Organ transplants are one of the few available options for treating patients with end-stage organ failure of any kind, including kidney, liver, heart, and lung. However, once a new organ is transplanted, the immune system may see the new organ as a threat and begin the process of organ rejection. For this reason, patients need to take anti-rejection medications to help slow this process down.
Anti-rejection medications help patients to have a better quality of life and live longer after transplant surgery. These medications help to ensure that a transplanted organ is accepted and that it can carry out its function in the new body. This is done through the provision of temporary immune system suppression.
Organ Rejection
The immune system is built to protect the body from any threats, foreign and domestic. This means that it can potentially create protective mechanisms to attack a newly transplanted organ, as it will see it as an unfamiliar object in its environment.
Organ transplants involve moving tissue and/or organs from one body to another to treat organ failure. Implants can fail because the body naturally identifies the organ as foreign and activates the immune system, damaging the organ. This immune response is called organ rejection.
There are 3 types of organ rejection:
· --- hyperacute rejection --- rejection occurs within mins to hrs of transport
· --- acute rejection --- occurs within weeks to months of implantation
· --- chronic rejection --- occurs over the course of many years
In order to inhibit organ rejection, transplant patients must take medication to suppress the immune system (immunosuppression).
What is an Immunosuppresant Drug?
Immunosuppresant drugs are designed to inhibit a specific part of the immune system to prevent transplant rejection. Immunosuppresant drugs must be take for life in order for the transplant to be successful.
How Immunosuppressant Medication Work
Immunosuppressant drugs work in 3 ways:
· 1: Preventing the activation of immune cells.
· 2: Decreasing the levels of immune response (inflammation).
· 3: Blocking production of immune cells
These medications assist the transplanted organ as it integrates into the body by masking the immune system response.
Because different medications can be used in conjunction to create an increasingly efficient system with a larger control over unwanted side effects, it is not uncommon for physician to use multiple anti-rejection medications.
Tiered Anti-Rejection
Due to the complexity of immune response control, multiple classes of medications are utilized in anti-rejection therapy, each with a specific target.
Calcineurin Inhibitors
Calcineurin inhibitors are a widely prescribed anti-rejection therapy due to their efficiency in targeting a single major controller of immune response: the calcineurin enzyme.
Cyclosporine and tacrolimus are the two most widely prescribed calcineurin inhibitors, and they are prescribed in post care of transplant surgeries on heart, kidney, and liver organs because they decrease the risk of active immunologic organ response.
Antiproliferative Agents
For immune system modulation, antiproliferative agents are used to slow the rate of division of the targeted immune cells to create a weaker response to the targeted organ.
In this group, mycophenolate, and azathioprine are among the most prescribed and most effective in conjunction with calcineurin inhibitors.
Corticosteroids
Corticosteroids are effective for lessening inflammation while suppressing the immune system. They are commonly used in the early post-transplant period to prevent acute rejection.
One of the most common corticosteroids prescribed is:
· Prednisone
These medications are very effective; however, the long-term side effects of corticosteroids leads to their use in lower dosages as time goes on.
mTOR Inhibitors
A type of anti-rejection medication are the mTOR inhibitors. These medications inhibit the action of a specific protein that is required for the growth and division of immune cells.
One example of this category of medication is:
· Sirolimus
These drugs are also sometimes prescribed in the event that the patient cannot tolerate the other classes of anti-rejection medications.
Importance of Anti-Rejection Medications
Medications for organ transplant rejection are crucial for the management of organ transplants. They prevent the immune system from attacking and destroying the transplanted organ.
These medications do the following:
· Protect transplanted organs from being damaged by the immune system
· Decrease the incidence of transplant failure
· Increase the post-transplant survival rate
· Allow transplanted organs to work as they should
When patients take their medications as prescribed, they are able to prolong the function of the transplanted organ.
Importance of Taking Medication Regularly
Consistency with prescribed anti-rejection medications is key. Missing doses can raise chances of transplants being rejected. Therefore, transplant patients must be diligent with their meds, and also with their checkups.
To help adjust medications, doctors do regular blood tests to check the levels to help balance effectiveness and side effects.
Possible Side Effects
Anti-rejection meds are crucial, but can lead to side effects due to their nature of lowering the immune response. Some of the most common side effects are:
· Increased chances for infection
· Heightened blood pressure
· Weight gain
· Kidney issues
· Diabetes
· Thinning of bones
In most cases, doctors will reduce doses to decrease side effects.
Lifestyle Considerations for Transplant Patients
Transplant patients will need to make some lifestyle changes to help aid in their overall health. Some recommended habits are:
· Eating a healthy and well balanced diet
· Regular exercise per direction of a physician
· Minimized risk for exposure to infections
· Good personal hygiene
· Regular medical checkups
In short, transplant patients must adopt healthy habits to help ensure their transplanted organ stays healthy and works well for a long period of time.
March 2023
Future treatments target how the body responds to transplanted organs
New medications that offer less side effects and are more targeted for immune suppression are also being developed.
Research in \"personalized medicine\" will enable doctors to craft treatment plans for patients based on their specific immune systems.
Conclusion
Medications that prevent the body from rejecting transplanted organs are crucial for the success of organ transplants. Although these medications require the patient to be vigilant in their compliance for the rest of their lives, the benefits far outweigh the drawbacks, allowing transplant patients to enjoy more years of life.
Improved organ function is possible for years when combined with effective medical therapy and adherence to a prescribed regimen, along with the healthy lifestyle changes of the recipient.
