1. Post Transplant Immune Suppression
Lung Transplant Education Series
Valerie Durney, NP, CCTC

2. OVERVIEW Post Transplant Immune Suppression
Why do I need these medications?
Which of my medications suppress my immune system?
What are common side effects of these medications?
What symptoms should I be aware of?
What are important things to know about these pills?
Post Transplant Immune Suppression

3. Post Transplant Immune Suppression
After lung transplant your immune system needs to be altered to prevent rejection or your own body trying to fight the new lung(s)
Ideally, your body will become tolerant to the new lung
Post Transplant Immune Suppression

4. Post Transplant Immune Suppression
We achieve this goal with the medications you are prescribed, they work in combination to suppress your immune system
It is extremely important to take your medications as directed
Once you are home develop a system to ensure you take your medications on time
Post Transplant Immune Suppression

5. Post Transplant Immune Suppression
The transplant team will monitor your blood levels to achieve the most appropriate level of immune suppression for you
This may place you at risk for catching illnesses from others
Post Transplant Immune Suppression

6. PRECAUTIONS
Precautions need to be instituted at home to help prevent the spread of infection
Good hand-washing is the #1 precaution in stopping the spread of infection
Post Transplant Immune Suppression

7. WHICH OF MY MEDICATIONS SUPPRESS MY IMMUNE SYSTEM
Prograf
CellCept
Prednisone
Post Transplant Immune Suppression

8. PROGRAF Post Transplant Immune Suppression Most important medication!
Needs to be taken every 12 hours
Interacts with many medications
Post Transplant Immune Suppression

9. PROGRAF: COMMON SIDE EFFECTS
Tremors
Headache
GI: Nausea/diarrhea
Kidney problems
Low magnesium
Elevated blood sugars
Mag in foods: green leafy veggies, string beans, legumes, bananas, nuts, avocados
Post Transplant Immune Suppression

10. Formulations: 0.5mg, 1mg & 5mg capsules
PROGRAF
Formulations: 0.5mg, 1mg & 5mg capsules
BRAND NAME NECESSARY
Acceptable alternative to Prograf is: Hecoria
(this a newer brand name medication)
Post Transplant Immune Suppression

11. PROGRAF Post Transplant Immune Suppression
We will check blood levels of Prograf to ensure your level is within a target range
Blood levels need to be a 12 hour trough-this means your blood is drawn 12 hours after your last dose
Please eat/drink as usual prior to your clinic labs as you do NOT have to be fasting
Post Transplant Immune Suppression

12. PROGRAF Post Transplant Immune Suppression
You can take your AM Prograf dose after your blood is drawn
Please avoid grapefruit juice, as this can elevate your blood level of Prograf
Fresca contains grapefruit!
Post Transplant Immune Suppression

13. Alternative to CellCept is Myfortic. This is enteric coated CellCept
Formulations: 250 & 500mg capsules
Taken every 12 hours
Important to take with food
Should be separated from antacids
Generic Ok
Alternative to CellCept is Myfortic. This is enteric coated CellCept
Post Transplant Immune Suppression

14. CELLCEPT: COMMON SIDE EFFECTS
Nausea/vomiting
Diarrhea
Low blood counts
*Pregnancy concerns*
Post Transplant Immune Suppression

15. PREDNISONE Post Transplant Immune Suppression
Tapered dosing over the first 4 months after transplant
Goal dose = 5mg
Taken every morning
Generic Ok
Post Transplant Immune Suppression

16. PREDNISONE: COMMON SIDE EFFECTS
Elevated blood sugars
Elevated blood pressure
Weight gain
Puffy face
Insomnia
Irritability/moodiness
Bone weakness/osteoporosis
Post Transplant Immune Suppression

17. GENERAL TIPS Post Transplant Immune Suppression
Keep out of reach of children
Check with transplant team before starting a new medication prescribed from another provider
Always swallow capsules whole and never chew/crush or open capsules
Post Transplant Immune Suppression

18. GENERAL TIPS Post Transplant Immune Suppression
Purchase a pill box to keep organized
Consider setting an alarm to avoid forgetting doses
Discuss with transplant team any concerns about side effects to medications
Avoid herbal supplements
Post Transplant Immune Suppression

19. GENERAL TIPS Post Transplant Immune Suppression
Always keep an up to date medication list with you at all times
Plan ahead for refills!
Please purchase a medical alert bracelet in case of emergencies that states you are a transplant patient and keep a list of your medications in your wallet
Post Transplant Immune Suppression

20. Post Transplant Immune Suppression
Always contact your transplant coordinator for with any questions or concerns!
Linda: (last names starting with A-K)
Betsy: (last names starting with L-Z)
or via Patient Gateway

21. REFERENCES Transplantation Drug Manual, 5th Edition
J. Pirsch, H. Sollinger, X. Liang
Landes Bioscience
Austin, TX USA
Transplantliving.org
BWH: A Guide To The Care of Lung Transplant Recipients At BWH