Especially directly after the transplantation, taking immunosuppressants is of great importance. These drugs suppress the function of your defense system (=immune system) and allow your new kidney a smooth arrival in its new workplace. But also afterwards, they are one of the most important components for a long, hard working kidney. You will learn everything you need to know about in this article.
One of the basic building blocks of your body's defense system are your white blood cells and antibodies, which swarm through your bloodstream in large quantities. They are vigilantly searching your body for invaders or diseased cells that could pose a threat to your health. These include, for example, bacteria and viruses, degenerated cancer cells or foreign bodies. It is therefore no wonder that your immune system also becomes overly active when you receive a new kidney transplant. After all, from one day to the next, a new organ has suddenly appeared in your body.
What is rejection?
Before the transplant, tests are done to see how well the new kidney fits your body and immune system. For example, the blood group and tissue characteristics (e.g. HLA characteristics) of the donor and recipient are compared. In summary, these are referred to as immunological characteristics. If these immunological characteristics match completely, we speak of a perfect match!
But no matter how good these precautions may be, the new kidney still contains a bunch of foreign information that can make your immune system skeptical and lead to rejection of the kidney. Simply put, this means that your body and the new kidney can no longer get along. This rejection can occur early (acute or hyper-acute rejection) or later after the transplant (chronic rejection). The signs of rejection vary. Often there is general malaise, loss of function of your new kidney, or an inflammatory reaction with fever. In some cases, rejection can even lead to a complete loss of graft function. To detect these problems early, regular follow-up appointments with your medical team will take place after the transplant.
What are immunosuppressants?
To minimize the likelihood of rejection, medications called immunosuppressants exist. As the name suggests, they suppress the action of your immune system in the body. So by slowing down in this way, your new kidney escapes the radar of your immune forces and can arrive in your body in a more relaxed way.
But what exactly are immunosuppressants? In general, these drugs mainly slow down the cells of your immune system. These include, above all, the T and B lymphocytes. These cells not only recognize foreign bodies and invaders, but also subsequently mobilize reinforcement in the form of antibodies or inflammatory cells. So they're kind of like spooks or the alarm system in your body. There are a whole range of immunosuppressants and their exact effects can vary. It always depends on the particular class of substance. We will now take a closer look at what exactly this is in the next section.
What classes of immunosuppressants are there?
There are different categories of immunosuppressants. For a better ¨overview, we have summarized the most important substance classes in the following table once:
The main feature of each class of drugs is that they slow down the action of your immune system in different ways. In the next part of this article, you'll learn more about the exact mechanism of action of the different classes.
How do the individual immunosuppressants work?
Directly after transplantation, different classes of immunosuppressants are often combined. These can be up to three different drugs. They complement each other in their inhibitory effects on your immune system and thus help prevent rejection.
1. Corticosteroids
Corticosteroids inhibit the immune system in several ways. For one thing, they stop messengers from accumulating and being sent out between the cells of your immune system. In this way, they interfere with communication and ensure that your immune cells cannot mobilize new cells to defend against your transplant. In other words, they slow down the proliferation and activation of new immune cells.
Common corticosteroids include cortisol or prednisolone. These drugs can be given both in tablet form or intravenously.
2. Calcineurin inhibitors
The well-known calcineurin inhibitors include tacrolimus and ciclosporin. They mainly attack the immune system scouts, the T lymphocytes. They prevent full activation of these T lymphocytes and thus protect your new kidney from your own immune system. These drugs are administered in the form of tablets immediately after the transplant.
3. mTOR inhibitors
Optimally, mTOR inhibitors prevent T lymphocytes from dividing and thus multiplying. This prevents the formation of new immune cells. Well-known drugs from this class are sirolimus and everolimus.
4. DNA synthesis inhibitors
Just like mTOR inhibitors, DNA synthesis inhibitors interfere with the division of your immune cells, preventing new immune cells from forming. Well-known agents in this class include mycophenolic acid and the azathioprine.
5. Antibodies
Unlike the drugs above, antibodies often directly destroy T and B lymphocytes. They specifically target your immune cells and are therefore used more frequently in the period around transplantation. In combination with the drugs mentioned above, they lead to particularly strong immunosuppression.
What are the side effects of immunosuppressants?
The effect of immunosuppressants after transplantation is indispensable to give your new kidney a perfect start in its new working environment. Nevertheless, there are some important side effects to consider when taking these medications. Always remember that there is an appropriate response for all of these side effects. Some of them you can get rid of quickly with the right knowledge:
1. Infection management after transplantation
Braking your immune system, as you can already guess, naturally has negative effects. Your body may be more accepting of your new kidney, but unfortunately it is also less able to recognize pathogens such as bacteria, viruses, or fungi. Infections are therefore a frequent complication after transplantation and must always be controlled and treated by your medical team. Your infection levels will therefore be monitored regularly after transplantation. In addition, you should also take your temperature regularly at home and contact your medical team quickly in case of symptoms such as fever, diarrhea or cough. Just make it your routine! In the logbook of the Mizu app, you can document all your values regularly.
2. Regular cancer screening
Suppressing your immune system may also increase your risk for cancer. With regular preventive care, however, you are already very well protected. You can find out which preventive examinations are particularly important for you in other articles in the Mizu app.
3. Post-transplant diabetes mellitus (=PTDM)
Immunosuppressants from the corticosteroid substance class in particular can mess up your metabolism. As a result, therapy with these drugs after transplantation can lead to the appearance of a new diabetes (=post-transplant diabetes mellitus) or to high levels of your blood lipids, such as cholesterol. These side effects can be prevented with a healthy diet, sufficient exercise and regular weight checks, and the risk of their occurrence can be optimally reduced. You can record your values, as always, in the logbook of the Mizu app.
4. Monitoring kidney function
Some of the immunosuppressants in high amounts can also lead to restrictions in the function of your new kidney. This is because the drugs can reduce the blood flow to your new kidney. However, in such a case, your medical team will help you find a solution to manage this side effect as best as possible.
How are the effects and side effects of immunosuppressants controlled?
Because of the above mentioned side effects, the dose of your immunosuppressants should always be chosen as high as necessary but as low as possible. This way you keep the positive effects and the side effects in the right balance. To make this possible, your medical team will carry out regular laboratory checks to keep an eye on the drug level in your blood. If it is too high, side effects may be more frequent and the dosage may need to be reduced. If your level is too low, rejection may occur and your healthcare team will likely increase the dose again.
Of course, regardless of your lab results, you should always keep an eye out for possible side effect symptoms such as fever or weight gain. It is also important to attend all necessary check-ups. This will make it easy for you to manage your immunosuppressants.
How can the Mizu app help me manage my immunosuppressants?
A 2007 study by Gordon and colleagues showed that nearly 50% of people stopped taking their immunosuppressants regularly at some point after kidney transplantation. This increases the risk of rejection and makes it more difficult for your medical team to maintain a constant drug level. With the Mizu app, you can easily be reminded to take your medication and document your daily intake. This may help you keep track of your medications after kidney transplantation. Just give it a try and see if this function also helps you take your medication.
