Do I have to worry about long-term effects of immunosuppression?

The success of organ transplantation has resulted in longer survival after the operation for today’s patients. This longer survival comes at a price, however: far more long-term complications than were seen in the past. More attention must therefore be paid to the long-term effects of the immunosuppressive drugs and their cumulative effects. For example, cyclosporine can cause hypertension and high cholesterol. Over the course of many years this combination results in heart attack and stroke. When expected survival after transplantation was short, these long-term issues were of minimal concern. Today, with longer survival being commonplace, heart disease is one of the major causes of death in transplant recipients.

The incidence of hypertension is attributed to the primary immunosuppressive agents. Standard antihypertensive medications are effective in treating this complication.

As noted earlier, over the long term hypertension can result in heart or vascular disease.

Obesity is another common problem after transplantation. Because many patients suffer from malnutrition before transplantation, these individuals are counseled to improve their nutrition afterward to help the healing process. Unfortunately, patients may become accustomed to this increased calorie intake and have a hard time cutting back their food consumption once recovery from surgery has been achieved. The subsequent obesity can decrease mobility and increase the risk of coronary artery disease.

Diabetes mellitus is frequently encountered in organ transplant recipients. Once again, the culprit is often the immunosuppressive agents, particularly tacrolimus and prednisone. The incidence of obesity correlates with diabetes incidence and both are cardiac risk factors.

Transplant-associated lymphoma is a feared complication of the immunosuppressive drugs. Fortunately, it occurs in only 1% to 2% of transplant recipients. This kind of lymphoma is associated with infection with the Epstein-Barr virus. Many patients who develop posttransplant lymphoproliferative disease (PTLD) can be treated with a reduction in immunosuppression, which may cause the PTLD to regress. In rare cases the PTLD becomes a true lymphoma and chemotherapy is required.

Transplant recipients have higher rates of both skin cancer and cervical cancer. Proper skin care, especially sun protection, is essential in these patients. For women, annual Pap smears are recommended.