Last Updated: September 16, 2024
Medically reviewed by NKF Patient Education Team
About immunosuppressants (anti-rejection medicines)
Your immune system’s job is to fight anything that is “foreign” to your body. It looks for things that do not belong, like bacteria and viruses (germs). For people who have received a kidney transplant, your immune system will also try to fight, or reject, your new kidney since it isn’t like the rest of your body. So, anti–rejection (immunosuppressant) medications are needed to increase your chances of keeping your new kidney healthy.
Anti-rejection medicines are for life – your new kidney is depending on them! Stopping, missing, or skipping these medicines will very likely cause rejection, either right away or over time.
How they work
Immunosuppressants are what protect your new kidney from your own body’s natural attack response. There are many types of anti-rejection medicines, and each works in a slightly different way. The goal with these medicines is to find the right balance between stopping your immune system from fighting your new kidney while keeping it strong enough to fight other germs and prevent serious infections. So, most people who have received a kidney transplant will need a combination of anti-rejection medicines to help achieve this balance.
Everyone has a different level of risk for rejecting their new kidney. So, your transplant team will design a medication regimen (number of medicines and their doses) specifically for you and your situation.
Types
There are 3 groups of anti-rejection (immunosuppressant) medications:
- Induction medicines: – a strong anti-rejection medicine given intravenously (IV) before you receive your transplant (usually in the operating room) and repeated one or more times in the days after your transplant surgery. This medicine helps get your body’s immune system ready to accept the new kidney. Your transplant team will determine the specific medicine and number of doses you need based on your personal risk for kidney rejection.
- Maintenance medicines: anti-rejection medicines you will take for as long as you have your transplanted kidney. These medicines are started shortly after your surgery (while you are still in the hospital) and then you will be responsible for managing them long-term after your transplant. More information about these medicines is shared below.
- Rejection treatments: medicines which are used if your body starts to reject your kidney, also called a rejection episode. If you have symptoms of rejection, call your transplant team right away as this can be a medical emergency.
Common maintenance immunosuppressants (anti-rejection medicines)
The list below is focused on the most common “maintenance medicines”. These are the medicines that need to be taken every day to help you prevent the rejection of your kidney transplant. Most patients will need a combination of medicines from this list to get the most benefit of keeping your new kidney healthy.
There are some foods that affect these medications and make them stronger or weaker, such as grapefruit and grapefruit juice. Read more about NKF's Nutrition Coach.
Effectiveness
These medicines have been proven to help stop the body from rejecting the new kidney for many years after transplant surgery. To increase your chances of success, you should always take your anti-rejection medications as prescribed by your transplant doctor (or another member of your transplant team). This still holds true no matter how you feel or if you think your transplanted kidney is working well enough to no longer need them.
These medicines are for life – your new kidney is depending on them! Stopping, missing, or skipping these medicines will very likely cause rejection, either right away or over time. Kidney rejection is hard to diagnose in its early stages. Rejection often cannot be stopped once it starts and results in the loss of the transplanted kidney.
Keep in mind that your anti-rejection medicines may change over time – doses may change, new medicines may be added, and/or some medicines may be stopped. It’s important to check in regularly with your transplant team and always follow your most recently updated medication list.
Side effects and monitoring
Anti-rejection (immunosuppressant) medicines have several possible side effects. These are usually manageable for most patients and often get better over time. Some of the most common side effects of anti-rejection (immunosuppressant) medications include:
- High blood pressure
- Diabetes
- High cholesterol
- An increased chance of having infections
- Gastrointestinal (stomach/digestive) side effects
- Increased risk of some forms of cancer
To help with side effects, you will need regular blood draw labs to check how much medicine is in your blood. If there is too much medicine, your side effects may be worse. If there isn’t enough medicine, your kidney may not be protected enough. When you first get your transplant, you will have blood draws more often. As time goes by, you will not need them as often. Even if your blood draw labs say your medicine levels are in the goal ranges, tell your transplant team about any side effects or symptoms you are feeling. Your healthcare professional may be able to change your doses and/or switch to a different medicine.
Tips for taking your anti-rection medications
Living with daily medicines often means creating new habits so you can remember to take them in a way that fits into your routine. Talk to your transplant team if you are having trouble sticking to your medicine schedule. Some common barriers and potential solutions shared by patients include:
| Common Barriers | Tips to Help | |
|---|---|---|
I forget to take my medicine(s) or forget to take them on time because…
| Alarms, alerts, calendars, smartphone apps, journals, and/or a watch can help remind you. Don’t turn it off until you have taken your medication. | |
I can’t remember if I’ve taken them already. It is inconvenient to take my medicine(s). | Use pill boxes to organize your medications by time of day and day of the week. You can tell if you’ve taken your medication that day if they are missing from the box. | |
I just don’t think about it because I’m feeling well.
| Place medications where you can easily see them (but out of reach of children or pets.)
| |
I forget to bring them when I leave my house.
| Keep a small amount of your medication in a purse or bag, at your desk, or other helpful places that you go often. Make sure these medicines are stored at a controlled room temperature. Also, be sure to rotate regularly so they don’t expire. | |
I can’t remember which medicines I take or how much.
| Post a medication calendar in sight showing your medicine names, doses/amounts, and days/times you take them. Have a copy to bring in your bag or car to every doctor appointment. Ask for written instructions and an updated list anytime your medicines change. |
If a healthcare professional outside of your transplant team gives you a prescription for a new medicine, let your transplant team know right away before taking it. The same is true for any over-the-counter medicines, herbal supplements, or vitamins you are planning to take. Many medicines and supplements can interfere with your anti-rejection medicines. The combinations can sometimes stop your anti-rejection medicines from working or make the medicine level in your blood go too high and cause side effects. To learn more about how foods and supplements can affect your anti-rejection medicines, visit Diet after Kidney Transplant.
Paying for anti-rejection medicines after transplant
Anti-rejection medicines can be expensive, but there are a lot of ways to get help paying for them. It is very important to always take your medicines as prescribed. Don’t lower your doses or stretch out doses to try and save money. This is extremely dangerous and should not be done because it can hurt your kidney and/or cause rejection. Call your transplant center’s financial coordinators and/or social workers if you are having trouble or are worried about paying for your medication. If you have Medicare, you can also reach out to a certified Medicare counselor in your state.
No insurance
If you meet the following criteria:
- had your kidney transplant at a Medicare-approved facility in the United States,
- do not have Medicaid, and
- do not have any other form of insurance,
you may be eligible for Medicare Part B-ID to cover only your immunosuppressants. Even if you are under 65 and it has been more than three years since your transplant, lifetime Medicare coverage for immunosuppressants is available.
Other prescription assistance programs
Some companies offer prescription assistance programs for patients on their medications to those who qualify. Visit the NKF Prescription Discount and Assistance Resources page for a list of assistance programs available for medicines that people with kidney disease and/or kidney transplant may need.
Questions to ask
- What maintenance medicines does your transplant center use after transplant?
- Will any of these anti-rejection medicines interact with my other medicines and/or health conditions?
- If you have a new problem bothering you: Could my medicines be causing this?
- If you cannot tolerate your medicine’s side effects: What are my other options for medicine?
- Who can I call if I am having trouble paying for my medication? Does your center have access to any programs that can help?
- How often will you want me to have bloodwork to check my medicine levels? How will that change over time after my transplant?
- Will you keep following up with me about my medicines after one year? If not, how do you help patients transition back to another healthcare professional (like my regular nephrologist)?
- Who should I contact if I plan to become pregnant (or unexpectedly become pregnant) in the future?
More resources
- NKF Cares: a patient hotline to answer any questions you may have about kidney disease, transplant, or living donation. Call toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org.
