Evaluation: The Side Effects of Medication by Holly and Nicolas
Managing Your Immunosuppressive Medications After Your Kidney Transplant
Evaluation by Jim Myers
1. Introduction
I have been asked to evaluate a study on the effects of immunosuppressant medications after a kidney transplant and the proper way to take the medications and to track them by the GET ON TRACK Study Group. This is a very interesting and timely topic for transplanted kidney patients. I found this study to be complete in addressing issues of concern to kidney transplant patients and helpful in terms of suggestions for taking and tracking your anti-rejection medications.
2. Basics: Your Immune System and Anti-rejection Medications
The description of why immunosuppressant medications are necessary after a kidney transplant are succinct and to the point: if you do not take the medications, your body's natural inclination is to reject your transplanted kidney as a foreign body. The other point very skillful made here is that the anti-rejection medications must be taken for the rest of the transplanted organs life.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782235/; https://www.webmd.com/a-to-z-guides/organ-transplant-after-the-transplant.
What is not discussed here is the consequences of not taking the medications as directed, namely going on or back to dialysis or the possibility of death. https://my.clevelandclinic.org/health/articles/21134-kidney-transplant-rejection; https://www.sciencedirect.com/science/article/pii/S0085253815485023; https://pubmed.ncbi.nlm.nih.gov/12371992/
The authors do a very good job of laying the foundation for side effects of the immunosuppression medications like infection and cancer. Many of us on anti-rejection medications have been advised to regularly consult with a dermatologist (skin doctor). https://www.aad.org/public/fad/what-is-a-derm.
It may have been appropriate hear to mention that such a consult may be necessary to detect infections or cancer while taking immunosuppressants for early treatment and prevention of serious issues.
https://www.newswise.com/articles/transplant-patients-need-to-be-examined-by-a-dermatologist-the-american-dermatologic-association-endorses-enhanced-screening-surveillance-and-prevention-of-skin-cancer-and-skin-infection-in-patients-with-solid-organ-transplants; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2423225/.
The other possible side effects are adequately described and the advice to consult with your transplant team about side effect issues is excellent. The foundation for tracking the taking of your meds and dealing with the side effects is very well done.
3. What Research Evidence Shows: A Statement of the Issues for This Study
This section of the paper is particularly well done. It lays out the Issues for the rest of the discussion in a perfect way:
A. How do we deal with and track the Side effects of our anti-rejection medications that have such an impact on the kidney transplant patient's well-being?
B. The importance of taking our anti-rejection medications as directed to avoid rejection.
4. How to Track the Side Effects of Your Immunosuppressive Medications
The authors have developed a chart in this section of the study to keep track of your side effects from the medications. This is a wonderfully prudent idea. In this day and age of My Chart/Email ability to communicate with your post-transplant nephrologist, as well as the popularity of telehealth visits, the sooner your doctor is made aware of the Issues, the sooner appropriate adjustments can be made. Terrific guidance here, particularly in light of the Coronavirus and difficulty with face-to-face meetings at this point in time.
5. How to Track If You Are Correctly Taking Your Immunosuppressive Medications
Great advice given here as well. The tracking of taking your immunnosupressants is vital, particularly early on in your experience. I was asked to chart my anti-rejection medications twice a day at a certain time and to track my temperature, blood pressure and heart rate all in the same chart.
Greater emphasis may be needed here on the importance of taking your meds at a certain time in the morning and evening every day. https://caredx.com/patients-and-caregivers/patient-resources/does-timing-matter-when-taking-anti-rejection-medications-for-your-transplanted-kidney-or-heart/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540791/.
6. How to Deal with Side Effects of Your Immunosuppressive Medications
This is an exquisitely well-written section of the study. The advice to consult with your post-transplant team so they can make adjustments is spot on. Great job here.
7. How to Take Your Immunosuppressive Medications Correctly
Again, this is a nearly perfect section of the study. All of the advice given here has been discussed with me by my kidney transplant team. This is the best section of the study. The advice that follows about taking your medications correctly and charting has already been covered in this review.
8. Conclusions
I really liked the paper and I felt that it gives great direction to the kidney transplant patient concerning the taking and charting of his/her immunosuppressant medications. I have made some suggestions for improvements based on my experiences as kidney transplant patient on anti-rejection medications, but overall this paper is solid. A great job to help the new kidney transplant patient in particular.
• Relevance of Content
I found the content to be extremely relevant for kidney transplant patients taking immunosuppressant medications. Succinct and to the point. The advice given here is very helpful for the transplant patient.
• Usefulness of Content
The content is completely useful. No esoteric fluff here. Down and dirty information and guidance that can be immediately put to good use. Strongest point of this study!
• Clarity of Content
Clear as a bell content here. Very readable and understandable. A valuable read any kidney transplant patient could understand.
• Applicability of Information
Prefect applicability to the kidney transplant patient. Very sharply focused on the matter of immunosuppressants, how to take them, how to chart them and the importance of consistently taking them.
My overall assessment is this is an excellent paper, particularly for someone who has been newly transplanted and is seeking correct guidance. A great job here!
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