Kidney Rejection Treatment

The American Association of Kidney Patients notes on its Web site that numerous medications help prevent rejection of transplanted organs by suppressing recipients' immune systems. It notes that doctors often prescribe anti-rejection medications in combination, and that "the most common cause of rejection in modern kidney transplantation is that the patient does not follow the medication treatment plan." Patients usually receive injectable medications for a week or two after transplant surgery, then switch to capsules or tablets when they leave the hospital---sometimes for the rest of their lives. Some transplant recipients might also benefit from occasional immunoglobulin injections or plasma exchanges.

Cyclosporin

• Three companies produce U.S. Food and Drug Administration-approved versions of cyclosporin that have an indication for preventing kidney transplant rejection. Patients can take Gengraf from Abbott, Neoral from Novartis or Sandimmune from Novartis, in conjunction with azathioprine or a corticosteroid. Taking cyclosporin increases risk for cancer, kidney damage, high blood pressure and excess body hair. Cyclosporin, and each of the immunosuppressive medications taken to prevent kidney transplant rejection, leaves patients vulnerable to opportunistic infections.

Corticosteroids

• The American Association of Kidney Patients identifies prednisone as the most-prescribed corticosteroid for kidney recipients. Prednisone and similar drugs such as methylprednisolone (e.g., Medrol from Pfizer) and hydrocortisone (e.g., Cortef from Pfizer) can cause high blood pressure, glaucoma, fluid retention, mood swings and loss of bone calcium.

Tacrolimus or Sirolimus

• Astellas produces the brand-name tacrolimus product Prograf for the U.S. market, and Sandoz produces a generic equivalent. The only FDA-approved sirolimus product is Wyeth's Rapamune. Like cyclosporin, tacrolimus and sirolimus are the basis of many long-term anti-rejection medications. Tacrolimus and sirolimus can increase risks for cancer, high blood pressure and kidney damage. Patients can take tacrolimus in conjunction with corticosteroids. Patients taking sirolimus may also take cyclosporin or corticosteroids.

Mycophenolate Mofetil

• Kidney transplant recipients who take mycophenolate mofetil must also take cyclosporin and corticosteroids. The medication is sold in the United States as CellCept by Roche, and in generic versions by Accord Healthcare, Apotex, Mylan, Roxane, Sandoz, Teva and Zydus. Younger women who take mycophenolate mofetil must avoid becoming pregnant, because it can cause birth defects and miscarriages. All patients taking mycophenolate mofetil have increased risks for lymphoma, diarrhea or constipation, hypertension and anemia.

Azathioprine

• Azathioprine works to prevent kidney-transplant rejection only when a patient takes it in conjunction with other immune system-suppressing drugs. FDA-approved versions of azathioprine include Azasan from Salix, Imuran from Prometheus, and generic products from Bedford, Mylan, Roxane and Zydus. Taking azathioprine raises the risk for cancer, nausea, and anemia and other blood disorders. Both men and women taking azathioprine must use effective contraception, because the medication can cause congenital deformities.

Basiliximab, Daclizumab or Antithymocyte Globulin

• Novartis sells basiliximab under the name Simulect, while Roche markets daclizumab as Zenapax. Both medications are bioengineered forms of immunoglobulin G1. Antithymocyte globulin, which Pfizer markets as Atagam, is a purified form of equine immunoglobulin G1. When administered to kidney recipients, basiliximab, daclizumab and antithymocyte globulin bind with and inactivate disease-fighting cells, called lymphocytes, that normally attack a new kidney as a foreign object. Patients on basiliximab or daclizumab must also take cyclosporin and corticosteroids. Doctors might prescribe antithymocyte globulin in addition to other anti-rejection drugs.

Plasmapheresis

• Some transplant recipients might also benefit from plasmapheresis. This involves removing the liquid, or plasma, portion of their blood and replacing it with plasma that contains fewer immunoglobulin M antibodies. When concentrations of immunoglobulin M in become too high, patients can suffer blood clots and stroke. The body can overproduce it in response to the transplantation of a kidney.