Survival of a renal allograph requires CONSTANT monitoring and matching the current state of rejection affairs (there are ALWAYS some to consider since the allograph is NOT the same DNA) and overall glomerular filtration rate of the graph. It is a constant and dynamic process if the kidney is survive at all. The better the genetic match initially, the better is the longevity, but STILL the monitoring is mandatory
Rejection protocols are designed based upon feedback lab values that denote the state of renal function of EACH INDIVIDUAL as well as state of rejection and are modified to the personal variable of the recipient.
Medical rejection protocols have improved dramatically over the past 30 years but they must be used with the specific nature of the rejection process.
Although there are multiple methods of mixing and matching the above drugs, the most common combination employed by the transplant centers is Tacrolimus, Mycophenolate Mofetil and Prednisone.
The blood levels of Tacrolimus, Cyclosporine and Sirolimus have to be monitored closely. There are many other medications and food and supplements that alter the levels (up or down) in the blood, and you need to be aware of it. The list is long but some of the common ones are grapefruit juice, St. John’s Wort, erythromycin, anti TB medications, antiseizure medications and common blood pressure medications (cardizem or diltiazem, and Verapamil).
https://www.kidney.org/transplantati...ons-TheLowDown
https://www.kidney.org/atoz/content/yourmedications
Quote: Most of the immunosuppressants are powerful drugs, and hence have side effects.
For some of them, levels in the blood are to be monitored frequently. Too little of the drug will put you at risk for rejection, while too much might mean side effects. So, it takes your caregivers some time to achieve the right balance of immunosuppressionn.
Broadly, the immunosuppressants can be classified into 2 categories:
Induction agents: Powerful antirejection medications used at the time of transplant.
Maintenance agents: Antirejection medications used for the long term.
Think of a real estate mortgage; the down payment serves as the induction agent and the monthly payments serve as maintenance agents. If the down payment is good enough you can reduce the monthly payments substantially, and the concept is similar for immunosuppression.
NONE of the medical maintenance is exactly the same but MUST be predicated on the status of the recipient's blood work. None remain the same forever: some meds are added others are stopped, just about all must be tweaked here and there for best functioning.
I have been attending my wife's visits to her nephrologist now for years and have sat in on some of his explanations of just what is reviewed above.
Merely LOOKING at a patient tells you NOTHING about what is going on physiologically and is dynamic and evolving process
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