Heart and Lung Transplant (cont.)
Francisco Talavera, PharmD, PhD
To prevent rejection, powerful drugs must be used to suppress the immune system after a heart or lung transplant. In general, most people take a "triple therapy" of drugs, which includes cyclosporine, corticosteroids, and azathioprine.
- Cyclosporine: This drug interferes with communication between the T cells of the immune system. The drug is used immediately after the transplant and for maintenance of immunosuppression. Common side effects include tremor, high blood pressure, and kidney damage. Other minor side effects include excessive facial hair growth, thickening of gingiva, and diabetes. These side effects are usually related to the dose and can often be reversed with proper dosing.
- Corticosteroids: These drugs block T-cell communication as well. They are usually used at high doses initially after the transplant and if rejection is detected. Corticosteroids have many different side effects, including easy bruising of the skin, osteoporosis, damage or death of portions of bone, high blood pressure, high blood sugar or diabetes, stomach ulcers, weight gain, acne, mood swings, and a "moon" face. Because of these side effects, many transplant centers are trying to reduce the maintenance dose of this drug as much as possible or even to replace it with other drugs.
- Azathioprine: This drug slows production of T cells in the immune system. It is usually used for long-term maintenance of immunosuppression. The most common side effects of this drug are suppression of bone marrow functions, such as making blood cells, and liver damage. Many transplant centers are now using a newer drug called mycophenolate mofetil instead of azathioprine.
Newer drugs include tacrolimus
, and mizoribine. These drugs are now being used in an attempt to reduce side effects. They are also being used as replacement drugs after episodes of rejection.