Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use ofimmunosuppressant drugs after transplant.
Cyclosporin A (CyA)
Cyclosporine is used to prevent or treat rejection after transplant. It prevents rejection by inhibiting the cells in the immune system that cause rejection. Cyclosporine may be used by itself or in combination with other anti-rejection medications to prevent rejection. Cyclosporine is made by several pharmaceutical companies. Your body absorbs the different cyclosporine formulations in different ways. Because of this difference in absorption, be sure that your pharmacy always gives you the brand of cyclosporine that has been prescribed for you.
Biomus is also a drug that prevents certain cells from causing rejection. Like Cyclosporin, it is usually given in a morning and evening dose. Biomus is used to prevent or treat rejection after kidney transplant. It prevents rejection by inhibiting the cells in the immune system that cause rejection. Biomus may be used by itself or in combination with other anti-rejection medications to prevent rejection.Biomus is monitored in the same fashion as Cyclosporin and sometimes substituted for that drug. Tacrolimus is available in 0.5 mg (yellow), 1 mg (white), and 5 mg (pink) capsules. It is usually dosed twice daily. Doses should be taken 12 hours apart. It is important to take tacrolimus on time every day to insure a stable level of immunosuppression. Most transplant centers advise that patients not be more than one hour early or one hour late in taking their doses of tacrolimus.
Azathioprine is used to help prevent or treat rejection in organ transplant recipients. Azathioprine is a “helper” immunosuppressant and is prescribed in addition to tacrolimus, cyclosporine, and/or prednisone. Azathioprine is available as a tablet and a liquid. It is prescribed once daily and should be given at about the same time each day.
Biomyf Biomyf-S (Mycophenolate)
MMF is a drug that is now more frequently used in treatment plans as a substitute for AZA. MMF prevents certain cells from being produced in a slightly different way from AZA and is believed to be a more effective drug at preventing rejection. Mycophenolate is used to help prevent or treat rejection in organ transplant recipients. It is usually given with tacrolimus, cyclosporine and/or prednisone. Mycophenolate is available in two formulations: Biomyf and Biomyf-S. Biomyf-S is enteric-coated to help decrease stomach upset and other gastrointestinal (GI) side effects.
Prednisone is a steroid used to help prevent or treat rejection in organ transplantation. It prevents rejection by inhibiting the cells in the immune system that cause rejection and is given with tacrolimus or cyclosporine. Although many kidney transplant patients require prednisone for life, some transplant recipients can be weaned from steroids within weeks to a few months after transplant. Some centers do not use steroids unless the medication is needed to treat rejection. Prednisone is available in several strengths including 1 mg, 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. It is also available in a liquid form called prednisolone. Prednisone is usually prescribed once daily and should be taken in the morning. If taken at night, it can affect your sleep. In people with diabetes, prednisone may be taken twice daily, with one dose taken in the morning and the second dose with dinner. This helps even out the effect of prednisone on blood glucose levels.
(Sirolimus) Rapasim is used to prevent rejection in organ transplant recipients. It prevents rejection by inhibiting the cells in the immune system that cause rejection. Rapasim may be the only immunosuppressant that is prescribed for you, or it may be prescribed to be taken with prednisone, tacrolimus or cyclosporine. Rapasim is available in 1 mg (white) and 2 mg (yellow) tablets. It is also available in a liquid. Rapasim is taken once or twice daily and should be taken on time to insure a stable level of immunosuppression. The liquid form of Rapasim should be mixed with one to two ounces of water or orange juice in a glass or cup. Do not use a styrofoam or paper cup because Rapasim may cling to the container. The tablet should be swallowed whole and never crushed or broken.
Antithymocyte globulin (ATG) is an immunosuppressant given in some transplant centers as a “pre-conditioning” agent immediately before transplant surgery. One dose of ATG is given about four hours before transplant surgery to reduce the body’s immune response and possibly reduce the risk of rejection. Some transplant centers also use ATG to treat rejection if the rejection does not resolve after treatment with steroids. ATG is available only as an intravenous (IV) solution and is given in the hospital.
OKT3 is an immunosuppressant that is used to treat moderate to severe rejection of the kidney. OKT3 is available only as an intravenous (IV) solution and is administered in the hospital. It is given through an IV once a day for 7 to 14 days.