The medicines you will be taking after your transplant to keep your body from rejecting your new kidney are called immunosuppressants. You will have to take these medicines every day for as long as you have your transplant. In some cases, even after a transplant stops working, we recommend remaining on small doses of these medicines to prevent antibody formation. This will make you more likely to have another compatible transplant later.
There are a number of immunosuppressants that can be used. You will not be taking all of these medicines but will be on some combination of them. All of them have potential side effects, but remember that not all patients suffer from all the side effects listed.
PROGRAF (FK506) – is taken twice a day. The side effects of this drug include headache, hand tremors, nausea, diarrhea, high blood pressure, increased blood sugar and potassium, and decreased magnesium. Prograf can also harm your kidneys over time. The dosing of this drug is based on the amount of drug in your blood. You must take care to dose it 12 hours apart and have your blood tests done just before your morning dose.
CYCLOSPORINE – is taken twice a day. The side effects of this drug include high blood pressure, mild hand tremors, headache, and increased growth of hair. Cyclosporine can also harm your kidneys over time. You must take care to dose it 12 hours apart and have your blood tests done just before your morning dose.
RAPAMUNE (SIROLIMUS) – is taken once a day in the morning. The side effects of this drug are ankle swelling, abdominal pain, nausea, diarrhea or constipation, joint aches, fever, headache, high blood pressure, anemia, and high cholesterol and triglyceride levels. Blood levels are also measured for this medicine so blood test should be done before your morning dose.
CELLCEPT - is taken two to four times a day. The side effects of this drug are diarrhea, nausea, vomiting, rash and low white blood cell count with increased risk for infection.
PREDNISONE – is taken for a few days immediately after your transplant. Some patients will suffer from difficulty sleeping or may feel “hyper”. These feelings will pass in a few days. Some patients will need to be on prednisone long term. The decision to use prednisone will be based on the type of kidney disease you have and your risk for rejection. The major side effects of long-term prednisone are increased appetite, stomach ulcers, osteoporosis, diabetes, cataracts, mood swings and Cushing’s syndrome. Cushing’s syndrome includes round cheeks, protruding abdomen, fat deposits over the upper back, acne, and increased growth of facial and body hair. Most patients are not on high enough doses to suffer from these side effects, and these side effects will decrease or disappear as the dose is decreased.
All the immunosuppressant drugs listed above work to try and prevent your immune system from rejection your transplanted organ. This also means that they make it harder for your immune system to fight bacteria, viruses and cancer cells. This puts you at higher risk for infection and cancer. You will have to take antibiotics for the first three to six months after your transplant to help prevent infection. You will need to have regular physicals with your primary care doctor for cancer screening including screening for skin cancer which is the most common post-transplant cancer.
In addition to the immunosuppressants and antibiotics, you may also need to take other medicines to treat high blood pressure, diabetes or other conditions. It is not uncommon for patients to go home on ten to twelve different medicines after their transplant. You need to be committed to taking your medicines and following doctor’s orders for any changes.