Treating Kidney Failure With Kidney Transplantation
XI. Medications
- Anti-Rejection Medications
Numerous anti-rejection medications are currently in use for the prevention and treatment of rejection in people with kidney transplants. As you will see in tables 4, 5 and 6, there are three different groups of anti-rejection medications:- Induction Therapy: Includes those anti-rejection medications given at the time of the surgery and for a specified time after surgery to suppress the initial response of the body (Table 4)
- Maintenance Therapy: Includes those anti-rejection medications given daily to maintain the function of the transplanted kidney (Table 5)
- Treatment of Acute Rejection: Includes those anti-rejection medications given when the transplanted kidney shows evidence that the body is trying to reject it (Table 6)
You will probably become most familiar with the medications in group 2--those you take on a daily basis to prevent rejection. Most transplant recipients take three medications for this purpose. Frequently, your primary medications may be either cyclosporine or tacrolimus . You will also be taking some kind of steroid such as prednisone. You may also take a third anti-rejection medication such as mycophenolate mofetil or azathioprine. (See table 5 for a listing of medications used for maintenance therapy.) Your transplant team will speak to you about what combination of medications is best for you.
As you look at the tables, you will see that some anti-rejection medications have multiple purposes. You should learn about the medications you are taking, and take them exactly as your doctor has directed you without substituting or mixing them.
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You will need to take large doses of your maintenance medications (see table 5) to start. Your doses will be reduced later on. Anti-rejection medications all have possible side effects. These side effects do not affect everyone, and they are usually not a problem in most people. If you develop a problem with one medication, the dose can be adjusted, or you can be switched to another medication.
It is important to make sure your pharmacist does not switch any of your anti-rejection medications without informing you and your transplant doctor. Your primary immunosuppressants should never be switched without your doctor's approval. If you have any questions, check with your transplant team.
Broad Effects of Anti-Rejection Medications
While each of these anti-rejection medications have specific side effects, their overall effect is to depress your body's immune response. This makes you more prone to a variety of infections, many of which are rare in the general population. Most transplant centers place patients on medications to prevent these infections, especially in the first couple of months after the transplant when the dosages of anti-rejection medications are high. Careful monitoring for signs of infection along with rapid diagnosis and treatment of infections that do occur are important in the long-term success of kidney transplants. There is also an increased chance of tumors, especially of the skin. To help reduce the risk of skin tumors, you should always use sun block when you are outdoors. - Other Medications
A variety of other medications are used to prevent different problems that may occur in patients with transplants. Some of these medications help to prevent infections. This includes medications to treat bacteria, viruses and fungus. These medications are shown in Table 7.
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Most kidney transplant patients will also need to be treated with blood pressure medications. Control of high blood pressure is important for the long-term success of the transplant and to prevent other problems like heart attacks and/or strokes.
Because most transplant patients need to take so many medications, the chance is increased that interactions may occur between the different medications. Some of these interactions may be harmful to the transplanted kidney or to the patient. The doctor who is managing these medications should be knowledgeable about these interactions and take them into consideration when dealing with the patient. You should be knowledgeable about your medications. Never take a medication prescribed by another doctor unless you check with your transplant team.
