The administration of immunosuppressants slows down your immune system and helps your body to accept your new kidney. This is how you protect yourself from a rejection reaction. Taking these medications correctly is important to strike a balance between protecting your new kidney and the side effects from taking too high a dose. In this article, you will learn how to best control your immunosuppressants.
Your immune system is responsible for detecting invaders or diseased cells that may pose a threat to your health. When these cells or pathogens are recognized by your immune cells, the rest of your immune system is activated to fight them and keep your body fit and healthy.
Bacteria and viruses, degenerated cancer cells, or even foreign bodies can activate your immune system in a healthy state. It's no wonder, then, that your immune system also becomes alert when you receive a new kidney transplant. After all, your new kidney is not an organ that naturally belongs to your body. If your immune system is activated after transplantation, a rejection reaction will occur.
What are immunosuppressants?
To increase your body's acceptance of your new organ, the function of your immune system can be suppressed by medications called immunosuppressants. Immunosuppressants target the cells and antibodies of your immune system and suppress their function. This helps prevent your new kidney from being rejected. However, pathogens such as bacteria, viruses or fungi can now hide more easily from your immune system.
Why is it important to take immunosuppressants correctly?
As with most things in life, it is important to find the right balance with immunosuppressants. If immunosuppressants are taken in too high a dose or too often, the likelihood of side effects increases. If drugs are taken too infrequently or in too low a dose, the likelihood of a rejection reaction by your immune system increases. Optimal dose adjustment is therefore extremely important to keep your organ as healthy as possible in the long term.
It is therefore extremely important that you take your immunosuppressants after transplantation not only regularly, but also at the times prescribed by your medical team. The exact schedule for taking your medications will, of course, be provided by your transplant team. In the Mizu app, you can document the intake of your medications and thus keep an exact overview.
What are the different forms of immunosuppressants?
In general, immunosuppressants slow down the activity of the cells and antibodies of your immune system. They do this either by restricting the formation of new cells and antibodies, or by interfering with the function of the existing cells and antibodies of your immune system.
The most important cells of your immune system are the so-called T and B lymphocytes, as well as the various forms of granulocytes. These cells not only recognize foreign bodies and invaders, but also subsequently mobilize reinforcements in the form of antibodies or inflammatory cells.
The exact effect of the various immunosuppressants always depends on the individual substance classes and the active ingredients they contain. We have summarized these for you in a separate, detailed article on immunosuppressants.
In general, immunosuppressants can be categorized as follows:
How do I know if I am taking my medication correctly?
To keep track of the effects of your immunosuppressants and prevent over- or under-dosing, two things are especially important:
- Regular lab checks: To keep track of the exact amount of medication in your blood, laboratory checks are performed regularly. This often involves what is known as a "trough level check". You'll find out what that is in a moment.
- Symptoms: In addition to lab tests, physical symptoms can also give you an indication of whether you have too much or too little immunosuppressant in your blood.
We will take a closer look at both of these methods below.
What is trough level control with immunosuppressants?
A so-called trough level control is often used in a laboratory test. When you take a drug, the amount of that drug in your blood is highest shortly after you take it. Over time, the drug is then broken down by your kidneys and liver. This is a natural process. So the concentration of the drug in your blood always depends on when you take it. It decreases as time passes after you take the medicine. After a while, the active ingredient in the drug will have been completely removed from your blood.
To ensure that your transplant team receives comparable values at every laboratory check, they always determine the concentration of your immunosuppressants at the same time. This time is usually chosen just before the next dose of the drug. So if you take your medication every 12 hours, the trough level check will be done just before those 12 hours are up and just before you take your next dose. Several trough level values can be compared by your medical team.
How high should the trough levels of immunosuppressants be?
Trough level controls are not performed for all drugs. For example, this technique is not used for corticosteroids. However, it is commonly used for calcineurin inhibitors, such as tacrolimus, or mTOR inhibitors, such as sirolimus and everolimus.
In general, the target value for the trough level is individual for each patient and depends on the time after transplantation. You will always receive the exact target values for the trough levels of your immunosuppressants from your medical team. You can then document these in the logbook of your Mizu app to always keep track of the development of your medication levels.
Below you will find a summary of some general target values for the most important immunosuppressants. However, keep in mind that these values do not necessarily apply to you and that your own values will always be set by your medical team.
What other blood values are important?
Too high a dose of your immunosuppressants may not only increase the risk of infection, but may also limit the function of your new kidney. This is because the medications can also negatively affect the flow of blood through your kidney if the dose is high.
The result can be a decrease in your kidney function. You can recognize this, for example, by an increase in the concentration of degradation products such as creatinine, urea or cystatin C in your blood. At the same time, there is often a drop in the so-called estimated glomerular filtration rate (= eGFR) in the blood. You can find more detailed information about this in the article on monitoring kidney function.
Another side effect of immunosuppressants can be an increase in your blood sugar levels and blood lipids (e.g. cholesterol). You can also document these values in the logbook of your Mizu app.
What are the symptoms of too high or too low a dose?
In addition to your lab values, a look at possible symptoms will help you to recognize an overdose or underdose of your immunosuppressants early on, or to quickly detect side effects.
An overdose can lead to an infection, a decrease in your kidney function, or changes in your metabolism. These side effects may show up as the following symptoms:
- Fever
- Fatigue and tiredness
- Decrease in urine production
- Cough, cold, diarrhea, or pain
- Significant weight gain
- High blood pressure
- Water retention (=edema)
If the dose is too low, rejection by your immune system may result. You can recognize this most easily by a decrease in your kidney function and possibly also by the following symptoms:
- Fever
- Fatigue and tiredness
- Decrease in urine production
- Pain over your new kidney
- Weight gain
- Water retention (=edema)
As you can see, the symptoms of each complication are relatively similar. If you keep these different factors in mind, you can react quickly and talk to your medical team if the worst happens. Keep in mind, however, that an infection, rejection, or other side effects can also manifest themselves through other symptoms. So if in doubt, always talk to your transplant team.
What should I keep in mind when taking immunosuppressants?
In general, it is most important to take your medications regularly - as recommended by your transplant team - and to attend the recommended follow-up appointments. This will help your transplant team and your new kidney do their best work. A healthy lifestyle, diet and exercise will also help your body cope better with the medications. You will also be able to manage any side effects much better.
It is also important to know that some medications or foods can influence the effect of your immunosuppressants. These include, for example, St. John's Wort or grapefruit. Teas or juices containing these foods should therefore be avoided. Adjustment of the medication may also be necessary during pregnancy or while breastfeeding. If necessary, your medical team will always discuss this information with you.
