The most commonly used immunosuppressive drugs after kidney transplantation are usually given as a combination to prevent rejection while minimizing side effects.
1. Calcineurin Inhibitors (Mainstay Drugs)
- Tacrolimus (most commonly used worldwide)
- Cyclosporine
Monitoring:
- Drug trough levels
- Renal function (serum creatinine)
- Blood pressure
- Blood glucose (especially with tacrolimus)
2. Antimetabolites
- Mycophenolate Mofetil (MMF) (CellCept)
- Mycophenolic Acid (Myfortic)
- Azathioprine (less commonly used now)
Monitoring:
- CBC (can cause leukopenia, anemia, thrombocytopenia)
- Gastrointestinal symptoms
3. Corticosteroids
- Prednisolone
- Prednisone
Monitoring:
- Blood glucose
- Blood pressure
- Weight gain
- Infection signs
- Osteoporosis risk
4. mTOR Inhibitors
- Sirolimus (Rapamycin)
- Everolimus
Usually used in selected patients or when calcineurin inhibitors need to be reduced.
Common Maintenance Regimen
Many kidney transplant recipients receive:
- Tacrolimus
- Mycophenolate Mofetil
- Prednisolone
This “triple therapy” is one of the most common maintenance regimens worldwide.
Common Infection Prophylaxis After Transplant
Because of immunosuppression, patients often receive:
- Co-trimoxazole (Septrin) – Pneumocystis prophylaxis
- Valganciclovir – CMV prophylaxis in high-risk patients
- Antifungal prophylaxis in selected cases
Important Nursing Monitoring
As a ward nurse, monitor:
- Temperature and signs of infection
- Urine output
- Daily weight
- Blood pressure
- Serum creatinine and eGFR
- Tacrolimus/Cyclosporine levels (when ordered)
- CBC and liver function tests
- Medication adherence
Signs of possible rejection include reduced urine output, rising creatinine, graft tenderness, fever, hypertension, and fluid retention. These should be reported promptly to the transplant team.
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