What are anti-rejection medications?
After you’ve had a transplant, your body sees your “new” liver, kidney, heart, lung, or intestine as something foreign. Your immune systems knows that the organ doesn’t “belong” and tries to attack it. Anti-rejection medications - also called immunosuppressive medications or immunosuppression - are prescribed to help prevent this attack, which is called rejection. These medications work by weakening your immune system, so it doesn’t attack or reject your transplanted organ.
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It’s completely normal to wonder why you have to take anti-rejection medications every day—especially when you’re feeling okay. Keep in mind that these medications help your body accept your transplanted organ. You will need to take anti-rejection medication for the rest of your life. That can feel like a lot—and it’s okay to feel that way. The good news is that your transplant team will work with you over time, adjusting your doses or medications as needed to keep things balanced and working well for you.
- These meds help prevent your immune system from rejecting your transplanted organ.
- They help your transplanted organ do its job and keep you healthy.
- You will need to take these medications for the rest of your life. Over time, your doctor may adjust your dose or the type of anti-rejection medication you take. But you will always be taking immunosuppression to prevent rejection and keep you and your transplanted organ healthy.
Your Anti-Rejection Medications
There are different types of anti-rejection medications. Each type works in a different way to prevent rejection. They can also work together to keep your immune system from attacking your transplanted organ. You may take one type of medication (for example, tacrolimus) or you may take a combination of different types (tacrolimus, prednisone, and mycophenolate).
The most common type of anti-rejection medication stops certain cells in your immune system from attacking your transplanted organ.
- Examples: tacrolimus (Prograf™, Astagraf™, Envarsus™), cyclosporine (Neoral™, Sandimmune™)
- How they work: They block the signals that tell your immune system to attack (reject) your transplanted organ.
- What you should know: These medications can affect the health of your kidneys. Your doctor will check certain blood tests when you get your labs done to be sure your kidneys are doing well.
Another type of immunosuppression calms down the immune system by reducing swelling (inflammation) of the organ tissue. These are called steroids. This “helper” type of medication works with other anti-rejection medications to prevent or treat rejection.
- Examples: prednisone, methylprednisolone, budesonide (Entocort™)
- How they work: They suppress your immune system and help prevent rejection.
- What you should know: Taking steroids in high doses and over a long period of time can cause side effects. Some patients may have mood changes or high blood pressure or high blood sugar levels. Bone weakness can also happen which can cause your bones to break (fracture) easier if you fall.
Immunosuppression can also help by stopping your immune system from making too many cells that could attack your transplanted organ.
- Examples: mycophenolate mofetil (Cellcept™, Myfortic™), azathioprine (Imuran™)
- How they work: They control the growth of immune cells that might attack the transplanted organ
Other anti-rejection medications can stop your immune system from making too many cells that can start or “trigger” rejection (mTOR Inhibitors)
- Examples: sirolimus (Rapamune™), everolimus (Zortress™)
- How they work: These medications block the signals that tell your immune system to attack the transplanted organ.
- What you should know: They can interfere with wound healing. You should let your transplant team know if you will be having any elective surgery or procedures. Your doctor may lower or hold this medication for some time before and after your surgery so that you will heal normally.
Will I have side effects from my anti-rejection medications?
Although anti-rejection medications are very important for protecting your transplanted organ, they can have side effects. These are the most common side effects that you should know:
- Increased risk of infection: Since your immune system is weakened, you have a greater risk of getting sick. Good handwashing is an important habit to help you stay healthy. Be sure to wash your hands before and after preparing food and eating, and after you go to the bathroom. Avoid people who are ill and being in crowded areas - particularly during cold and flu season.
- Kidney health: Some anti-rejection medications can affect your kidneys, so regular testing is important. Your team will check your kidney health with routine labs.
- High blood pressure and high blood sugar (glucose) levels: Some medicines can raise your blood pressure or blood sugar, especially right after your transplant or if you’re being treated for rejection. If this happens, your doctors will give you medicine to help control these health issues.
- Mood changes, weight gain, or bone issues: If you’re on steroids (prednisone) for a long time, you might notice changes in your mood or you may gain weight. Bones can weaken and break more easily if you take prednisone for a long time.
- Interaction with other medications: There are some medications such as antibiotics, acne treatments, or medicines to treat depression that may interact with your transplant medications and cause other problems. Always let your transplant team know if another doctor has prescribed a new medication for you. It is important to check with your team before starting new medications.
Key Tips for You
- Take my meds on time: Skipping doses can lead to your transplanted organ being rejected or cause other complications. Make it a habit to take your medications as prescribed, every day. Use a weekly pill container and alarms to help you remember to take your meds on time!
- Be aware of infections: Since you are taking medicines that suppress your immune system, you may get infections more easily. Stay on top of things like washing your hands and getting your flu shot. If your best friend has a cold, you might want to stay in touch by phone for a day or two rather than getting together. If you feel sick, be sure to contact your transplant team or local doctor to let them know and get advice. Always call your doctor if you have a fever!
- Track my medications: It’s a good idea to keep a list of all your medications and share it with every doctor you see, not just your transplant team. You can keep this list on your phone so you always have it with you.
- Getting labs: You will have regular blood tests to check your medication levels and ensure your transplanted organ and kidneys are functioning well. Be sure that you get your labs as requested by your team. You will need to do this more frequently if you are early on after transplant or if you have been sick. But if you are doing well, labs are usually every one to three months.
- Talk to my team: If you notice any side effects or don’t feel well, let your transplant team know right away. They may be able to adjust your medications to help you feel better.
You Can Do It!
Taking your anti-rejection medications is one of the most important things you can do to be healthy and have a successful transplant! Although these medications have side effects, staying on top of your meds and working closely with your transplant team will help keep your transplant health on track. Reach out to your team if you have questions or need support —it’s your health, and your team is here to help you.
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