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Immunosuppression after solid organ transplantation is complex. Over the past 50 years, the medical community has witnessed great advances in the care of patients receiving organ transplants. Improved therapeutic strategies have been associated with better patient and graft survival rates; however, the adverse effects associated with these agents and the risks of long-term immunosuppression present a number of challenges for the clinician. With all the successes of immunosuppressive therapies come the obligations to tailor treatments to meet the individual patient's characteristics and to balance the risks and benefits of these medications.
Immunosuppressants are drugs or medicines that lower the body's ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants:
- Induction drugs: Powerful antirejection medicine used at the time of transplant
- Maintenance drugs: Antirejection medications used for the long term.
Think of a real estate mortgage; the down payment is like the induction drug and the monthly payments are like maintenance drugs. If the down payment is good enough you can lower the monthly payments, the same as for immunosuppression.
There are usually 4 classes of maintenance drugs:
- Calcineurin Inhibitors: Tacrolimus and Cyclosporine
- Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine
- mTOR inhibitor: Sirolimus
- Steroids: Prednisone
What are immunosuppressants used for?
When you get a kidney transplant, your body knows that the new kidney is foreign (that is, not originally part of your body). Your body will attack the new kidney and try to damage or destroy it. The immunosuppressant drugs suppress your body's ability to do this. The goal is to adjust these drugs to prevent rejection and to minimize any side effects of the drugs.
Are there any signs or symptoms I should watch for?
Yes. Even though you are taking your medicines every day, you may still develop rejection of the kidney transplant. You need to know your body very well. If you have any of the following, you should call your transplant center right away:
- a drop in your urine output
- a fever above 100 degrees
- tenderness of your new kidney
- bloody urine
- flu-like feelings
- weight gain (more than 3 pounds in two days)
The transplant center will probably ask you to have some blood tests and maybe other tests. The long-term success of your kidney transplant depends largely on careful follow-up and a good working relationship between you and your transplant team.
Are there other medicines and food that can act against immunosuppressants?
Yes. There are many other medicines, food, and supplements that can change the levels (up or down) of immunosuppressants in the blood. Some of the common ones are grapefruit juice, St. John's Wort, erythromycin, anti-TB (tuberculosis) medicines, anti-seizure medicines and common blood pressure medicines (cardizem or diltiazem, and Verapamil).
Are there any side effects from taking these drugs?
Yes. One of the side effects of these drugs is an increased chance of infections. This is more of a problem in the early period after a transplant or following treatment of a rejection because the dosage of these drugs is higher at these times. You should call the transplant center if you have:
- a fever above 100 degrees
- drainage from your surgical scar
- burning when you pass your urine
- a cold or cough that will not go away
The most common side effects of the immunosuppressant drugs are "stomach upset". If this happens, ask your doctor if you can space your medicine at different times to help with this problem.
About 6 months to a year after transplant, the immunosuppression is usually lowered and the chance of side effects should be low. If you still have side effects, speak to your transplant team to either change the dose or switch to a different medicine. Changes to immunosuppressant medicine should only be made after checking with your transplant center.
16 Symptoms of Immune System Problems
When your immune system is on point, it’s a lifesaver. But as good as it may be, it’s not perfect. Sometimes, this group of special cells, tissues, and organs doesn’t act the way it should.
If it kicks into action too often, you may get a condition like allergies, asthma, or eczema. Or if your immune system starts to attack your body instead of safeguarding it, you could have an autoimmune disorder like rheumatoid arthritis or type 1 diabetes.
1. Cold Hands
2. Bathroom Problems
3. Dry Eyes
5. Mild Fever
8. Joints Ache
9. Patchy Hair Loss
10. Repeated Infections
11. Sensitive to Sun
12. Tingling or Numbness in Your Hands and Feet
13. Trouble Swallowing
14. Unexplained Weight Change
15. White Patches
16. Yellowing of Your Skin or EyesImmunosuppressive
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