Medication Side Effects in Transplantation

1
Medication Side Effects in Transplantation

• Shirley Schlessinger, MD, FACP
• Transplant Nephrologist
• University of Mississippi Medical Center

2
Two Types of Med Fall-Out

• Extension of the Therapeutic Effect of
  anti-rejection meds (immunosuppression)
• All patients at risk
• Dose-related
• Consider net immunosuppression of each patient
  in risk assessment and management
• True Side Effects
• Less predictable
• Different / unique for each patient
• May be dose-related / timing related

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Therapeutic Extension of Immunosuppression Meds

• Malignancy
• Skin
• Lips / mouth
• Cervical
• Blood / lymph nodes
• Renal
• Other
• Infection
• Fungal, viral, bacterial

Have regular recommended screening!! Report all
growths or lumps to your doctor!
These are RARE! You will be given medication to
prevent!!! But the preventive meds can ALSO
have side effects!
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True Side Effects

• Metabolic (Weight Gain / Diabetes Mellitus)
• Cardiovascular (High Blood Pressure/Cholesterol)
• Cosmetic (hair loss/growth skin changes, acne,
  chipmunk cheeks)
• Bone / joint (DJD, AVN, osteopenia/porosis, gout)
• Gastrointestinal (Diarrhea, GERD, constipation,
  etc)
• Psychological / Quality of life (anxiety,
  depression, insomnia, erectile dysfunction)

And OTHER SOB, Anemia, etc
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Weight Gain is Multi-factorial!

• Prednisone stimulated appetite!!!!
• Reduced dietary restrictions (cheese, milk,
  fluids!)
• Improved appetite with cleaner blood
• De-conditioned muscles with poor exercise habits
• Pre-transplant prep with good exercise and eating
  habits can help control this!!!

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Coping with side effects

• Changing dosage, schedule or even IS meds will
  sometimes help dramatically (YOUR DOCTOR MUST
  MAKE THESE CHANGES!!!)
• Lifestyle changes (exercise, diet, volunteer
  work)
• Physical therapy, counseling
• Sharing with other recipients
• Medications (heaven forbid more pills!)

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Take Home Messages

• No one gets ALL the side effects, but (almost??)
  EVERYONE gets some side effects
• All my patients say the side effects are still
  worth the transplant, and all want another
  transplant once they lose function(even the
  folks with the WORST side effects!!!!)
• DO NOT SUFFER in SILENCE!
• Often things can be done to help reduce or
  eliminate side effects but you MUST tell someone!
  (include your transplant team)