Why Different Anti Rejection Drugs

[LarryG]

I am on only two Anti Rejection drugs. Prograf and Myfortic. I also had a living donor. I know a friend who has been given Prednizone as an anti rejection drug but she has a cadaver kidney. I was wondering why people are given different types of drugs and what is the protocol behind why you are given certain kinds compared to another?

[RichardMEL]

mate, consider yourself lucky to not be on the preds!!!!

Some transplant centers have (newish) non-steroid protocols, and maybe yours is one of them. That's a blessing. Many places still use the steroids as standard, including down here in the wonderful land of oz.

I think there's the two different sorts of main anti-rejection drugs (or 3 if you include the preds which seems to be used more as an anti-inflamatory than anything else from what I can gather) because the two act on different areas. Is prograf a type of cyclosporin? I always get confused. I know Trac is a different drug. Seems like everyone is on cellcept.

I guess the basic reason is there's no one drug that does it all and they need to mix and match a couple of drugs, and in differing doses because every transplant patient is slightly different with what they need and how much. Things like toxicity of the immunosupressants in the donated kidney are a concern and is also part of the equation.

I'm sure others have a better answer to this one.

[jbeany]

Prograf is the brand name for Tacrolimus.

I'm on Prograf, Myfortic and prednisone.  My center has not gone to a non-steroid protocol.   

I think every center has a standard plan that they start everyone on, and they only tweak it if a patient has problems with the meds.  They do what they are comfortable with.  If they have had good results, they don't see a lot of incentive to try something new, like the no-steroid plan.  If the stats back up the fact that it's better in a decade or so, they will all switch, most likely. 

[edersham]

I'm on the same two  anti-rejection drugs as you. I totally agree with Richard about the prednisone. I got to experience four months of a low dose of that not because of rejection  but because my white blood cell count crashed and they thought it was the cellcept when it turned out to be either the bactrim or the valcyte. That 4 mos was a little slice of hell and it took another 2 to get back to normal. Enjoy every day your on a non-steroid protocol in my opinion. But it will be the drug of choice to stop any rejection episodes so if I have to go there I'm going to duct tape my mouth shut between medication times so I can't eat everthing with 10 miles or so.
Ed

[lawphi]

Living kidneys tend to need less suppression to last. 

My husband was transplanted on prednisone originally.  Even a steroid free transplant center would keep him on prednisone this time around.

He also had reactions with brand name cell cept, but no issues with generic cell cept. 

[rsudock]

First transplant started on Prograf but had high blood sugars switched me to Neoral.

Second transplant Prograf, Cellcept, and Prednisone...even though I had a living donor still need a lot of immunesuppression my PRA is high...blood sugars seem to be holding steady though! yeah!

[cariad]

My husband was transplanted on prednisone originally.  Even a steroid free transplant center would keep him on prednisone this time around.

I don't think this is necessarily true. Northwestern does not use prednisone, ever - I have not heard of one person out of that hospital on prednisone.

There are journal articles that have been available 10 years or so that say there is no good reason to keep transplant patients on prednisone, and evidence suggests it's actually harmful. (Not too difficult to believe considering some of the very serious side effects.)

As to different forms of immunosuppression, prednisone and Imuran are the original drugs, and as my GP said "If you did not do well on those, you were screwed." I don't think Imuran has any descendants, but could be wrong. Cyclosporin was huge news (for the initiated) back in the late 70s, and Prograf is the descendant of that. Cellcept and Myfortic are in the same family as Rapamune, so those who cannot tolerate the one can try the other. Then there are the infusions, though most seem to be brought out only in a crisis. The only one I know anything about is Belatacept because at one point I was going to try to go through that clinical trial, but I don't know if that one has gone to market yet. Bristol-Meyers bought the rights to it and it shows promise in reducing the need for daily immunosuppression.

[Chris]

Also some are more organ specific. Some are not used for a heart transplant for example, but can't remember which one or ones. Other reasons depend on how a person reacts to the medication. I was on Prograf and CellCept with intermittant use of Myfortic but after 10 years, I developed a reaction to the CellCept/Myfortic drug and was switched to Rapamune while still on Prograf. Now my creatinine is a lot better being on Rapamune. It's always good to have a back up drug though if one develops a problem taking something. My center is non steroidal, but some patients had to be put on steroids due to their tolerance of the drugs being used.

[lawphi]

My husband is a re-transplant and will always have to have prednisone.   On a side, his kidney came from Northwestern

With a living kidney, his dosages are a lot smaller than with his cadaver graft.  The goal is only 2.5 mg of prednisone.

[Chris]

That's the dose of prednisone I am on for my arthritis. However t did not giv me the puffy face or appetite. I was hoping for the appetite part when I was first on 5 mg.

[cariad]

My husband is a re-transplant and will always have to have prednisone.   On a side, his kidney came from Northwestern

With a living kidney, his dosages are a lot smaller than with his cadaver graft.  The goal is only 2.5 mg of prednisone.

Perhaps your husband's is a special case. There are loads of re-transplants who are off prednisone, though I have heard that argument before (that second transplants should take steroids) from Cedars. Hopefully your husband will get down to maintenance doses quickly, as less is always better.

The thing is, even if you don't see the effects of pred externally (weight gain) longterm use deteriorates your bones, teeth, can cause diabetes, raging insomnia, and much more. The smallest dose of prednisone is going to be more than your body will make itself. My surgeon would not even authorize my taking a short course of prednisone for non-renal reasons. I feel so lucky to have found Northwestern, (though its faults as a centre are glaringly obvious to me).

[rsudock]

I am hoping someday I can be off Prednisone but I have been on it for so long...who knows?