have improved your health, and that rejection can occur at any time, even long after the transplant. The best way to protect your transplanted organ is to understand everything about your medications and to adopt a healthy lifestyle. Never hesitate to ask questions and discuss your concerns with your transplant doctor and your transplant team. Working together with your team results in the best chances for a long-term and successful outcome.

Anti-rejection medications - M. Roy First, MDAbout the Author
M. Roy First, MD, is Vice President for Medical Affairs, Research and Development, Astellas Pharma US, Deerfield, IL. Previously, he was Professor of Medicine, Division of Nephrology, University of Cincinnati Medical Center. He is a Past President of the American Society of Transplant Physicians.

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