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Wednesday, December 11, 2013
Anti-Rejection Alternatives After Lung Transplantat
My father had a single lung transplant seven years ago and has been using prednisone ever since. The prednisone has caused a number of health issues including type II diabetes. Currently, he is taking the lowest dose on a daily basis.
Are there any alternative medications that can be recommended? Can he eventually be weaned off of the prednisone? What are the risks if he were to stop taking the prednisone? Thank you.
After receiving a lung transplant typically several medications are used to blunt the host's immune response and allow for tolerance of the transplanted lung (i.e. - to minimize rejection of the transplanted lung). This "cocktail" of medications may include from three to five different medications, each of which alters the host's immune response in a different manner. The risk of rejection is minimized through the combined use of these medications.
Prednisone has been a staple of this "cocktail" of anti-rejection medications since the inception of organ transplantation. Despite its side-effect profile,the overwhelming majority of programs, while attempting to balance the administered dose against the severity of the side effects, continue to use it for the life of the recipient.
Since prednisone affects a particular portion of the host's immune response and there is presently no alternative medication that functions in the same manner, its discontinuation will increase the chances of rejection. The decision to suspend the medication should be an individual one made between the recipient and his/her physician taking into account the risks (i.e. -side effects) and benefits (i.e.-anti-rejection properties) of such action.
David R Nunley, MD, FCCP
Former Associate Professor
College of Medicine
The Ohio State University