Life After Your Transplant: Living With Immunosuppression

[okarol]

Article Link: http://www.webmd.com/heart-disease/living-with-an-organ-transplant/immunosuppression?page=1

Living With an Organ Transplant

Life After Your Transplant: Living With Immunosuppression
Living with your transplant: avoiding organ rejection and infection, taking medications

Your body's defenses are always on the prowl for germs and other foreign organisms. Unfortunately, this means that your body is not a very well-mannered host. It treats your life-saving transplanted organ just like it treats a mere freeloading germ. It attacks. Organ rejection is your own body's misguided attempt to protect you.

However, immunosuppressant drugs can block the effects of these natural defenses. They usually allow your body to live in relative harmony with the new organ. The catch is that by blocking your defenses, you become more vulnerable to infections. It's the trade-off of getting a transplant.

"Living with a transplant is always about keeping the balance between rejection and infection," says Barry Friedman, RN, administrative director of the Solid Organ Transplant Program at the Children's Medical Center in Dallas. "You need to take enough of your medicines to prevent organ rejection. But you can't take so much that your risk of infection gets too high."

The good news is that doctors are much more successful at striking a balance these days. No, you won't have to live in a sterile bubble to stay healthy. And after the first few weeks or months, the restrictions on your life really aren't that hard to live with.

"In general, if you have reasonable and healthy habits, you'll be fine," says Jeffrey D. Punch, MD, chief of the Division of Transplantation at the University of Michigan Health System, Ann Arbor.
What Precautions Do I Need to Take After Surgery?

Right after surgery, you're particularly vulnerable. You'll be in the induction phase of immunosuppression. You'll be on pretty high doses; it's key that you take extra care. You should:

    * Wash your hands often. Hand washing is an excellent way to reduce your exposure to germs. It's especially important before you eat.
    * Avoid people who are sick. It's best to limit your contact with anyone who has a cold or any other infection like measles or chicken pox.
    * Avoid people who have been recently vaccinated. Some vaccines, such as the new nasal flu vaccine or the measles vaccine, have a living virus in them. These could be a risk to people with weak immune systems.
    * Stay out of crowded areas. For example, avoid malls and movie theaters.
    * Don't take care of the pets. Pets carry germs, so limit your exposure to them. You don't have to kick them out of the house. Instead, look at this as an excuse to make your spouse or kids clean out the litter box for a change.
    * Don't garden. Some dangerous bacteria live in the soil. So let your garden go wild for a few months. Or make your kids do your weeding for you.
    * Brush and floss daily. Both help keep your mouth free of infections. Have your teeth cleaned regularly.
    * Don't ignore cuts or scratches. Clean them and put on a bandage. Get in touch with your health care provider if you have any signs of infection.
    * Practice very safe sex. Sexually transmitted diseases like herpes can be a problem for anyone. But they can be dangerous for people who have had a transplant. Condoms may not be enough to fully protect you. Even saliva can expose you to colds and viruses. So be careful. Ask your health care provider about what's safe in your case.

Obviously, specific recommendations depend on your health and situation. Where you live can make a difference. If you're in a city, it's harder to avoid crowds. Living in the country poses different risks, such as exposure to farm animals or potentially unsafe well water, Friedman says. Ask your health care adviser for recommendations.
Lifetime Precautions

Over the next six months to a year, your health care team will probably reduce your medicine. You'll settle into the "maintenance phase" on a lower dose. At this point, you can usually relax some of your safety measures. You won't be as susceptible to infection. But you should still take precautions. Wash your hands regularly and limit your contact with people who are sick or recently vaccinated.

If you ever have an episode where your body rejects your new organ (organ rejection), your doctor may need to change your medicines or boost the dosage of your immunosuppressant medication. This is called "anti-rejection immunotherapy." Since your immune system will be further suppressed, you'll need to take those extra precautions again.

Your doctor may also occasionally need to change some of the medicines. Some may not work as well over time. New and more effective drugs may also come on the market that will replace your old ones.
Taking Your Medicine

Living with a transplant usually means taking a lot of medication, probably for the rest of your life. Most people take six to 12 different medications daily, Punch says. It could be more. Taking so many pills may sound daunting.

"Some people are overwhelmed by the number of medications they have to take," says Richard Perez, MD, PhD, and the director of the Transplant Center at the University of California Medical Center at Davis. "But you have to remember that a lot of these patients were sick, and already on a complicated medication regimen anyway."

In fact, Perez says, many people find that their medication regimen is less complicated after a transplant.

Taking your medication is absolutely crucial to staying healthy. Here are some tips.

    * When it comes to taking your medicine, strictly follow your health care provider's advice.
    * Use weekly or daily pillboxes to set up your doses beforehand, and keep track.
    * Use alarm clocks, timers, or digital watches to help you remember your doses.
    * Ask your family members to help you stay on your medication schedule.
    * Keep your medicines away from children and pets.
    * Store your medication in a cool, dry place.
    * Keep a list of all your medicines somewhere obvious.
    * If you miss a dose, don't assume you can double up with your next one.
    * Keep track of how much medicine you have left. Always call the pharmacy for refills early.
    * If your doctor agrees, take your medication with food to prevent gastrointestinal side effects.
    * Set up your doses so that they coincide with other daily activities, such as brushing your teeth, eating lunch, or going to bed.
    * Never stop taking a medication without your health care provider's ok.

[stauffenberg]

A further element of the balance involved in taking anti-rejection drugs, and by far the most important aspect, is the balance between taking enough immunosuppressive medication to avoid rejection, but not so much as to damage the kidney by the toxic side-effects of the medication.  This is actually impossible to get exactly right, since the amount required to prevent rejection overlaps with the amount sufficient to damage the kidney, but the goal is to get the most anti-rejection protection with the least renal damage.

I always thought that must be the best proof that there is no God, or that God is the Devil, that the organ transplant for which anti-rejection drugs are most often prescribed is kidney transplants, and yet the immunosuppressive drugs are poisons specifically targeted to destroy kidneys!  Why, oh why, was just this coincidence so necessary in the design of the world by a supposedly benign Creator?

[okarol]

Similar to the idea of chemotherapy - you get enough poison to kill off the bad cells, but hopefully the cure doesn't kill you in the process.