Bowel transplant medicines

You will need to take immunosuppressant medicines to reduce the risk of bowel rejection. This usually consists of 2 or 3 different medicines. The doses of these medicines usually reduce over time, but some immunosuppressant medicines will be needed for the lifetime of the bowel transplant.

It is extremely important that you take your immunosuppressant medicines as prescribed. You are at risk of rejection of the bowel if your immunosuppression levels are too low. You are also at increased risk of side effects if your immunosuppression levels are too high.

The immunosuppressant medicine levels in your blood will be checked regularly.

Common immunosuppressants and their side effects include: 

• Tacrolimus: in high doses, this can impair kidney function. Blood tests are needed to make sure the correct dose is given. Blood sugars can be raised. Tremors can occur.
• Steroids (e.g. prednisolone): this can cause high blood pressure, increased appetite and thinned skin. Blood sugars can be raised.
• Mycophenolate mofetil: this can cause diarrhoea or nausea. The number of white cells in the blood can be reduced. Women who wish to get pregnant and are taking mycophenolate mofetil should discuss with their transplant team if they need an alternative immunosuppressant.
• Azathioprine: the number of white cells in the blood can be reduced

You will need antibiotic and antiviral medicines to reduce the risk of infection. Some of these stop approximately 12 months after a transplant, but your transplant team will advise you about this.

You will need tablet painkillers for the first few months. These can cause constipation, itching or nausea.

You may need medicines to lower your blood pressure.

High blood pressure can be a side effect of immunosuppressant medicines. There are many different types of blood pressure tablets.

These are known as anticoagulants and work to thin your blood and prevent clots. Some transplant patients will be prescribed anticoagulants to reduce the risk of blood clots.

If blood clots occur, blood thinning medications can help prevent the blood clots from growing.

Some immunosuppressants and blood thinners can cause stomach irritation, so you are likely be given medicines to protect the lining of your stomach.

Loperamide or codeine may be needed to slow down bowel activity and reduce stoma output.

You may need medicines to lower your blood sugar levels, especially if you had diabetes before the transplant.

Some immunosuppressants can raise your blood sugar.

Unless your doctor says otherwise, you will need to continue to take any medicines you were taking before your transplant for other health issues.

You may also need other medication for new health issues that have been diagnosed during or since your transplant.

Because immunosuppressants work by lowering your immune system, this means you are more likely to pick up infections.

You will be given some extra medicines to prevent infection alongside the immunosuppressant medicines in the first months after transplant.

Learn more about bowel transplants and infections

Some of the immunosuppressant medicines can weaken your bones (osteoporosis). This is particularly true for women after the menopause.

Your kidney transplant team will advise you whether you need a bone scan to measure how strong your bones are ("bone density"), and whether you need medicines to strengthen your bones. If you break a bone following your transplant, tell your transplant team.

Weight gain is common after a transplant, especially in the first year. Some of the medicines, in particular, prednisolone, may cause weight gain or increase your appetite.

Patients who have diabetes before the transplant may find that their blood sugars are more difficult to control in the first 3 to 6 months after the transplant.

This is usually due to the immunosuppressant medicines, which can increase your blood sugars. Some patients that were not diabetic before the transplant become diabetic following the transplant.

This is usually due to the immunosuppressant medicines and also due to weight gain.

Increased blood pressure can occur with some immunosuppressant medicines. This can often be resolved by amending the dosage, if possible.

Immunosuppressants can irritate your stomach lining. Your care team is likely to give you medicines to help protect your stomach and prevent these side effects.

Mycophenolate mofetil can commonly cause nausea (sickness) or diarrhoea or increased stoma output.

Many recipients of bowel transplants can lose some kidney function. This may be because of the immunosuppressant medications that can reduce your kidney function.

Sometimes this can be so severe that bowel transplant patients might need dialysis or a kidney transplant.