Most people need to take anti-rejection drugs for the entire life of the transplanted organ. The type of anti-rejection drug you receive depends on a number of factors, including the status of your immune system, which organ(s) has been transplanted, and your medical history. Treatment will typically involve a combination of different types of anti-rejection drugs to help you get the best treatment results with minimal side effects. Each anti-rejection drug works in a slightly different way, but all stop T cells (part of the immune system) from recognising your transplanted organ as foreign and attacking it (see video below).
STAGES OF IMMUNOSUPPRESSION
A course of intensive immunosuppression sometimes started before the transplant operation and continued for about 2 weeks afterwards, usually using antibodies against T and B cells.
Long-term immunosuppression given for the entire duration of the transplant consisting of the lowest dose that works to prevent rejection. Initially (over the first 3 months) a higher dose might be given, which is reduced as your transplant becomes more stable.
Acute rejection therapy:
A short course of high-dose immunosuppression, usually a corticosteroid, given to treat an episode of rejection.
The main types of anti-rejection drugs are listed in the sections below. The drugs are identified here by the name of the active ingredient. You will find this, and the brand name, on the packaging. Note that not all of the medicines can be used in all types of organ transplant and not all medicines are available in all countries.
Reporting of side effects: If you get any side effects with your anti-rejection medicine, talk to your doctor, pharmacist, nurse, or a member of your transplant team. This includes any possible side effects not listed in the package leaflet. Patients in the UK can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of medicines.
When you receive a new organ through transplantation, your immune system will recognise it as foreign. T cells will travel to the new tissue, multiply, recruit more immune cells to the area and destroy your transplant. To protect your new organ from your immune system, the T cells must be suppressed by medication. Anti-rejection medications work by reducing T cell multiplication and by decreasing T cell messages to other immune cells, all of which protect your transplanted organ from your immune system. Without these medications, your T cells will return to normal function and destroy cells of the transplanted organ. This is how life-long use of anti-rejection medication ensures the ongoing health of your transplanted organ.
Antibody therapy, given directly into your vein by an intravenous drip, can be used for induction therapy.
Basiliximab and antithymocyte immunoglobulin (ATG) are both antibody therapies. Basiliximab prevents the growth of T cells. ATG also prevents the multiplication of T cells as well as stopping them, and B cells (another part of the immune system), from moving from the bloodstream into parts of the body, such as the transplanted organ.
Calcineurin inhibitors (CNIs) are mainly used for maintenance therapy. They can also be used as a treatment if you experience organ rejection.
Tacrolimus and ciclosporin are both calcineurin inhibitors. They protect the transplanted organ by acting against calcineurin so that T cells are not activated and do not attack the transplanted organ.
mTOR (mammalian target of rapamycin) inhibitors are mainly used in combination with other anti-rejection drugs for maintenance therapy.
Sirolimus and everolimus are both mTOR inhibitors. These protect the transplanted organ by blocking the activity of mTOR, which stops the T cells from multiplying.
Anti-proliferative agents are used in combination with other anti-rejection drugs for maintenance therapy throughout the life of the transplanted organ.
Mycophenolate mofetil (MMF) and azathioprine are anti-proliferative agents. They protect the transplanted organ by blocking the production of DNA in B and T cells which prevents these cells from multiplying.
Corticosteroids are a type of steroid and are found in various medications used to treat conditions where the immune system needs to be suppressed, e.g. in tablets for rheumatoid arthritis, and creams for eczema and psoriasis. Prednisolone and methylprednisolone are corticosteroids which are used in transplantation.
High doses of intravenous corticosteroid are often the first treatment for acute transplant rejection. They may also be taken as daily tablets for maintenance therapy along with other anti-rejection medications.