In order to preserve the implanted kidney, one must consistently take special medications whose purpose is to prevent rejection of the implant by the body’s immune system.
Remember, the anti-rejection medications are your life-savers. Take them strictly on time. You must take sufficient medications to cover any absence from home – any trip or vacation or any other time out of your home. Not taking your medication on time can cause irreversible damage.
Routine treatment against rejection generally includes taking certain medications orally:
Prednisone – This medication is given in high dosages during the first days after the transplant. The dosage is gradually reduced to 5-7.5 mg per day, taken once or twice. The main possible side effects are weight gain, edema, swelling of the face, hair growth, pimples, diabetes, hypertension, and excessive fats in the blood. In addition anxiety and insomnia are possible.
Cyclosporin – A very important anti-rejection drug. The daily dosage is determined by testing the level of the drug found in the blood each morning. If the level is too low, the kidney may be rejected, and if too high, the kidney may be damaged causing an increase in Creatinine levels. Therefore it is critical to take the medication systematically and monitor blood levels. The nephrologist will alter the recommended dosage based on measured levels.
One should avoid drinking grapefruit juice, which increases the levels of cyclosporine, during drug use. Since other medications also affect the levels, one should notify the nephrologist when taking any other drug. Principal possible side effects are excessive hair growth, swelling of the gums, hypertension, excessive fats in the blood, and diabetes.
Prograf (“Tacrolimus”) – The mechanism of action of Prograf is similar to that of Cyclosporin. With this medication also, it is critical to take it systematically and monitor blood levels. As with cyclosporine, grapefruit juice and various drugs influence the level of Prograf in the blood. If the level is too low, the kidney may be rejected, and if too high, the kidney may be damaged causing an increase in Creatinine levels. Principal possible side effects include hand tremors (which usually cease with reduced dosage), hypertension, excessive fats in the blood(less often than with Cyclosporine), and diabetes(more often than with Cyclosporine). Prograf does not cause excessive hair growth or swelling of the gums, but sometimes leads to hair loss.
Imuran – One of the first anti-rejection medications. Today its use is much reduced due to the availability of better medications. Principal possible side effects: reduced white blood cell count and damage to liver function.
Cellcept or Myfortic – Given in combination with Cyclosporine or Prograf and together with Prednisone. Principal possible side effects include diarrhea, stomach pains, and reduced white blood cell count. These side effects generally disappear by reducing the dosage or stopping them temporarily. These drugs do not damage kidney function.
Rapamune or Everolimus – Anti-rejection medications introduced recently. Their mechanism of action is based on hindering the messages which command the lymphocytes to divide. In contrast to Cyclosporine and Prograf , Rapamune and Everolimus do not damage kidney function. Use of these drugs demands constant monitoring of their levels in the blood. Principal possible side effects include excessive fats in the blood, anemia, and reduced blood platelets.
Medications in case of rejection
In the vast majority of cases it is possible to successfully treat even severe rejection with medications. These medications are administered intravenously for a few days.
Solu medrol (Methylprednisolone) – A medication of the steroid family (like Prednisone) given in high dosages. The main possible side effects are hypertension, elevated blood sugar and even diabetes.
Thymoglobuline – Given in cases of rejection which does not respond to Solu medrol.
IVIG – This medication which is composed of antibodies administered by intravenous infusion, is used in cases of severe rejection occurring during the first days after the transplant.
Medications for the first days
In general, during the first days after the transplant, the recipient receives special medications whose purpose is to help retain the kidney in the body. Retention drugs are:
Thymoglobuline or ATG – These two medications include antibodies to neutralize T cells – the cells which are directly responsible for rejecting the transplant. Principal possible side effects of both drugs include fever, chills, joint pain, and greater susceptibility to infection. Side effects can be reduced by giving steroids, antihistamines, and Paracetamol prior to taking these drugs, according to doctor’s orders.
Simulect or Zenapax (discontinued) – Composed of humanized antibodies against lymphocytes. Their function is to neutralize the activity of cells which might cause rejection. There are no side effects except for rare cases of allergy.
Most transplant recipients also are given additional medications to prevent the side effects of the anti-rejection drugs.