Organ Transplant

After the Transplant

Why does organ rejection occur?

Your body has a natural defense system called the immune system that protects you from infection and disease. The immune system defends your body by producing antibodies and "killer" cells that destroy foreign substances (such as viruses and bacteria). Since the donor organ doesn't match your own tissue exactly, your body tries to destroy the transplanted organ by rejecting it. Rejection is nature's way of protecting your body.

What medicines will I need to take?

After an organ transplant, you will need to take antirejection medicines, or immunosuppressants, for as long as you have the donor organ. Because your immune system will try to destroy the new organ, antirejection medicines are needed to decrease your immune system's response so the new organ stays healthy.

Antirejection medicines weaken your immune system and decrease your body's ability to fight infections, cancer, and other diseases. Over the years since organ transplants were first done, these medicines have greatly improved. Researchers are finding out more all the time about how to better regulate the immune system after a transplant. Current medicines still have the potential to speed up illness or create new disease, such as heart problems, diabetes, cancer, and osteoporosis. But these medicines also will save your life by keeping your body from rejecting the donor organ. It is important to take these medicines daily and exactly as prescribed.

Taking medicines daily for the rest of your life is not as hard as it sounds. It may help to talk to someone who has had a transplant and who can give you some assurance that you will be able to make the medicines a part of your daily routine. Over time, probably, fewer medicines will be needed. Additional medicines may occasionally be needed to fight infection or other health problems related to your transplant.

Generally, the antirejection medicines you will take after an organ transplant include:

Corticosteroids, such as prednisone or methylprednisolone. A high dose of corticosteroid, often methylprednisolone, is given right before your transplant, to decrease your immune system's activity, reduce inflammation, and prevent rejection. High doses of corticosteroids are usually continued for a few days after your surgery and then tapered 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, and psychosis (trouble telling the difference between what is real and what is not real)—some people may feel "out of it" or have hallucinations while taking high doses of steroids. But these side effects are temporary. Prolonged use of corticosteroids can cause glaucoma, steroid-induced diabetes, and increase your risk of getting an opportunistic infection (such as pneumocystis pneumonia), which is a type of infection that occurs in people with weakened immune systems. Some experts are finding that some people may be able to avoid use of steroids or to use them sparingly.

Calcineurin inhibitors, such as tacrolimus and cyclosporine. These block the message that causes rejection. You probably will always need to take calcineurin inhibitors, because they are an important part of your lifelong care after a transplant. While these medicines are helpful, they also have potentially serious side effects such as high blood pressure, too much potassium in the blood (hyperkalemia), and kidney problems. These medicines can also cause nausea, vomiting, diarrhea, high cholesterol, tremors, seizures, and put you at increased risk of developing infection and cancer. There is a great deal of research on the development of newer calcineurin inhibitors with fewer side effects. Ask your doctor for more information if you are having any of these side effects.

Antiproliferative agents, such as mycophenolate mofetil, azathioprine, and sirolimus. Antiproliferative agents prevent the immune cells from multiplying. These antirejection medicines are also an important part of your lifelong care after a transplant. They prevent your immune system from attacking and destroying the donor organ. Common side effects can include nausea, anemia, reduced number of white blood cells (leukopenia), high triglycerides, and intestinal upset. Antiproliferative agents also increase your risk of getting an opportunistic infection, cancer, and other life-threatening conditions.

Monoclonal antibodies, the most common being anti-IL2 receptor antibodies that block the growth of immune cells that are responsible for rejection. These antibodies are used early after transplantation with calcineurin inhibitors and antiproliferative agents.

Polyclonal antibodies, such as antithymocyte globulin-equine and antithymocyte globulin-rabbit. Polyclonal antibodies temporarily deplete the body's immune cells. These medicines 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, joint pain, and decreased number of white blood cells (leukopenia). Severe side effects may include an increased risk for cancer and opportunistic infections, serum sickness (a bad reaction to your own tissues), and a condition that prevents your body from making antibodies that fight infection.

What kind of physical issues will I face after transplant?

Almost immediately after a transplant, many people report feeling better than they have in years. The physical limitations you have will depend on the type of transplant you had, other conditions you may have, and whether your body rejects the donor organ. You will likely not face major physical limitations after you have healed from your transplant.

The daily antirejection medicines can cause some bothersome and sometimes serious side effects in some people. High blood pressure and high cholesterol are common problems after a transplant, although these illnesses can be treated with other medicines. You may be at increased risk for getting certain types of cancer and conditions such as diabetes. You will be at higher risk for infections, especially opportunistic infections, because your antirejection medicines will weaken your immune system. It is important to keep your regular appointments with your doctor or the transplant center so you can be monitored for these illnesses.

What kind of emotional issues will I face?

Having an organ transplant may cause many emotional issues both for you and those who care about you. When your organ comes from a deceased donor, you may sometimes think about that and what it meant to the donor's family. It is common to have some depression after an organ transplant, although not everyone does. If you think you may be depressed, it is important to tell your transplant coordinator, doctor, or someone who cares about you. The earlier depression is treated, the more quickly you will recover and the better you will feel.

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Author:	Caroline Rea, RN, BS, MS	Last Updated: January 24, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Philip Belitsky, MD, FRCSC - Urology
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