Did you know?

Your immune system (a group of cells and proteins in your body) works to protect you from things that can make you sick, like bacteria and viruses. When you receive a new transplanted kidney, your immune system sees it as something that does not belong in your body. You will have to take anti-rejection pills (called immunosuppressants) to prevent your immune system from attacking and damaging your new kidney.

You must take immunosuppressant pills for as long as your new kidney is working. Most patients will need to take a combination of two or three immunosuppressant medications. Immunosuppressant pills will make your immune system slow down and not work as well. Because of this, you will be being at risk of getting infections and some forms of cancer (you probably will be advised to regularly consult with a dermatologist, take a look at helpful links below). Your transplant doctor may give you some medications to try to prevent infections after your transplant. You will need to get regular follow-up with your family doctor through blood samples after your transplant. Remember that a kidney transplant involves an abrupt and aggressive change in medication. Within a few days, your body should get used to many medications that you have never taken before.

Side Effects

All medications (pills) can cause side effects, but not everyone will get side effects. You may feel side effects from one or more of your medications after transplant. Some of the more common side effects that you may get include stomach issues such as nausea (an urge to throw up) or diarrhea (loose runny stool), tremor (shaking), high blood sugar, low red blood cells, mood changes, and easy bruising. Because of this, your doctor will ask for labs frequently in the first year to ensure that the current dosing of anti-rejection pills is working properly. Certain anti-rejection pills can do more harm than good if the dosing is incorrect.

Additionally, it is very likely that you develop new health conditions that might also occur as a side-effect of anti-rejection medications, such as high blood pressure, higher cholesterol and lipid levels in the blood, weight gain and anemia. Also, you might experience side effects of the medications to manage these “new” conditions that can impact on your post-transplantation phase.

You may find it difficult to deal with the side effects from some medications that you need to take after the transplant. Remember that your transplant team is here to help! Ask your team if you find it difficult to take these medications every day.

  • Studies show that medication side effects can affect a patient’s well-being.
  • As many as 1 in 4 transplant patients do not take their anti-rejection medications as instructed by their doctors (the right number of pills at the right time). Patients who do not take their immunosuppressant medications correctly have a greater chance of having rejection and losing their transplant. This can lead to a need to go back to dialysis.

How am I doing?

Medication side effects are common after a kidney transplant. Dealing with medication side effects can affect your well-being. Sometimes side effects decrease as your body “gets used to” your new medications. If side effects continue to be a problem for you, your transplant team is here to help.

The list of possible side effects from immunosuppressant medications is long. Fortunately, not all patients will feel all the side effects. It is a good idea to keep track of the side effects that you feel.

 

Date Side effect How bad is the side effect(mild moderate or severe) Notes

PRINT THIS TABLE

Taking your medications correctly

Taking medications correctly is not as easy as it seems. Use this weekly tracking sheet to see how well you are doing at taking your medications correctly. Fill in the dates, and then put a check in the box once you have taken your medication correctly.

Time of day Medication name Dose Day Day Day Day Day Day Day

PRINT THIS TABLE

What can I do?

Your transplant team is here to help. If you are having problems with side effects from your medications, let your team know. They will help you with different ways to decrease the side effect so you can cope better. For example, they may change the amount of your medication or when you take your medication. In some cases, they may change your medication to try to reduce side effects. Sometimes they may add another medication to try to lessen a side effect. Medication changes should only be done with advice from your transplant team. This is why talking to them about side effects is so important.

Taking your medications correctly

There are several things that you can do to help you remember to take your medications correctly.

  • Learn the names of all your medications, as well as the dose and reason for taking each one.
  • Write down your medications along with when you take them. You may also keep track of your medications in an app.
  • Try to make medication a part of your daily routine, so that taking medications becomes a habit.
  • Use alarms (such as on your phone, watch or clock) to help you remember when to take your medications.
  • Use a pillbox or dosette to help you organize your medications.
  • Ask your pharmacy to package your medications according to the date and time of when you need to take them. This is called a blister or bubble pack.
  • Ask for help at any time if you are having difficulty! The medications can be confusing, especially right after the transplant. Things will get easier when taking medications becomes part of your routine.

How can I do it?

Keep track of your side effects and show them to your transplant team. This way your team can help you manage them. You can use the same table presented in the previous section “How am I doing? – Dealing with side effects” to keep track of your side effects.

Taking your medications correctly

The weekly tracking sheet can also be used to help you keep track of your medications. Fill in the dates, and then put a check in the box once you have taken your medication correctly. You can use the same table presented in the previous section “How am I doing? – Taking your medications correctly” to keep track of your medications.

You can meet with a pharmacist during your routine appointments. The side effects form (presented previously in the section “How am I doing?”) would come in handy during this encounter, and it can also be used when you go to your local pharmacy.

And remember your anti-rejection medications need to be taken:

  • Every day
  • At the same times

By taking your anti-rejection medications at the same time each day and as prescribed, you will keep the medications at an even level in your blood.

More Information

This section was written by Dr Holly Mansell (BSP, PharmD; Associate Professor College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon/Canada) and Dr Nicola Rosaasen (BSc, BSP; Transplant Pharmacist, Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon/Canada).

And reviewed by Jessica Donnan (MHA, RN, CHE; Regional Practice Initiatives Lead (Interim), Vancouver Coastal Health) and Marianna Leung (PharmD, ACPR, BScPharm, BCPS, FCSHP; Clinical Pharmacy Specialist-Renal Transplant); Patrick Gee (Ph.D, JLC, Patient-partner and Minister; Founder/CEHD; iAdvocate, Inc.); Nicolas Fernandez (patient partner); James Myers (kidney transplant recipient); AND by our research team.

References for side effects:

  1. Kugler C, Geyer S, Gottlieb J, et al. Symptom experience after solid organ transplantation. J Psychosom Res. 2009;66(2): 101-110. doi:10.1016/j.psychores.2008.007.017
  2. Aladwan S, Harrison JJ, Blackburn DF, Taylor J, Blydt-Hansen TD, Mansell H. A Canadian Survey on Adverse Symptoms Experienced by Solid Organ Transplant Recipients. Prog Transplant. 2020;30(3):254-264. doi: 10.1177/1526924820933821

References for medication adherence:

  1. Dew MA, DiMartini AF, De Vito Dabbs A, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation. 2007;83:858–73.
  2. Pinsky BW, Takemoto SK, Lentine KL, et al. Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transplant. 2009;9:2597–606.
  3. Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. J Am Soc Nephrol. 2017;28(8):2290-2301. doi: 10.1681/ASN.2017020216.

Helpful links

  1. https://www.aad.org/public/fad/what-is-a-derm
  2. https://www.newswise.com/articles/transplant-patients-need-to-be-examined-by-a-dermatologist-the-american-dermatologic-association-endorses-enhanced-screening-surveillance-and-prevention-of-skin-cancer-and-skin-infection-in-patients-with-solid-organ-transplants
  3. https://caredx.com/patients-and-caregivers/patient-resources/does-timing-matter-when-taking-anti-rejection-medications-for-your-transplanted-kidney-or-heart/