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Organ Transplants: Antirejection Medicines

Topic Overview

People who have had an organ transplant need antirejection medicines, or immunosuppressants. This is because your immune system will try to destroy the new organ. These medicines weaken your immune system and decrease your body's ability to destroy your new organ. But they also decrease your body's ability to fight infections, cancer, and other diseases.

Here are some of the medicines you may need to take. You may have to take other medicines to prevent infection or to control other health problems you have (like high blood pressure).

Corticosteroids

A high dose of a corticosteroid is given right before your transplant. It decreases your immune system's activity, reduces inflammation, and prevents rejection. A high dose is usually continued for a few days after your surgery. Then the dosage is slowly reduced to the lowest dose that helps prevent rejection.

Taking high doses of corticosteroids for just a few days may cause temporary side effects such as high blood pressure, high cholesterol, weight gain, sleep problems, and anxiety. High doses can sometimes cause more severe side effects, such as extreme agitation, paranoia, psychosis, and hallucinations.

Using corticosteroids for a long time can cause glaucoma or steroid-induced diabetes.

Corticosteroids include prednisone or methylprednisolone.

Calcineurin inhibitors

These medicines block the message that causes rejection. You probably will always need to take calcineurin inhibitors.

Side effects include high blood pressure, too much potassium in the blood (hyperkalemia), and kidney problems. These medicines can also cause nausea, vomiting, diarrhea, high cholesterol, tremors, and seizures.

Calcineurin inhibitors include tacrolimus and cyclosporine.

Antiproliferative agents

These medicines prevent the immune cells from multiplying and prevent your immune system from attacking and destroying the donor organ.

Common side effects can include nausea, anemia, high triglycerides, and intestinal upset.

Antiproliferative agents include mycophenolate mofetil, azathioprine, and sirolimus.

Monoclonal antibodies

These antibodies block the growth of immune cells that are responsible for rejection. They are used early after transplantation along with calcineurin inhibitors and antiproliferative agents.

Monoclonal antibodies include daclizumab, basiliximab, and rituximab.

Polyclonal antibodies

These medicines temporarily deplete the body's immune cells. They are used in the hours and days immediately after your organ transplant to prevent your body from rejecting the donor organ. They may also be used again if your body starts to reject the donor organ.

They are often used to reduce early use of calcineurin inhibitors, which can have serious side effects. Side effects of polyclonal antibodies include fever, itching, and joint pain.

Polyclonal antibodies include antithymocyte globulin-equine and antithymocyte globulin-rabbit.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Last Revised May 18, 2012

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