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Medication Side Effects in Transplantation. Shirley Schlessinger, MD, FACP Transplant Nephrologist University of Mississippi Medical Center. Two Types of Med “Fall-Out”. Extension of the “Therapeutic Effect” of anti-rejection meds (immunosuppression) All patients at risk Dose-related

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Medication Side Effects in Transplantation

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Medication Side Effects in Transplantation

Shirley Schlessinger, MD, FACP

Transplant Nephrologist

University of Mississippi Medical Center


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Two Types of Med “Fall-Out”

  • Extension of the “Therapeutic Effect” of anti-rejection meds (immunosuppression)

    • All patients at risk

    • Dose-related

    • Consider “net immunosuppression” of each patient in risk assessment and management

  • True “Side Effects”

    • Less predictable

    • Different / unique for each patient

    • May be dose-related / timing related


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Therapeutic Extension of Immunosuppression Meds

  • Malignancy

    • Skin

    • Lips / mouth

    • Cervical

    • Blood / lymph nodes

    • Renal

    • Other

  • Infection

    • Fungal, viral, bacterial

Have regular recommended screening!!

Report all “growths” or “lumps” to your doctor!

These are RARE!

You will be given medication to prevent!!!

But the preventive meds can ALSO have side effects!


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True “Side Effects”

  • Metabolic (Weight Gain / Diabetes Mellitus)

  • Cardiovascular (High Blood Pressure/Cholesterol)

  • Cosmetic (hair loss/growth; skin changes, acne, chipmunk cheeks)

  • Bone / joint (DJD, AVN, osteopenia/porosis, gout)

  • Gastrointestinal (Diarrhea, GERD, constipation, etc)

  • Psychological / Quality of life (anxiety, depression, insomnia, erectile dysfunction)

And OTHER… SOB, Anemia, etc…


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Weight Gain is Multi-factorial!

  • Prednisone stimulated appetite!!!!

  • Reduced dietary restrictions (cheese, milk, fluids!)

  • Improved appetite with “cleaner blood”

  • De-conditioned muscles with poor exercise habits

    Pre-transplant prep with good exercise and eating habits can help control this!!!


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Coping with side effects

  • Changing dosage, schedule or even IS meds will sometimes help dramatically (YOUR DOCTOR MUST MAKE THESE CHANGES!!!)

  • Lifestyle changes (exercise, diet, volunteer work)

  • Physical therapy, counseling

  • Sharing with other recipients

  • Medications (heaven forbid more pills…!)


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Take Home Messages:

  • No one gets ALL the side effects, but (almost??) EVERYONE gets some side effects…

  • All my patients say the side effects are still worth the transplant, and all want another transplant once they lose function…(even the folks with the WORST side effects!!!!)

  • DO NOT SUFFER in SILENCE!

    Often things can be done to help reduce or eliminate side effects but you MUST tell someone! (include your transplant team)


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