FAQ’s for the Transplant Recipient

Separating Myths from Good Advice for the Transplant Recipient

Transplant recipients should avoid eating raw seafood.

Transplant recipients have weakened immune systems, so the risk of food poisoning which can lead to an infection is greater.  It is good advice to avoid raw fish, oysters, shrimp, sushi and refrigerated smoked seafood unless it is an ingredient in a cooked dish such as a casserole.  Canned fish such as tuna or salmon can be eaten safely.

Transplant recipients should avoid grapefruit and grapefruit juice.

Transplant recipients taking cyclosporine, tacrolimus, or sirolimus are advised to avoid grapefruit and grapefruit juice.  Research shows that grapefruit juice can block an enzyme in the intestines that is responsible for the breakdown and absorption of these medications, leading to increased amounts of these medications in the body, which may hurt the kidneys.

In addition, because absorption of other medicines may also be affected by grapefruit juice, it is a good idea to ask your pharmacist whether grapefruit juice will interact with any of your other prescribed medicines. 

Transplant recipients should pre-medicate before every visit to the dentist.

Good dental care is recommended for everyone, but because transplant recipients take immunosuppressant (anti-rejection) medications, they are at an increased risk for developing mouth infections that could lead to serious complications.  Every transplant center has a protocol for dental prophylaxis after transplantation.  You should consult with your transplant coordinator to ask about the protocol recommended by your physicians.  Also, let your dentist know that you are taking immunosuppressants; he or she may recommend pre-medicating before each visit.

Transplant recipients should not donate blood.

The American Red Cross and most blood centers have eligibility guidelines that prevent someone who is taking immunosuppressants from donating blood.  These immunosuppressants could be harmful to the person who receives the blood.

Some flu vaccines can make transplant recipients sick.

Two different formulations of the influenza vaccine are available; the influenza injection (flu shot) and the influenza nasal spray.  While flu shots are considered safe for transplant recipients, flu sprays are not.

Transplant recipients can catch disease from changing the cat litter box.

It is OK to dispose of litter if it is in a liner so that you are not touching any of the stool directly.  Washing your hands often is also very important.  The germs are in the cat stool, not the lining or box.

Animals, even household pets, can sometimes carry diseases, and while few are likely to be life threatening, transplant patients who take immunosuppressants are at a greater risk of catching a disease.  It is not recommended that a transplant recipient clean a cat’s litter box if at all possible.  Also, the litter and liner should be replaced frequently and the litter box should be cleaned at least every month with disinfectant soap or hot boiling water (by someone other that the transplant recipient, if possible.)

Transplant patients should follow a set schedule when taking their medications.

Transplant patients are usually on multiple medications.  Many times it is perfectly okay to take your doses of multiple medications at the same time.  For example, prednisone taken with cyclosporine is not likely to cause serious problems.

However, there may be situations when two medicines should not be taken at the same time because they interact with one another.  For example, any antacid and oral antibiotic should not be taken at the same time of the day because the antibiotic would be less well absorbed and the infection could go untreated.

There are also examples of “gray” areas.  For instance, the anti-rejection drugs cyclosporine and sirolimus interact with each other if taken at the same time.  The cyclosporine causes the concentration of sirolimus in the body to become higher than normal, leading to an increased chance that one will experience serious side effects from the sirolimus.  Yet sometimes the doses of cyclosporine and sirolimus can be adjusted to maintain appropriate drug levels of each medication when taken together.  Transplant centers are well aware of this drug interaction, and may choose to adjust medication dosages rather that separate the timing of the two medicines.

When taking your medication, the most important thing to remember is to be consistent in when and how you take your medicines.  Take your drugs the same way every day.  Consistency helps your health care provider adjust your medications to your individual needs.  Since medication regimens are individualized, check with your transplant center or pharmacist whenever you have a drug related question.

                         *Source:  NKF Transplant Chronicles
                                       “Don’t Eat Grapefruit After Changing the Cat Litter!”
                                        By Jack Fassnacht

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