Common Side Effects of Renal Transplant Immune Suppresants

Common Side Effects of Renal Transplant Immune Suppressants

Tacrolimus

  • Toxicity mediated by vasoconstriction to the afferent arterioles
  • Symptoms/signs: Hand tremors, headache, nausea, thrombotic microangiopathy, hyperkalemia
  • Calcium channel blockers can prevent the renal vasoconstriction thus most transplant patients with HTN are on dihydropyridine CCBs

 

Mycophenolate

  • Symptoms/signs: diarrhea, abdominal pain, nausea, leukopenia, anemia, thrombocytopenia, tremor
  • Can cause microscopic colitis

 

Diarrhea

  •  Common SE in patients on Mycophenolate and Tacro [common regimen]
    • Diarrhea [usually severe] can precede Tacro toxicity
      • Diarrhea causes increased Tacro levels due to absorption and intraluminal metabolism
    • Mechanism
      • enzymatic activity of the CYP3A system + P-glycopeptide in enterocytes damaged by inflammation and infection lead to decreased intraluminal tacro metabolism

 

Additional Information for Overnight Admits:

  • Transplant teams do not want the night team to change transplant medications overnight
  • Exception: If pt has severe diarrhea, can hold night tacro dose and inform the day team
  • Ensure the pt gets a daily tacrolimus level (order q am at 5:00). Always order tacrolimus dose at 6:00 am and 6:00 pm (regardless of what time patient takes at home, lab can only run am tacro levels at a certain time in batches)
  • EXCEPTION: If late afternoon admission, consider paging the fellow (since its early) and ask if they want the evening dose held until the am level comes back
  • Transplant patients with normal kidney function can have regular diet