Anti-Rejection Drugs: How Do Organ Transplant Medications Work?
Key takeaways:
Organ transplant medications are life-preserving medications that suppress your immune system. With their use, you can limit the risk of your body rejecting the transplanted organ.
Many different transplant rejection medications are available. Often, they're taken in combination with one another. Together they can keep your immune system at bay.
A common side effect of organ transplant medications is an increased risk of infection. You can help prevent illness by using good handwashing technique, staying up to date on vaccinations, and avoiding people who are sick. You may also take medications to prevent certain types of infection.
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Table of contents
One marvel of modern medicine is that we can replace failing organs with newer, healthier ones. Organ transplants save tens of thousands of lives each year across the U.S. — most often amongst kidney and liver transplant recipients. But a new organ is a life-saving journey, and it’s important to take care of it.
After a transplant, it’s necessary to take medication to prevent complications from occurring. But many organ transplant medications (“anti-rejection drugs”) are available, and they each work in different ways.
What medications are prescribed for an organ transplant?
After your transplant, you'll likely need to take two or three different immunosuppressant medications. They’re important tools to make sure your body doesn't reject the new organ or have a bad reaction to it. They also aim to improve quality and length of life. These medications include:
Calcineurin inhibitors: This group includes tacrolimus (Prograf, Astagraf XL, Envarsus XR), non-modified cyclosporine (Sandimmune), and modified cyclosporine (Gengraf, Neoral).
Antiproliferative agents: Mycophenolate mofetil (CellCept) and mycophenolate sodium (Myfortic) are two common examples. But other medications, like azathioprine (Azasan, Imuran), everolimus (Zortress), and sirolimus (Rapamune), are also available.
Corticosteroids: Prednisone and prednisolone are two go-to steroids, but other steroids may be prescribed instead, depending on the situation.
How do organ transplant medications work?
The medications you take after a transplant prevent your immune system from rejecting your new organ. In general, they do this by reducing the activity of your immune system. But the specific way they do this varies by drug class.
Here's how three different types of medications work to inhibit your immune system:
Calcineurin inhibitors: Calcineurin is an enzyme (protein) that activates T cells, a key part of your immune system. By taking a calcineurin inhibitor, you block calcineurin’s ability to prompt your immune system to attack your organ.
Antiproliferative agents: Antiproliferative medications slow the growth and replication of certain immune system cells.
Corticosteroids: Steroids work by calming down how reactive your immune system is.
In order to be best protected, you'll likely take several organ transplant medications at the same time. Taking a few medications instead of just one can reduce their individual toxicity and lessen the risk of rejection.
What are the risks and side effects of organ transplant medications?
Like all medications, organ transplant medications have side effects. Some side effects are relatively minor, while others are more serious.
Infection is one of the more common risks. Because of their effects on your immune system, transplant medications increase your risk of getting sick. That's why it's important to take extra steps to protect yourself. You can do this by making sure to wash your hands, wear a mask around crowds, and follow other safety measures. Staying up to date on vaccines is also crucial.
While taking immunosuppressants, you may get a fever, chills, body aches, or have other symptoms of infection. It's important to let your healthcare team know right away about these symptoms. An infection can become very serious if left untreated. You’re also more at risk for developing what are known as an "opportunistic" infection during this time. Pneumocystis pneumonia or cytomegalovirus are two examples; they’re more likely to develop because your immune system is weaker than normal.
There are also medication-specific side effects. For instance, tacrolimus and cyclosporine can cause side effects like:
Headache
High blood pressure
Diarrhea
Abdominal pain
Urinary tract infections
Kidney problems
Diabetes
Other medications have side effects, too. For instance, steroids can increase the risk of high blood pressure and high blood glucose (sugar). They can also lead to weight gain, weaker bones, and vision changes. Mycophenolate drugs can cause low white blood cell counts and birth defects if taken during pregnancy.
Keep in mind: These are only a few examples of possible transplant medication side effects. Your transplant team can talk to you about how to manage the side effects from the specific medications you’re taking. But if you experience a severe side effect, such as difficulty breathing or chest pain, seek emergency medical attention right away.
What should you do if you miss an anti-rejection medication dose?
Immunosuppressants are time-sensitive medications. Certain immunosuppressants also have a small safety window, so taking consistent doses is important when possible.
Generally speaking, if you miss a dose for your medication, you should take it as soon as you remember. But when it comes to transplant medications, the time you take your dose needs to be more precise. Every organ transplant medication has different instructions for what to do if you miss a dose. Here’s what to do for three particular medications:
Astagraf XL (tacrolimus extended-release capsules): If you miss a dose, you can take it up to 14 hours after your regularly scheduled time. However, if it's beyond 14 hours, you should skip your dose and take the next one as originally scheduled.
Envarsus XR (tacrolimus extended-release tablets): A missed dose can be taken for up to 15 hours after your regularly scheduled dose.
CellCept (mycophenolate mofetil): In general, you should take a missed dose unless it’s 2 hours until your next dose.
In order to get specific instructions for your organ transplant medications, you should contact your transplant specialist on what you should do. These timeframes are also based on the medications’ approved labeling. Your transplant center may have different recommendations.
How do you stay healthy when taking immunosuppressants?
Immunosuppressants have benefits and risks. But because these anti-rejection drugs are life-saving and taken long-term, it’s important to make sure that they’re tolerable and safe over time. Depending on the medications you’re taking, your transplant team will routinely monitor medication levels in your body to make sure they’re where they should be.
Preventing infection and managing side effects are also top of mind. Transplant medications can dampen your immune system’s ability to fight off infections. This means you are more likely to get sick if you come in contact with people that have ailments like the common cold, flu, or COVID-19.
Similarly, preventing opportunistic infections is important. You’ll likely receive antibiotics or antiviral medications in the months after your transplant as a precaution. Depending on your risk factors and transplant type, your transplant team can give you more detailed information about which ones you may need.
Taking extra precautions to prevent getting sick is important. Here are four things you can do to help protect yourself:
1. Maintain proper hand hygiene
The CDC recommends that you wash your hands with soap for a minimum of 20 seconds at a time. It’s important to wash your hands before and after certain activities, like eating food, using the bathroom, and touching pets.
2. Get vaccinated
If you’re taking immunosuppressant medications, there are certain vaccines you should receive and others that you should avoid. Your transplant team can tell you which vaccines are safe and which ones aren’t recommended.
Generally speaking, you should avoid live vaccines, like the chickenpox and measles vaccine. And if you plan to travel, there are also specific travel vaccines that you may need to get. These vaccines may take some time to become effective, so it's best to visit your healthcare provider at least 1 month before your trip.
3. Avoid touching your face
Your skin is your first line of defense against viruses and bacteria. These germs can easily enter your body through your nose, eyes, and mouth. So it's important to avoid touching these areas as much as possible.
If you're traveling or commuting, particularly in crowded settings such as on an airplane or bus, you should cover your nose and mouth with a mask.
4. Take care of open wounds
If you have an open cut or scrape, it can be a gateway for bacteria and viruses to enter your body. It’s important to cover or treat these wounds to the best of your ability.
In case you notice any signs of infection, such as fever or if the wound looks infected, you should seek advice from your healthcare provider.
The bottom line
You’ll likely need to take a few organ transplant medications (“anti-rejection drugs”) after your transplant surgery. This includes a combination of medications that suppress your immune system in different ways. For example, you may be taking a calcineurin inhibitor like tacrolimus, an antiproliferative drug like mycophenolate mofetil, and a steroid like prednisone.
It’s important to let your care team know if you experience any new or unusual side effects while taking these medications. It’s also important to take your medications consistently and to check in with your transplant team to make sure everything is working according to plan.
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References
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Centers for Disease Control and Prevention. (2021). Pneumocystis pneumonia.
Centers for Disease Control and Prevention. (2022). When and how to wash your hands.
Danziger-Isakov, L., et al. (2019). Vaccination of solid organ transplant candidates and recipients: Guidelines from the American society of transplantation infectious diseases community of practice.
Extending Medicare Coverage for Preventive and Other Services. (2000). 5. Immunosuppressive drugs for transplant patients. Institute of Medicine (US) Committee on Medicare Coverage Extensions.
MedlinePlus. (2021) Therapeutic drug monitoring.
MedlinePlus. (2021). Transplant rejection.
Organ Procurement & Transplantation Network. (2023). 2022 organ transplants again set annual records; organ donation from deceased donors continues 12-year record-setting trend.
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