Kidney Transplant (cont.)
Kidney Transplant Medical Treatment
The most critical part of kidney transplantation is preventing rejection of the graft kidney.
- Different transplant centers use different drug combinations to fight rejection of a transplanted kidney.
- The drugs work by suppressing your immune system, which is programmed to reject anything "foreign," such as a new organ.
- Like any medication, these drugs can have unpleasant side effects.
- Some of the most common immune-suppressing drugs used in transplantation are described here.
- Cyclosporine: This drug interferes with communication between the T cells of the immune system. It is started immediately after the transplant to suppress the immune system and continued indefinitely. Common side effects include tremor, high blood pressure, and kidney damage. 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 given at high doses for a short period immediately after the transplant and again if rejection is suspected. Corticosteroids have many different side effects, including easy bruising of the skin, osteoporosis, avascular necrosis (bone death), high blood pressure, high blood sugar, stomach ulcers, weight gain, acne, mood swings, and a round face. Because of these side effects, many transplant centers are trying to reduce the maintenance dose of the drug as much as possible or even to replace it with other drugs.
- Azathioprine: This drug slows the production of T cells in the immune system. Azathioprine is usually used for long-term maintenance of immunosuppression. The most common side effects of this drug are suppression of the bone marrow, which produces blood cells, and liver damage. Many transplant centers are now using a newer drug called mycophenolate mofetil instead of azathioprine.
- Newer antirejection drugs include tacrolimus, sirolimus, and mizoribine, among others. These drugs are now being used to try to reduce side effects and to replace drugs after episodes of rejection.
- Other costly and experimental treatments include using antibodies to attack specific parts of the immune system to decrease its response.
Michael B McDonnell, MD, Staff Physician, Department of Emergency Medicine, University of Southern California
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