Transplant and Immunosuppressants: A Guide to Kidney Health Month
Your kidneys are an important organ, they are responsible for filtering waste and excess water from your blood, as well as maintaining your bodies fluid and pH balance and producing some hormones. Conditions like high blood pressure, diabetes, and lupus can lead to kidney damage, leading to kidney disease later in life. When a person’s kidneys begin to fail, dialysis is often scheduled to assist the kidneys. There are two different kinds of dialysis; Hemodialysis and Peritoneal dialysis. Hemodialysis takes place by having a machine, called a dialyzer, remove blood from your body, filter it, and return the cleaned blood back to your body. Peritoneal dialysis differs from hemodialysis in that it doesn’t filter the blood by removing it from your body, but through your abdomen. Some patients like peritoneal dialysis for the convenience, as it can be done at home, work, or while traveling without the need to visit a dialysis center regularly.
Transplant
Kidney transplant is the preferred treatment for patients with End Stage Renal Disease (ESRD). Patients have demonstrated improved long-term survival when placed on a transplant list compared to patients who stay on dialysis. In fact, those who undergo transplantation experience better Quality of Life (QOL) and have a projected survival benefit of 10 years over those on dialysis. There are two types of kidney transplants: Living donor and Deceased donor. A deceased donor kidney comes from someone who has died and chosen to donate one to someone in need, where a living donor kidney comes from a healthy person who is still alive. Living donor kidneys aren’t as common as deceased donor kidneys, but they last on average longer than deceased donor kidneys (15-20 years vs. 7-10 years). Talk with your transplant team to see which options are right for you.
Management of Kidney Transplantation
Although there are many benefits of kidney transplantation, receiving a donor kidney doesn’t “Cure” a patient’s kidney disease, and success long term depends on many variables. One of the biggest risks to a new transplanted kidney is rejection. Rejection happens when your body’s immune system recognizes a transplanted organ as foreign from the rest of your body and attacks it. Healthcare providers reduce rejection risk with the help of immunosuppression medication like Steroids (prednisone), Tacrolimus, and Mycophenolate, all available at Rx Outreach. One of the most important responsibilities you will have post-transplant is to follow a medication regimen prescribed by your transplant team. These anti-rejection medications help to reduce the risk of your body rejecting a transplanted organ, and must be taken at the same time every day to ensure the medication levels in your body is maintained! Some side effects of anti-rejection medications include an elevated blood glucose, high blood pressure, nephrotoxicity (toxic to kidneys), increased cancer risk, and a decrease in your ability to fight infections. Some foods can interact with immunosuppression medication levels, such as grapefruit, pomegranate, pomelo, blood orange, and black licorice. It’s best to avoid these foods as they could dangerously increase the amount of anti-rejection medication in your body and cause dangerous side effects.
Hydration and diet
Hydration is very important following a successful kidney transplant. It’s suggested to drink 2-3 liters (8.5 cups, or 68 ounces) of water per day. It’s important to keep track of the fluids you choose since some (e.g., caffeinated drinks) can actually dehydrate you, so ease up on the coffee and double down on that H2O! Maintaining a balanced healthy diet is also important after a transplant, since some of the anti-rejection medications can cause an unwanted increase in bodyweight (Prednisone). Post-transplant, you should have fewer dietary restrictions than when you were on dialysis, and a heart-healthy diet low in sodium & fat is often recommended by transplant teams.
Elevated blood glucose
Some of the medications prescribed after a transplant (like Prednisone, Tacrolimus, and Mycophenolate) can make it harder for your body to control blood sugar. Up to one in three people will develop some high blood sugar levels post-transplant. Oftentimes this is temporary, however for some it’s not, and can develop into something called Post-transplant diabetes mellitus (PTDM). Having PTDM after a transplant can increase the risk of infections, cardiovascular complications, and organ rejection. Because of this, it’s important to monitor and manage your blood glucose levels closely with your team after a kidney transplant until you know how your medications affect you, and anytime your transplant team adjusts or changes your anti-rejection regimen/dose.
Cancer prevention
Patients who receive kidney transplants have an increased risk of developing cancers, up to 4 times higher during the first two years following the transplant due to the anti-rejection medications. The most common types of cancers following a kidney transplant are some skin cancers, lymphoma, and breast cancer. As a result, current clinical guidelines for kidney transplant recipients include monthly self-skin examinations, as well as annual total body examination by a dermatologist. It’s important to wear sunscreen and long sleeves to protect your skin and reduce your skin cancer risk. Your team may recommend other cancer screenings such as cervical, prostate, and breast cancer screening depending on your age, sex, and other conditions.
Labwork
Causes of kidney allograft dysfunction that requires rapid intervention are more common in the first few days to weeks, so early monitoring is crucial to the long-term health of the transplant. Common labs to check include drug levels, Basic Metabolic Panel (BMP), blood glucose, urinalysis, and electrolytes. All these tests help your transplant team know the health of your new kidney is, so It’s important to do every test recommended by your team.
Post Written By: Zach McNealy, PharmD Candidate, University of Health Sciences & Pharmacy (St. Louis)
