What sort of medications will I need to take?
Immediately after the transplant there will be a lot of new medications to take. Many of these will be stopped over the next weeks and months, but clearly anti-rejection medications (immunosuppressant drugs) have to be taken for as long as the kidney is working.
These are the main groups of new drugs:
- Anti-rejection – everyone will start on three different types of drugs to prevent rejection: prednisolone (steroids), Tacrolimus, and Mycophenolate mofetil. These act in different ways on the immune system so all three work well together. The highest doses are given at the start, and these are gradually reduced. Most people will be on two of these drugs in the long-term, and a small number will be on all three or just on one depending on individual risk of rejection.
- Stomach and bowel – patients not already taking a stomach or indigestion tablet will be started on one to protect the stomach while on the high doses of the new tablets. This can be stopped relatively soon in most people. As constipation after the surgery is common everyone is given medication to help the bowels to open.
- Prevention of infection – mouthwashes are prescribed four times a day to keep the mouth clean and free of infection. These can be stopped in the first few weeks as the doses of the anti-rejection drugs are reduced, standard good oral hygiene is recommended in the long-term. Everyone is given a drug called co-trimoxazole (Septrin®) to prevent a particular type of chest infection which is very uncommon but can be very serious if it does occur in people with a low immune system. It is usually given for six months. Some patients are also given an anti-viral drug called Valganciclovir. This is to reduce the chances of a virus called CMV causing a problem. This is a common virus which generally doesn’t cause a problem in healthy people. Only the people who have never had this virus before being transplanted, will need this tablet. Typically those who need it take it for three months (this drug is given out by the hospital rather than the GP practice).
- Blood thinning injections – everyone will have a small injection once a day after transplantation to reduce the chances of a blood clot forming. While a blood clot is rare it can be very serious and for people who are at higher risk we ask them to continue with this injection for a month in total.
While it can be difficult to take lots of pills, it is crucial to keeping the patient and the transplant well! Although there are many new medications, most people are able to stop some of the drugs that they were taking before the transplant. It is very important to tell the doctor or pharmacist if there are side-effects that are difficult to cope with, or it is not easy to get the medications on time from the GP or local chemist. In general it is a good idea to always attend the same pharmacist for your medications.
It is absolutely crucial to continue to take the anti-rejection medications that are prescribed. Remarkably there are some people who become complacent, or busy, or forgetful and do not take their pills regularly. The result is rejection of the kidney. While initially the results may be stable, sooner or later the kidney will fail. It is impossible to ‘get away’ without taking anti-rejection tablets.
The doses of the anti-rejection tablets will be reduced slowly over the course of time if the kidney continues to work well. The benefit of this is to reduce the long-terms side effects. It is important to remember however that although there can be downsides to taking this medication, the consequences of not taking anti-rejection tablets (failure of the kidney and dialysis treatment) are much more severe.