A Kidney transplant is the best treatment for most patients with end-stage renal disease and is associated with significant improvement in quality of life and survival of patients with successful kidney grafts. Because patient and graft survivor rates one year after transplantation are currently higher than 95% for recipients of living and deceased donor kidneys, there will be large numbers of successful recipients requiring long-term care and chronic immunosuppression.
Immunosuppressant drugs have to be taken during and after any kind of organ transplant. Primary care physicians, internists and the general public are becoming increasingly involved in this type of care, and will need basic information about immunosuppression and the medical management of these patients. Here are a few things you need to know about immunosuppressants.
What are immunosuppressants?
Immunosuppressants are drugs or medicines that suppress or reduce the strength of the body’s immune system and lower the body’s ability to reject a transplanted organ. That is, they help to accept the organ from someone else body. Another term for these drugs is anti-rejection drugs.
Uses of Immunosuppressants
Almost everyone who receives an organ transplant has to take immunosuppressant drugs. The body recognizes a transplanted organ as a foreign mass. This triggers a response by the body’s immune system to attack it.
By weakening the immune system, immunosuppressant drugs decrease the body’s reaction to the foreign organ. The drugs allow the transplanted organ to remain healthy and free from damage.
The goal is to adjust these drugs to prevent rejection and to minimize any side effects of the drugs.
Types of Immunosuppressant 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.
How Are the Drugs Administered?
All immunosuppressant drugs are only available with a prescription from a physician. They can be administered as tablets, capsules, liquids, and injections. A physician determines the best course of treatment using a combination of drugs. The goal of immunosuppressant therapy is to find the course that will prevent rejection and have the least harmful side effects.
A person taking immunosuppressant drugs must take them exactly as prescribed every day. Even the slightest change from the medication regimen can trigger an organ rejection. After missing a dose, it’s important to contact a physician immediately.
Regular blood tests are used to monitor the effectiveness of the drugs and the need for adjustments.
Side Effects
The most significant side effect of immunosuppressant drugs is an increased risk of infection. Other, less serious side effects can include loss of appetite, nausea, vomiting, increased hair growth, and hand trembling. These effects typically subside as the body adjusts to the immunosuppressant drugs.
The following side effects indicate the need for immediate attention:
- A feeling of being unusually tired or weak
- Fever above 100 degrees or chills
- Frequent urination or burning when you pass your urine
- A cold or cough that will not go away
Does everyone who gets a new kidney have to take immunosuppressants?
Almost everyone who has a transplant must take these drugs every day as directed. Even missing a single dose may make it more likely for you to have a rejection. The only time you should skip a dose is if your doctor or other health care team member tells you to do so. If you are not sure, call your doctor. Also, when you have a clinic visit, you should not take your immunosuppressant medicines until your blood is drawn for lab work.
Because of the large number of pills you may need to take each day, forgetting a dose is easy to do. You can do three things to help you remember your medicine:
- Know the name of each drug you take and what it does. If you have a good understanding of your drugs, you will be less likely to forget one.
- Use a pill box or organizer. This allows you to set up an entire week of pills. Once the week is set up, all you have to do is take the pills in each on the right day and time.
- Try to take your medicine at the same time every day.
What should I do if I miss a dose?
Take it as soon as you remember and call your doctor. If it is time for the next dose, do not take a double dose.
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 or development of swelling
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, erythromycin, anti-TB (tuberculosis) medicines, anti-seizure medicines and some blood pressure medicines.
NO MEDICATION SHOULD BE TAKEN WITHOUT CONSULTING WITH YOUR NEPHROLOGIST
Dr. P. N. Gupta
A graduate of K.G. Medical College, Lucknow, Dr Gupta obtained his DNB in Nephrology from Batra Hospital, New Delhi. He has worked at Fortis, Vasant Kung, Medanta, The Medicity and has obtained Fellowship in Kidney Transplantation. He worked with Prof Montgomery at Johns Hopkins, and has also obtained a visiting fellowship in ABO incompatible Kidney Transplantation. His special interest is in Kidney Transplantation and Dialysis in Acute Renal Failure and Chronic Renal Failure. He is currently Sr. Consultant, Nephrology & Transplant Physician at Paras Hospital, Gurgaon.
