Post Transplant

Patient Health Guide

advisory

December 2016 - Heater-cooler machine advisory

medication News: Apo-mycophenolic acid to replace myfortic

Rejection:

What is rejection?
We all have a protective defense mechanism in our body called our immune system. Our immune system is what fights foreign objects in our body such as bacteria and viruses. When we have a cold our immune system fights the virus and eventually the virus is destroyed. Your immune system recognizes your newly transplanted organ as a foreign body and wants to fight or "reject" that new transplant.

Your newly prescribed anti-rejection drugs will suppress with your immune system to protect your new transplant. Your health care team has to find the delicate balance of suppressing your immune system just enough so your body does not reject your new transplant yet leave your immune system healthy enough so that when you do get a virus you can still fight the viruses and bacteria you encounter on a day to day basis.

Rejection Episode:
It is likely that at some time you will experience an episode of rejection. It is referred to as an episode of rejection because it is usually a temporary, reversible event. It is most likely to occur in the first six months of having your new organ, but it can happen at any time as long as you have the organ.

Rejection may occur even if you have been taking your medications faithfully. While you may find this thought unsettling, it is a common occurrence. In most cases, with early detection and treatment, the transplant team should have no problem reversing the rejection completely. 

The best way to fight rejection is to stop it before it starts, and to recognize it and treat it early. You can work at preventing rejection by taking your medications faithfully. For early detection learn to identify the signs and symptoms of rejection and report them immediately to the transplant clinic nurse.

Signs of Rejection:
Early identification and reporting of symptoms are important in successfully treating and reversing rejection. Most rejection episodes are mild. You may not have any symptoms, and may only be aware that rejection is occurring because it was detected with a biopsy. On the other hand, you may also start to feel symptoms of the rejection episode.

Symptoms of early rejection include:

  • Decreased energy level
  • Reduced ability to exercise
  • Weight gain of over one kilogram (2.2 pounds) per day, or more, sometimes with swelling of the ankles 
  • Irregular or fast heart rate
  • Shortness of breath while doing normal activities
  • Decreased blood pressure

If you experience any of these symptoms, report it to your transplant team immediately.

Treatment of Rejection
When rejection is detected, it must be treated immediately. Treatment usually involves high doses of a steroid, which can be given intravenously, or by an increase in prednisone tablets taken orally. In most cases, this will reverse the rejection.

Chronic Rejection
Some transplant recipients may experience chronic rejection, a condition that most often occurs over a long period of time. Ongoing chronic rejection slowly damages the transplanted organ.

Unfortunately, unlike acute rejection, it is not possible to reverse the damage, although it sometimes is possible to halt the progression. As with acute rejection, chronic rejection can occur despite taking your medication regularly.

Infection

A possible side effect of anti-rejection drugs is an increase in infections. While suppression of the immune system is necessary to prevent organ rejection, it weakens the body's ability to fight off infections. Fortunately, there are ways of reducing the risk of infection while still maintaining adequate defenses against rejection.

The risk of contracting an infection is higher during the first few months following a transplant when your doses of anti-rejection drugs are high. As the doses fall, the risk of infection falls. As with rejection, the key to fighting an infection is to prevent it, identify it early, and treat it quickly.
Preventing Infection

The best way to prevent an infection is by avoiding close contact with people who may be ill. Most viruses, bacteria, and fungi are passed from person to person in tiny water droplets and may be transferred simply by shaking hands. Someone sneezing or coughing is sending out droplets, which you might breathe in, or transfer to your mouth or other mucous membrane (such as your eyes) with your hands.

During the first few months following your transplant, you must be diligent in avoiding infections. This may mean having to avoid normal close contact with family members or your spouse if they are sick.

You may not be able to prevent all infections, but you can certainly reduce the risk by washing your hands regularly and avoid putting your fingers in your mouth or touching your eyes. Family and friends with infections should also wash their hands before touching you.

Also avoid:

  • People with colds or infections
  • Crowded, poorly ventilated, smoke-filled rooms
  • Public transportation, especially at rush hours
  • Public whirlpools
  • Activities that may cause breaks in the skin (when gardening, for example, wear gloves)
  • Changing cat and bird litter
  • It also helps to alert your co-workers to the fact that you are on anti-rejections drugs

Post Transplant Medications:

After the transplant, you may be taking medications as a preventative measure against commonly occurring infections.

BC Transplant funds specific out-patient post solid organ and pancreatic islet medications. The medications funded by BC Transplant include immunosuppressants (anti-rejection drugs), anti-viral agents and red blood cell stimulating agents.
In order for these specific medications to be paid for by BC Transplant, patients must be registered with BC Transplant and with BC Medical Services Plan (MSP).

Patients are required to fill their prescriptions for these medications at one of the 12 BC Transplant partner pharmacies. 

Pharmacies in British Columbia that dispense medications for BC Transplant patients

The current list of funded medications is:

Immunosuppressants (anti-rejection)

  • Azathioprine
  • Cyclosporine
  • Mycophenolate Mofetil
  • Mycophenolate Sodium
  • Prednisone
  • Sirolimus
  • Tacrolimus EXTENDED Release
  • Tacrolimus IMMEDIATE Release

Anti-Virals

  • Adefovir
  • Entecavir
  • Lamivudine
  • Tenofovir
  • Valganciclovir

Erythrocyte Stimulating Agents

  • Darbepoetin
  • Erythropoietin

Maximum Day Supply Policy for BC Transplant (BCT) Prescriptions

BC Transplant funds a maximum number of days—100—supply for BC Transplant prescriptions. BC Transplant follows health care standards along with BC Fair PharmaCare, BC Cancer Agency, NIHB and Blue Cross. The standard is intended to address concerns regarding public safety, medication cost, and long-term storage of medications to avoid drug wastage.

For very stable patients, who are at least two years post- transplant and are not seen more frequently at the clinic than every 4 months, a 4 month supply may be dispensed. Should an extraordinary circumstance arise and more than a four month supply of drug is requested please contact BC Transplant at (604) 877- 2240 or pharmacy@bct.phsa.ca.