This is the final of three articles in the Westmeath Topic about kidney transplants and the medication used. This week I discuss preventative medication that must be taken due to the effects of anti-rejection drugs. While I specifically deal with kidney transplants, a lot of the advice given in this series of articles is true for any type of transplant (eg) Heart, lung, liver.
Benefits of Kidney Transplantation
Kidney transplants are not a cure but they allow you maintain a normal standard of living. A successful kidney transplant should mean you no longer need dialysis. Energy levels increase as the new kidneys starts producing red blood cells. Fluid and diet restrictions should end.
Prophylactic (preventative) Medications
Immunosuppressants must be prescribed long term to prevent your body rejecting the new kidney. However immunosuppressants also reduce the body’s ability to fight infections meaning you may need to be prescribed medication to prevent infections while on immunosuppressants.
Septrin® is an anti-biotic used to prevent and/or treat pneumonia and other bacterial infections. Immunosuppressants increase the risk of pneumonia and other infections as they reduce the body's ability to fight infections. Drink plenty of fluids while taking Septrin®. Side effects can include nausea, skin rashes, itching and increased risk of sunburn.
Valganciclovir (Valcyte®), Acyclovir (Zovirax®), Valacyclovir (Valtrex®)
These anti-virals are used for the treatment and prevention of viral infections including Cytomegalovirus (CMV) which is a type of herpes virus transmitted via bodily fluids. Valtrex is used to prevent or treat herpes simplex and shingles. Valtrex will not cure herpes virus completely but it will reduce the pain and help heal the sores. Valganciclovir (Valcyte®) or Acyclovir (Zovirax®) are mainly used to treat and prevent Cytomegalovirus (CMV). Antivirals are usually prescribed for about three months after transplant. Men should take contraceptive precautions while taking these drugs due to the risks of birth defects. Side effects can headaches, fever, nausea and vomiting, diarrhoea, low blood counts and insomnia
Taking with food or milk will increase absorption and reduce stomach irritation with antivirals. Blood counts must be monitored when taking antivirals and if lower than expected, the anti-viral must be lowered or held. Anti-virals should be avoided during pregnancy and you must not become pregnant for 90 days after finishing the anti-viral course because of their risk of birth defects. Men should also use barrier contraception (condoms) during and for three months after the course of anti-virals.
Diflucan® (Fluconazole) oral capsules or Mycostatin® (nystatin) oral suspension
Anti-fungal medication is used for the treatment and prevention of fungal infections of the mouth and throat. Antifungals usually need to be prescribed for about three months. Immunosuppressant medication increase the risk of fungal mouth infections and symptoms include mouth sores, white coating on tongue or difficulty swallowing. Antifungal medication may need to be re-commenced at different stages in the years after the transplant. Fluconazole and related antifungal medication can interact with some anti-rejection medications so the doses of anti-rejection medications will need to be adjusted when starting and stopping antifungal medication. Mycostatin® Oral Suspension (Nystatin) does not interact with the anti-rejection drugs in the same way. Side effects can include nausea and vomiting, diarrhoea, mouth and throat irritation and unpleasant taste
Anti-rejection medication can irritate the lining stomach and bring on stomach ulcers.
A proton pump inhibitor (PPI) may be prescribed to reduce stomach acid and protect the stomach and prevent ulcers. PPIs used include lansoprazole (Zoton®), Pantoprazole (Protium®), Omeprazole (Losec®), Rabeprazole (Pariet®) and Esomeprazole (Nexium®). All these now have less expensive but equally effective generic equivalents available.
Rejection occurs as the body recognises the transplanted kidney as a foreign object thus the transplanted kidney is attacked by the body’s immune system. Rejection is possible even if all precautions are taken. It is reckoned that 50% of kidney transplant patients will suffer at least one rejection episode; however a rejection episode does not mean you will lose the kidney, swift action from the transplant team (eg. increasing immunosuppressant dose, changing to a different dose) will normally stop the rejection and save the kidney. This is why it is so important to recognise the symptoms of rejection as getting quick treatment will save the kidney in most cases. The first rejection episode occurs within 6 months of transplant surgery in most cases. Rejection may be chronic meaning that it occurs slowly over a long period of time or it can be acute which means it occurs suddenly. You may feel perfectly well during a rejection episode which is why it is important to have lab tests checked regularly. High laboratory results (Blood Urea Nitrogen [BUN] & creatinine) can mean a rejection episode is occurring. An ultrasound or renal scan can help confirm a rejection episode and a kidney biopsy can act as a final confirmation.
If a rejection occurs, return to dialysis will be necessary. The rejected kidney may remain in place unless fever, pain, swelling, vomiting, etc occurs. If these symptoms occur the rejected kidney may need to be removed surgically. Your immunosuppressive medications will be discontinued
Become a donor
Give the gift of life, become an organ donor today. For an organ donor card, contact the Irish Kidney Association on LoCall 1890 543639 or logon to www.ika.ie
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended
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