Immunosuppressant Use Following Kidney Transplant

Immunosuppressant is a term used to describe medicines that lower the body's ability to reject a transplanted organ. Another term for these medicines is anti-rejection medicines.

When you get a kidney transplant, your body knows that the transplanted kidney is new and unknown to your body. Your body will attack the transplanted kidney and try to destroy it. This reaction is similar to other allergic reactions. Immunosuppressant medicines decrease your body's ability to do this. The goal is to adjust these medicines to prevent rejection yet minimize side effects.

Immunosuppressant medicines are given immediately after the transplant (induction immunosuppressants) and then continuously for long-term prevention of rejection (maintenance immunosuppressants). There are four different types (classes) of immunosuppressant medicines. You and your transplant team will work together to decide on the specific medicines that will best meet your needs. 

Most people with a transplant must take these medicines every day. 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 caregiver tells you. If you forget a dose of medicine, take it as soon as you remember and call your caregiver. If it is time for the next dose, do not take a double dose. Call your caregiver if you have any questions.

HOW CAN YOU BETTER UNDERSTAND AND ORGANIZE YOUR MEDICINES?

  • Know the name and purpose of each medicine.

  • Read all of the labels and inserts that come with your medicines.

  • Know what potential side effects to look for.

  • Know what each of your medicines look like (such as color, shape, size, and imprint).

  • Check with your pharmacist if you notice a difference in the size or color of your medicine after a refill.

  • Get all of your medicines at one pharmacy. The pharmacist will have all of your information and understand possible drug interactions.

  • Use a tool, such as a pill organizer, written chart from your caregiver, notebook, binder, or your own calendar to organize your daily medicines. Your tool should help you keep track of the:

  • Name of the medicine and dose.

  • Days to take the medicines.

  • Time of day to take the medicines.

  • If you are having trouble identifying your different medicines, keep them in the original bottles.

  • Set cues or reminders for taking your medicines.

  • Review your medicine schedule with a family member or friend so that person can help you with your medicines. Other household members should understand your medicines.

WHAT ARE SIDE EFFECTS OF IMMUNOSUPPRESSANT MEDICINES?

You should expect to have some side effects with your medicines. One of the side effects common to all the classes of immunosuppressants is an increased risk of infection. This is more of a problem in the early period after a transplant or following treatment of a rejection because the dosage of these medicines is higher at these times. You should call the transplant center if you have signs or symptoms of an infection. Those signs or symptoms may include:

  • A temperature above 100° F (37.8° C).

  • Drainage or bad odor of drainage from your surgical scar.

  • Burning when you pass your urine.

  • A cold or cough that will not go away.

  • Flu-like feelings.

Other side effects vary depending upon the class of immunosuppressant medicine. Adjusting medicine dosages or treating the side effects will often minimize problems. 

WHAT ARE SIGNS OR SYMPTOMS OF KIDNEY TRANSPLANT REJECTION?

Even though you are taking your medicines every day, you may still develop rejection of your transplanted kidney. You need to know your body very well. Call your transplant center right away if you have any signs of kidney transplant rejection. Those signs may include:

  • Decreased urine output.

  • A temperature above 100° F (37.8° C).

  • Tenderness in the area of your transplanted kidney.

  • Bloody or foul smelling urine.

  • Flu-like feelings.

  • Weight gain of more than 3 lb (1.4 kg) in 2 days. Weigh yourself daily and record your weights.

Blood tests and perhaps other tests may need to be done. The long-term success of your kidney transplant depends largely on complete follow up with your transplant team.