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현재 페이지 위치 : Organ Transplantation Center > Transplant Program > Medication > Drugs against Complications

Drugs against Complications

Prevention and treatment of complications (e.g. cardiovascular disorders, malignant tumors, recurrence, drug toxicity (mostly, nephrotoxicity), and chronic rejection reactions) are crucial. The following is common complications among organ recipients.

Infection

  1. Infections and rejection reactions are the most common and contradicting complications related to immunosuppression. The risk of infections is directly linked to the degree of immunosuppression and highest during the first three months and during the treatment of acute rejection reactions. Post-transplant infections can be classified by pathogen, site, and onset timing.
     
  2. Viral infections
    a. Viral infections are generally caused by cytomegalovirus (CMV) and herpes simplex virus (HSV).
    b. To avoid cytomegalovirus infections in case of renal transplant, valacyclovir or ganciclovir is administered for the first 90 days.
    c. To deal with herpes infections, acyclovir, ganciclovir, famciclovir, or valacyclovir can be applied.
     
  3. Fungal infections
    a. The use of nystatin or clotrimazole for 6 months is good for prevention of oral fungal (candida) infections. Shake nystatin well before use and gargle thoroughly with it before swallowing. For clotrimazole, do not swallow or chew it and please melt it slowly in the mouth.
    b. For liver transplant or combined pancreas and kidney transplant, itraconazole is used for 30 days. As it is absorbed better with food, please take it right after meal.
     
  4. Bacterial infections
    a. Bacterial infections usually occur within the first month in the urinary track, wound, and vessel junctions.
    b. Bactrim® (trimethoprim/sulfamethoxazole) can prevent pneumonia and urinary track infections. As this drug makes the skin more sensitive to sunlight, use sunblock outside. Also, drink a lot of water to facilitate drug excretion.
     
  5. Pneumocystis carinii pneumonia (PCP)
    a. This pathogen causes pneumonia among immunologically suppressed people.
    b. Bactrim® (trimethoprim/sulfamethoxazole) is used for its prevention.

Hypertension

  1. Steroid, cyclosporine, tacrolimus, and dysfunction of renal grafts may induce hypertension.
  2. It is required to develop a healthy lifestyle (e.g. dietary changes, smoking cessation, weight control, and regular exercise), take antihypertensives, and monitor the blood pressure.
  3. Commonly, nifedipine, carvedilol, and amlodipine are used as antihypertensives.

Hyperlipidemia

  1. The condition can be worsened by steroid, cyclosporine, tacrolimus, and diuretics.
  2. Follow an exercise regimen and keep away from high cholesterol food.
  3. Medications include fenofibrate, atorvastatin, and pravastatin.

Post-transplant Diabetes

  1. The use of steroid, cyclosporine, and tacrolimus may interfere with blood sugar level control.
  2. Insulin or oral hypoglycemic agents are used and a less use of immunosuppressants may improve the condition.

Hyperpotassemia

  1. This complication can occur due to the use of cyclosporine, tacrolimus, some antihypertensives, acidemia, or renal dysfunction.
  2. Avoid potassium-rich food and be careful when you concomitantly take drugs that may cause this condition.

Gastrointestinal Side Effects

  1. Immunosuppressants, especially steroid, may give gastrointestinal side effects such as heartburn.
  2. To prevent gastric ulcer, antacids (e.g. famotidine, ranitidine, etc.) and antigastric-secretion drugs (e.g. lansoprazole, esomeprazole, etc.) can be taken. While sucralfate is also effective, it reduces the absorption of tacrolimus and thus should be taken long before or after tacrolimus.

Osteoporosis

  1. Osteoporosis can be caused by the use of steroid.
  2. Calcium, vitamin D supplements, and oral bisphosphate drugs (e.g. alendronate, risedronate, etc.) can treat this condition.
  3. As food hinders the absorption of bisphosphate drugs, they should be taken at least 30 minutes before breakfast or 2 hours before and after a food intake. For their smooth delivery to the stomach, sit or stand up right and take them with a cup of water. Do not lie down at least within 30 minutes to avoid any adverse effect on the esophagus.

Tumors

  1. As an increased survival rate of recipients extends a life-long exposure to immunosuppressants, the onset of tumors among recipients becomes more common than among general populations. Among others, skin cancer is most frequently observed.
  2. To avoid skin cancer, minimize the dose of immunosuppressant and keep away from sunlight. Use a parasol, long-sleeved shirt, or sunblock with an SPF over 15.
  3. Keep a close eye on the skin and the lymph nodes and perform regular self-exams.