Directly after transplantation, the use of so-called immunosuppressants is of great importance. The purpose of these drugs is to suppress the function of the body's own defense system (=immune system) and thus enable the new kidney to arrive as gently as possible at its new site of action. At the same time, however, side effects may occur during the therapy. In this article you will learn what these are and how they can be prevented in the best possible way.
For most people, transplantation means a step back toward normality. Although many of the restrictions on life are removed compared to the time on dialysis, there are also some new points to consider for your own health and that of your new kidney after the transplant. These include the drugs that slow down (=suppress) your immune system after the transplant. These immunosuppressants are designed to prevent your immune system from recognizing your new organ as an invader and to enable your new kidney to arrive safely in your body. So, optimally, the job of immunosuppressants is to prevent what's called a rejection response from your new kidney.
As is often the case, there are of course advantages and disadvantages. So, although your new kidney will hopefully be better accepted by your body, these medications can also cause several side effects. Before we look at these in detail, however, let's first clarify what immunosuppressants are. You can already remember that side effects can occur, but there are always ways that you and your medical team can try to prevent or treat them.
Why should I take immunosuppressants after my kidney transplant?
Your immune system is responsible for recognizing invaders or diseased cells that may pose a threat to your health. Once these cells or pathogens have been recognized by your immune cells, the rest of your immune system is activated to fight them off and keep your body fit and healthy.
Bacteria and viruses, degenerate cancer cells, or even foreign bodies can activate your immune system. So it's no wonder that your immune system can become bright-eyed and bushy-tailed when you get a new kidney transplant. After all, your new kidney is not an organ that naturally belongs to your body. If your immune system is abnormally after transplantation, you may experience a rejection reaction.
This is why before the transplant tests are done to see how well the new kidney fits your body and your immune system. For this purpose, immunological characteristics, such as tissue characteristics (e.g. HLA characteristics), of the donor and recipient are compared. If these match, there is a high probability that the new kidney will be a particularly good match for your body.
Despite these precautions, the new kidney still contains foreign information and characteristics that can make your immune system skeptical and lead to a possible attack on the new kidney. This rejection can occur suddenly and quickly lead to a decrease in your transplant function (acute rejection) or can slowly and subliminally damage your new kidney (chronic rejection).
The signs of rejection vary. Often you don't notice the rejection yourself, and it only becomes apparent at your next checkup through a change in your lab parameters. Less frequently, you may experience reduced urine volume or general malaise. In some cases, rejection can even lead to a complete loss of kidney function. A real inflammatory reaction with fever and pain in the area of the new kidney is even rarer and usually associated with the suspension of immunosuppression. To catch these problems early, there are regular follow-up appointments with your team of physicians 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 the immune system. By slowing down the immune system, the new kidney escapes the radar of the defense forces and can thus arrive relaxed in your body.
Generally, these drugs mainly slow down the cells of the immune system. These include 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. However, the exact effect of immunosuppressants always depends on the individual substance class.
The following classes are distinguished among immunosuppressants:
What are common side effects of immunosuppressants?
The individual classes of immunosuppressants differ in terms of the active ingredients they contain and thus, of course, in their effects. In general, these inhibit the action of the immune system via different points of attack. If too few immunosuppressants are taken, side effects may occur less frequently, but this also means that a rejection reaction is more likely to occur.
If too many immunosuppressants are taken, side effects are more likely. It is therefore important to find the right balance. The dosage of immunosuppressants should therefore always be as high as necessary but as low as possible. In this way, the positive effects and the side effects can be kept in the right balance. But what are the side effects and how can you possibly recognize them?
1. Opportunistic infections after transplantation
This sounds a bit complicated at first glance, but it is actually quite simple to understand: As you can already imagine, slowing down the immune system also has its downside. Although the immune system now accepts the new kidney better, it also becomes less sensitive to pathogens. These include bacteria, viruses, and fungi. These can cause so-called opportunistic infections. These have this special name because, unlike "normal" infections, they often only lead to an infection when they can take advantage of a weak phase in your immune system.
Typical pathogens for opportunistic infections after transplantation are summarized here:
For more detailed information on opportunistic infections after kidney transplantation, how you can recognize them and how they are treated, see other articles in the Mizu App. So, as you can see, post-transplant infections are a relatively common complication and must always be monitored 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 if you experience symptoms such as fever, diarrhea, or a cough. In the logbook of the Mizu app you can regularly document all your values. In addition to opportunistic infections, urinary tract infections are particularly common after transplantation. Typical symptoms here are burning or pain during urination and possibly fever. Urinary tract infections account for about 40-50% of all infections after transplantation. They are usually treated by administration of antibiotics.
2. Increased risk of cancer after transplantation
In addition to bacteria and viruses, your slowed-down immune system may also recognize cancer cells less well after the transplant. Of course, this does not necessarily mean that cancer will occur. However, if necessary, you should participate in all recommended preventive examinations in order to be able to react early in case of any doubts.
This applies to screening for skin cancer, colon cancer and for the common forms of cancer in men (e.g. prostate) and women (e.g. cervical cancer, breast cancer). You can also find out how exactly screening after transplantation works and how you can also take regular precautions at home through self-examination in other articles on the Mizu app.
3. Post-transplant diabetes mellitus (=PTDM)
Corticosteroids, which include prednisolone and tacrolimus/cyclosporine, in particular can somewhat disturb 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 disturbances in your blood sugar levels. This post-transplant diabetes mellitus (=PTDM) is manifested by high blood glucose levels in the laboratory. Other symptoms may include cravings or weight gain.
Experts assume that this type of diabetes occurs in up to one third of transplant recipients. The most important measures that help with treatment and prevention are exercise, a change in diet and weight adjustment.
In addition to your blood glucose levels, blood lipids, such as cholesterol, may also be elevated due to immunosuppressive therapy. These laboratory values are checked regularly, especially shortly after transplantation. As always, you can record your values in the logbook of the Mizu app.
4. High blood pressure due to immunosuppressants
In addition to your metabolism, therapy with immunosuppressants can also affect your blood pressure. This can increase due to the use of the drugs. However, your blood pressure after transplantation also depends on other factors, such as your pre-transplant values and the quality of the donor kidney.
In general, high blood pressure levels can lead to a decrease in the function of your new kidney. Similar to high sugar levels, exercise, a healthy diet and adjusting your medications will help. As always, you will discuss the exact therapy with your medical team.
5. Decrease in kidney function
Some immunosuppressants in high doses can also lead to restrictions in the function of your new kidney. This is because the drugs decrease blood flow to your new kidney. However, these changes in your kidney function can usually be reversed and managed by adjusting the dose of your medication or switching to alternatives.
Nevertheless, regular monitoring of your kidney function is important. Make sure that you regularly and reliably attend your check-ups at your transplant center and your nephrologist. Anything else would be more than a pity, because you should support your precious new kidney in its work in the best possible way and look after and preserve it as long as possible.
6. Bone loss due to immunosuppressants
Therapy with immunosuppressants can also lead to so-called bone loss (= osteoporosis). Osteoporosis is a metabolic disease of the bones in which they lose density and strength. The reasons for these changes are often problems in the calcium and vitamin D balance. The result can be bone fractures. Other factors that promote the development of osteoporosis include personal physical activity level and diet.
Physical exercise, (muscle building training, walking outdoors, etc.), taking calcium and vitamin D supplements or other medications help in treatment and prevention. Your transplant team will explain to you exactly what measures are necessary.
7. Other side effects
Diarrhea can result not only from infections, but unfortunately can also be a side effect of your medications, especially when taking mycophenolic acid. If your transplant team has ruled out other causes, a dose reduction of this class of drugs may be necessary. Often, however, this side effect is temporary, and the mycophenolic acid dose can be increased again later. Sometimes, however, a switch to other agents, such as azathioprine, is necessary.
Low white blood cell counts (=leukopenia) can usually be caused by mycophenolic acid or azathioprine. Your transplant team may also respond by switching you to a lower dose. If you have very low white blood cell counts, you may even need to inject a medication for a few days to increase white blood cells. If you have low white blood cell counts and a fever, you should go to the hospital immediately. Your body can't handle infections in such a case, and it needs to be supported as soon as possible.
Trembling of the hands can occur especially in the first months after your transplantation and is often caused by Tacrolimus or Cyclosporin. Over time, this side effect usually subsides on its own, or subsides on its own with a lower dose of these medications.
It is best to discuss these more complicated side effects with your transplant team and never change your medications without an explicit recommendation from your nephrologist.
How can I manage the side effects of immunosuppressants?
As you can see, immunosuppressants are of great importance after transplantation and are used and adjusted by your medical team for a reason. However, there are some side effects that are often part of the regimen as well. It is important that you take your medications regularly to maintain as constant an effect level of these as possible. This will also help your medical team and your new kidney. At the same time, be sure to always discuss side effects proactively with your transplant team.
Your kidney function, the levels of these medications, and your blood glucose and blood lipid levels are usually recorded during regular laboratory tests and analyzed by your medical team. You can then document your corresponding lab values, your weight and your blood pressure values in your Mizu App logbook. This way, you can also keep track of your most important values yourself after the transplant. To detect possible infections at an early stage, you can also enter your infection values (e.g. CRP) and your temperature measurements in your logbook. This way you can always keep an eye on your health and discuss any abnormalities directly with your transplant team.
