Immunosuppressive Therapy
As with any transplantation procedure between genetically non-identical individuals, immunosuppressive drugs must be given to prevent the recipient’s immune system from destroying the donated organ, which it recognizes as foreign material. Hands present an especially difficult problem with respect to immunosuppressive therapy because they are composed of many different tissues. Skin, muscle, nerves, tendons, ligaments, bone, and blood vessels are among these tissues, and each of them has its own distinct degree of antigenicity and is rejected by different mechanisms. Thus, to prevent rejection of a hand transplant, it is likely that more than one immunosuppressive drug will be needed. Physicians have found that an approach called combination therapy, whereby the patient is put on a regimen of several different immunosuppressive drugs, is necessary to ensure the survival of a hand graft.
Selected immunosuppressive drugs prescribed for hand transplant
recipients:
• basiliximab
• FK506 (tacrolimus)
• MMS
• Prednizone
• myco-phenolate mofetil (MMF)
• antithymocyte globulins
(The drugs vary both in how they are administered
[oral, topical, etc.] and in when they are primarily used [immediately
following the procedure vs. maintenance therapy after the first crucial
months with the new graft])
The drug therapy format for hand transplant patients is similar to that
of kidney recipients. During the first few months after the transplantation
procedure, the patients must take especially high dosages of powerful
immunosuppressive drugs due to the heightened chances of rejection during
this initial period. When this critical period is over, the dosages of
the drugs may be tapered off, but the threat of graft rejection will never
subside; therefore, transplant patients must take these drugs every day
for the whole life of their new hand.
Though these drugs prevent the transplanted hand from being rejected,
there are unfortunate risks and side effects associated with these medications.
One direct consequence of taking immunosuppressive drugs is that the patient
is more susceptible to infection because of his weakened immune system.
This is especially true during those initial months following the operation
during which higher doses of the drugs are prescribed. The increased chances
of infection with which a hand recipient will always have to live may
necessitate that the patient alter his lifestyle somewhat to accommodate
for this heightened risk, particularly during the first six months.
Activities for the graft recipient to consider:
• Avoiding children with communicable diseases
• Avoiding crowds
• Wearing a mask while outside or in dusty, crowded places
• Avoiding emptying cat litter box
• No house plants
• No gardening
• No swimming in fresh water such as lakes or ponds
(Suggestions from www.handtransplant.org)
Besides the obvious increased susceptibility to infection that results from taking the immunosuppressive drugs, several other serious risks and unpleasant side effects are associated with the medications prescribed for graft recipients. These unfortunate consequences of immunosuppressive therapy should be weighed carefully by the potential hand transplantation patient before he decides to commit himself to the procedure.
Other increased risks associated with immunosuppressive therapy:
• Certain skin cancers
• Lymphomas
• Other cancers
• Diabetes
Some potential side effects of immunosuppressive medication:
• Hypertension
• Acne
• Hand tremor
• Gastrointestinal discomfort
• Increased hair growth
• Weight gain
• Liver and kidney dysfunction
• Diarrhea
(Side effects largely adapted from www.handtransplant.org)
