Skip to main content

Medical Complications of Immunosuppression

  • Chapter
Therapeutic Immunosuppression

Part of the book series: Immunology and Medicine Series ((IMME,volume 29))

  • 115 Accesses

Abstract

Transplantation effectively owes its existence to the development of immunosuppressive agents. Loss of allografts of all types to acute rejection has become less frequent as the potency and variety of immunosuppressive agents has continued to improve. Unfortunately, the medical complications of transplantation are also largely related to these agents. Each one has been associated with well-described side effects, all of which must be anticipated and managed by the physicians caring for these patients. There is a growing recognition that patient and graft survival may be highly influenced by the side effects of these agents. Cardiovascular disease is the leading cause of death in transplant patients, and its progression may be accelerated by various immunosuppressive agents. Likewise, graft loss is largely caused by chronic allograft rejection after the first two years. The influence of hyperlipidemia and other factors may play a major role in this process. Proper management of the medical complications after transplantation may offer an important opportunity to prevent premature death and graft loss.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Weinshilboum, RM, Sladek, SL. Mercaptopurine pharmacogenetics: Monogenic inheritance of erythrocyte thiopurine methyl transferase activity. Am J Hum Genet 1980; 32:651.

    PubMed  CAS  Google Scholar 

  2. Lennard, L, VanLoon, JA, Weinshilboum, RM. Pharmacogenetics of acute azathioprine toxicity: Relationship to thiopurine, methyl transferase, genetic polymorphism. Clin Pharmacol Ther 1989; 46:149.

    Article  PubMed  CAS  Google Scholar 

  3. European Mycophenolate Mofetil Cooperative Study Group. Placebo-controlled study of mycophenolate mofetil combined with cyclopsorin and corticosteroids for prevention of Acute Rejection. Lancet 1995;345(8961):1321

    Google Scholar 

  4. The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 1996;61(7): 1029

    Article  Google Scholar 

  5. McCauley J. The nephrotoxicity of FK 506 as compared with Cyclosporine. Curr Opin Nephrol Hyperten 1993;2:662–66

    Article  CAS  Google Scholar 

  6. Puschett JB, Greenberg A, Holley J, McCauley J. The spectrum of Cyclosporine nephrotoxicity. Am J Nephrol 1990;10:296–309

    Article  PubMed  CAS  Google Scholar 

  7. Randhawa P, Shapiro R, Jordan M, Starzl T. The histologic changes associated with allograft rejection and drug toxicity in renal transplant recipients maintained on FK 506: Clinical significance and comparison with Cyclosporine. Am J Surg Pathol 1993; 17

    Google Scholar 

  8. Groth, CG, Backman, L, Morales, J-M, et al. Sirolimus (rapamycin)-based therapy in human renal transplantation. Transplantation 1999; 67:1036.

    Article  PubMed  CAS  Google Scholar 

  9. Levey AS, Breto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease. What do we know? What do we need to know? Where do we go from here? Am J Kidney Dis 1996;27:347–354.

    Google Scholar 

  10. Danovitch GH. The Epidemic of Cardiovascular Disease in Chronic Renal Disease: A challenge to the Transplant Physician. Graft 1999;2:S108–112.

    Google Scholar 

  11. Arnadottir, M, Berg, AL. Treatment of hyperlipidemia in renal transplant recipients. Transplantation 1997; 63:339.

    Article  PubMed  CAS  Google Scholar 

  12. Hricik, DE. Posttransplant hyperlipidemia: The treatment dilemma. Am J Kidney Dis 1994; 23:766.

    PubMed  CAS  Google Scholar 

  13. Vathsala, A, Weinberg, RB, Schoenberg, L, et al. Lipid abnormalities in cyclosporine-prednisone-treated renal transplant recipients. Transplantation 1989; 48:37.

    Article  PubMed  CAS  Google Scholar 

  14. Hricik, DE, Bartucci, MR, Mayes, JT, Schulak, JA. The effects of steroid withdrawal on the lipoprotein profiles of cyclosporine-treated kidney and kidney-pancreas transplant recipients. Transplantation 1992; 54:868.

    Article  PubMed  CAS  Google Scholar 

  15. Satterthwaite, R, Aswad, S, Sunga, V, et al. Incidence of new-onset hypercholesterolemia in renal transplant patients treated with FK506 or Cyclosporine. Transplantation 1998; 65:446.

    Article  PubMed  CAS  Google Scholar 

  16. Murgia, MG, Jordan, S, Kahan, BD. The side effect profile of sirolimus: A phase I study in quiescent cyclosporine-prednisone-treated renal transplant patients. Kidney Int 1996; 49:209.

    Article  PubMed  CAS  Google Scholar 

  17. First RM, Neylan JF, Rocher LL, Tejani A. hypertension after renal transplantation. J Am Soc Nephrol 1994;4:S30–S36

    PubMed  CAS  Google Scholar 

  18. Luke RG. Pathophysiology and treatment of posttransplant hypertension. J Am Soc Nephrol 1991;2(Suppl 1):S37–S44

    PubMed  CAS  Google Scholar 

  19. Curtis JJ, Luke RG, Dubovsky E, et al. Cyclosporine in therapeutic doses increases renal allograft vascular resistance. Lancet 1986;2:447–479

    Google Scholar 

  20. McCauley, J.; Fung, J.; Jain, A.; Todo, S., and Starzl, T. E. The effects of FK 506 on renal function after liver transplantation. Transplant Proc. 1990 Feb; 22(1): 17–20.

    PubMed  CAS  Google Scholar 

  21. Laslow DA, Curtiss JJ. Post-transplant hypertension. Am J Hypertens 1990; 3; 721–725

    Google Scholar 

  22. Curtis JJ. Hypertension following kidney transplantation. Am J Kid Dis 1994;23(3): 471–475

    PubMed  CAS  Google Scholar 

  23. The Sixth Report of the Joint National Committee on Detection, Evaluation, and Diagnosis of High Blood Pressure (JNC VI). Arch Intern Med 1997; 157:2413.

    Article  Google Scholar 

  24. Grossman, E, Messerli, FH, Grodzicki, T, Kowey, P. Should a moratorium be placed on sublingual nifedipine capsules for hypertensive emergencies or pseudoemergencies? JAMA 1996; 276:1328.

    Article  PubMed  CAS  Google Scholar 

  25. Penn, I. Cancers complicating organ transplantation. N Engl J Med 1990; 323: 1767.

    Article  PubMed  CAS  Google Scholar 

  26. Barret W, First MR, Aron BS, Penn I. Clinical course of malignancies in renal tansplant recipients. Cancer 1993;72(7):2186–2189

    Article  Google Scholar 

  27. Penn, I. The changing patterns of posttransplant malignancies. Transplant Proc 1991;23:1101.

    PubMed  CAS  Google Scholar 

  28. Penn I. Occurrence of cancers in immunocompromised organ transplant recipients. Clinical Transplants 1990, P Terasaki ed. UCLA Tissue Typing laboratory, Los Angeles CA

    Google Scholar 

  29. Penn I. The effect of immunosuppression on pre-existing cancers. Tranplantation 1993;z55:742–747

    Article  CAS  Google Scholar 

  30. Weir MR, Kirkman RL, Strom TB, et al. Liver disease in recipients of long surviving renal allografts. Kidney Int 1985;28:839–844

    Article  PubMed  CAS  Google Scholar 

  31. Pereira BJ. Hepatitis C in organ transplantation: its significance and influence on transplantation policies. Curr Opin Nephrol Hyperten 1993;2:912–922

    Article  CAS  Google Scholar 

  32. Braun WE. Nephrology Forum: Long term complications of renal transplantation. Kidney Int 1990;37:1363–1378

    Article  PubMed  CAS  Google Scholar 

  33. Bass NM, Ockner RK. Drug Induced Liver Disease. Hepatology: A Textbook of Liver Disease. Ed: Zakim D, Boyer TD, WB Saunders Co, Philadelphia, 1990

    Google Scholar 

  34. Parfrey PS, Forbes RDC, Hutchinson TA, Kenick S, et al. The impact of renal transplantation on the course of hepatitis B liver disease. Transplantation 1985;39: 610–615

    Article  PubMed  CAS  Google Scholar 

  35. Periera BJG, Wright TL, Schmid CH, et al. The impact of pretransplantation hepatitis C infection on the outcome of renal transplantation. Transplantation 1995; 60:799–805

    PubMed  CAS  Google Scholar 

  36. Bodenheimer, H, Lindsay, KL, Davis, GL, et al. Tolerance and efficacy of oral ribavirin treatment of chronic hepatitis C: A multicenter trial. Hepatology 1997; 26:473.

    Article  PubMed  CAS  Google Scholar 

  37. Schalm, SW, Weiland, O, Hansen, BE, et al. Interferon-ribavirin for chronic hepatitis C with and without cirrhosis: Analysis of individual patient data of six controlled studies. Gastroenterology 1999; 117:408.

    Article  PubMed  CAS  Google Scholar 

  38. Magnone M, Holley JL, Shapiro R, Scantlebury V, McCauley J, Jordan M, Vivas C, Starzl T, Johnson JP. Interferon-alpha-induced acute renal allograft rejection. Transplantation 59(7): 1068–70,1995Apr.

    Article  PubMed  CAS  Google Scholar 

  39. Jindal RM. Posttransplant diabetes mellitus: A review. Transplantation 1994;58: 1289–1298

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

McCauley, J., Shapiro, R. (2001). Medical Complications of Immunosuppression. In: Thomson, A.W. (eds) Therapeutic Immunosuppression. Immunology and Medicine Series, vol 29. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-0765-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-94-010-0765-8_17

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3821-8

  • Online ISBN: 978-94-010-0765-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics