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After the Transplant

Receiving an organ transplant is a gift of life. During the past 20 years, remarkable strides have been made to increase the success of organ transplantation and to better the lives of patients. There have been important advances in medicine, including improvements in surgery and greater understanding in how to use anti-rejection drugs safely and effectively.

LIVING WITH YOUR TRANSPLANT

Keeping yourself and your new organ healthy takes a lifelong commitment. The more you know about your transplant, the more control you will have over your physical and mental health. This information will help you take charge of your health and improve your quality-of-life after receiving a transplant.

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Transplant recipients share a common bond although the experience and outcome can vary according to the type of organ.

  • Kidney
  • Heart
  • Liver
  • Other Organs

ORGAN REJECTION

Your body's immune system protects you from foreign invaders such as bacteria and viruses. However, a transplanted organ is made up of "foreign" cells and your immune system will try to attack your transplanted organ. This is called rejection.

To reduce the chance of rejection, your transplant team will try to match the blood type and tissue type of the donated organ to yours. You will also be prescribed anti-rejection drugs ("immunosuppressants") that control the activity of your immune system.

A rejection episode can occur while on anti-rejection drugs, especially during the first few months after surgery. The word "rejection" can be frightening. However, rejection does not mean that you will lose your new organ. Knowing what rejection is and how it can be prevented or reversed will help reduce your fears.

Three types of rejection can occur after receiving an organ transplant:

  • Hyperacute rejection occurs as soon as the donated organ is transplanted. This rarely occurs because transplant doctors make sure to match blood types and check if you have antibodies against the donated organ
  • Acute rejection occurs at least a few days after the transplant surgery when the body has had time to identify a foreign invader.
  • Chronic rejection is a very gradual type of graft injury that can occur over months or even years after transplantation.

DETECTING REJECTION

A rejection episode can usually be reversed if it is caught early. The transplant team can often detect the first signs of rejection. That is why it is important to keep all appointments with your transplant team. They may take blood tests and biopsies to check the status of your graft.

You should also recognize the signs and symptoms of rejection. Contact your transplant team immediately if you think you might be having a rejection episode. Symptoms of rejection and medical tests used to detect rejection can vary by the type of organ transplant.

  • Kidney, Kidney/Pancreas
  • Heart
  • Liver
  • Other Organs

TREATING A REJECTION EPISODE

Do not panic. There are a number of things that can be done if you experience a rejection episode. With appropriate treatment, most rejection episodes will go away.

If rejection is detected, your transplant team will quickly treat it. Many rejection episodes are treated at home, but in some cases you may be admitted to the hospital for treatment.

Your doctor will first try to reverse the rejection episode by making adjustments to your medications. It is possible that your immune system has become more sensitive to foreign invaders and so the doses of your anti-rejection medications may need to be adjusted. Your medication might be changed or an additional one might be added. Some transplant recipients may need to have other special treatments to stop the rejection.

PREVENTING REJECTION

There are different types of medications that are used to prevent rejection and there are different formulations of the same anti-rejection drug. For example, cyclosporine and tacrolimus are classified as "calcineurin inhibitors" (CNIs). These drugs inhibit a protein involved in the activation of some white blood cells (T-cells) that attack the transplanted organ.

Anti-metabolites are another group of anti-rejection medications and include mycophenolate mofetil, mycophenolic acid, and azathioprine. The anti-metabolites interfere with metabolic processes, which inhibit some while blood cells (T-and B-cells). Sirolimus is a newer anti-rejection agent that inhibits T-cell growth. Corticosteroids (prednisone or prednisolone) are also used as anti-rejection drugs. They are often given in higher doses during the first weeks after the transplant and then tapered to lower levels or completely eliminated within weeks or months following the surgery.

The Table lists important information about anti-rejection medications such as dosages and formulations.

Figure. Anti-rejection medications

Figure. Anti-rejection medications.

The goal of treatment with anti-rejection drugs is to moderate the immune system just enough to prevent rejection, without increasing the risk of infection while minimizing drug-related side effects. Your transplant team will adjust the dose depending upon your risk of rejection, your weight, and other medications that you might be taking. It is important to maintain the proper levels of anti-rejection drugs in the blood. You must take all of your medications as prescribed in order to prevent organ rejection.

TAKING MULTIPLE ANTI-REJECTION MEDICATIONS

To provide the greatest protection against rejection, your transplant team may prescribe several anti-rejection drugs. Your transplant team will decide what combination of anti-rejection drugs is best for you. In addition, your transplant team may want to reduce doses or eliminate some medications over time. Some of these medications will require regular blood tests to make sure you are getting the right amount.

Taking all of your transplant medications as prescribed is very important. It is a good idea to make a list of what medications you need to take, how much you should take, how to take them, and when to take them.

Keep track of your medications and make sure that you are taking them properly

Figure. Patient dosing schedule

Figure. Patient dosing schedule.

INTERACTIONS WITH FOODS OR OTHER MEDICATIONS

Do not take any new medications prescribed by other doctors until you check with your transplant team. Also be cautious about taking over-the-counter medications and herbal supplements. For example, some antacids and common pain relievers can injure your transplant by interacting with other medications, including blood pressure medications, anti-clotting medications, and anti-rejection medications. It is better to ask first when you’re not sure.

SIDE EFFECTS OF ANTI-REJECTION MEDICATIONS

People react differently to different medications. Some people may experience side effects with anti-rejection drugs, while others do not. Despite side effects, it is important that you continue taking your medications or reduce the doses. Your transplant team can help you reduce the side effects of anti-rejection drugs.

The Table lists common side effects of anti-rejection drugs.

Figure. Common side effects of anti-rejection medications

Figure. Common side effects of anti-rejection medications.

You may notice some side effects because they can change your appearance. These side effects may include weight gain, round face, acne, excessive hair growth, hair loss, or enlarged gums. You may also experience side effects such as diarrhea and others that you may not even notice, including high blood pressure, high cholesterol, diabetes, or infection.

It is important to tell your doctor or transplant coordinator if you are experiencing any side effects. Your transplant team may lower the dose or change your medications to decrease the side effects. You should not change your medications or stop taking them on your own. Talk to your transplant team about any concerns you have and be sure to follow your transplant team’s instructions.

Use the Table to keep track of your side effects and show the chart to your transplant team.

Figure. Tracking side effects

Figure. Tracking side effects.