WHAT YOU NEED TO KNOW ABOUT TRANSPLANTS
A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis.
During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working.
Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long.
If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney. You have to make a commitment to take care of yourself, by taking the medications as prescribed and adhering to the advice of your transplant team. Remember, you were not born with the transplanted organ and hence your body will try to reject it, and the immuno-suppressants will help your body to prevent the rejection.
Most of the immuno-suppressants are powerful drugs, and hence have side effects. For some of them, levels in the blood need to be monitored frequently. Too little of the drug will put you at risk for rejection, while too much might lead to side effects. It can take time for the transplant team to achieve the right balance of immuno-suppression drugs.
Broadly, the immuno-suppressants can be classified into 2 categories:
- Induction Agents: Powerful anti-rejection medications used at the time of transplant
- Maintenance Agents: Anti-rejection medications used for the long term.
The maintenance agents are generally 4 classes of drugs:
- Calcineurin Inhibitors: Tacrolimus and Cyclosporine
- Anti-proliferative Agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine
- mTOR Inhibitor: Sirolimus
- Steroids: Prednisone
Although there are multiple methods of mixing and matching the above drugs, the most common combination employed by the transplant team is Tacrolimus, Mycophenolate Mofetil and Prednisone.
The blood levels of Tacrolimus, Cyclosporine and Sirolimus have to be monitored closely. There are many other medications, food and supplements that alter the levels (up or down) in the blood, and you need to be aware of it. The list is long but some of the common ones are grapefruit juice, St. John's Wort, erythromycin, anti TB medications, anti-seizure medications and common blood pressure medications (cardizem or diltiazem, and Verapamil).
Calcineurin Inhibitors and the anti-proliferative agents are taken twice daily, and Sirolimus and Prednisone are taken once daily. Try to be consistent about the time of the day when you take your medications, that way you will remember to take them. Also, when you have a clinic appointment, do not take your anti-rejection medications till the blood is drawn for lab work.
The most common side effects of the immuno-suppressants are some sort of "stomach upset". Sometimes spacing the Calcineurin inhibitors and the anti-proliferative agents by more than an hour might help. Other specific side effects include:
- Tacrolimus: tremors, hair loss, headaches and increased chance of developing diabetes
- Cyclosporine: Hair growth (does not grow hair if you are already bald), gum enlargement, and tremors
- Sirolimus: Rash, bone marrow problems (anemia, low white count and low platelets), swelling of ankles, frothy urine (because of protein leakage from urine)
- Prednisone: This is branded as an "evil drug" because of the many side effects (weight gain, water retention, diabetes, acne et al). However, for the long term use a very small dose is prescribed (5 mg), and the major side effect is bone thinning which can be countered easily.
Again it is important for you to ask what types of immuno-suppressant combinations are used by your transplant team.
About 6 months to a year after transplant, the immuno-suppressants are generally lowered and the risk of side effects should be low. If you still continue to experience side effects, you need to speak to your transplant professional to either adjust the dose or switch to a different medication. Any changes to the immuno-suppressants should be handled (or changed) in consultation with your transplant team.
There are many newer medications that are being tested in clinical trials, one of these medications being tested is an intravenous medication, given once a month that is used instead of the Calcineurin inhibitors. The blood levels of the drug do not need to be monitored. So far it has been successful. It may take a few years for other new medications to be used on a regular basis.
Finally, the success of transplantation depends on many factors:
- Be adherent to your medications
- Adopt a healthy diet and lifestyle
- Cancer screening (mammograms, colonoscopy, pap smears, et al)
- Always wear sun block
- Get vaccinated every year for the flu and every other year for pneumonia