Cardiac Transplant Program

Immunosuppressant Therapy

There are three basic medications groups that comprise the backbone of current immunosuppressive therapy. You will get one drug from each category depending on your particular history. You will remain on one drug from category I & II for your whole life, but most patients are slowly weaned off category III (steroids) by the first year. With time your body becomes more tolerant of the new heart and that allows a gradual reduction of the doses of the anti-rejection drugs. Despite an increase in acceptance, the heart will be rejected if the drugs are stopped completely.

  • Category I: Antimetabolites prevent the immune system from making T & B cells that will reject the new heart.
    Dosage & Side Effects, Azathioprine (Imuran): 2mg/kg/day (titrated to white blood cell count of 5000/cc), low white blood cell count, bone marrow suppression, liver abnormalities, nausea; Mycophenolate mofetil: (Cell Cept) 1500 mg twice daily nausea, diarrhea, low white blood cell count; Rapamycin (RAD): titrated to white blood cell count, low white blood cell count, high cholesterol specifically triglycerides, low platletes, nausea
  • Category II, Anitproliferatives inhibit expansion of cell lines that modulate rejection.
    Dosage & Side Effects, Cyclosporine (Neoral): 4-6 mg/kg/day twice daily (titrated to trough blood levels), kidney problems, headache, tremors, high potassium, photosensitivity, thickening of the gums, increased hair growth; Tacrolimus (Prograf or FK506): 0.15-0.3 mg/kg/day twice daily (titrated to trough blood levels), kidney problems, high potassium, seizures, headache, tremor, high blood pressure
  • Category III, Steroids nonspecifically prevent expansion of cell lines that modulate rejection.
    Dosage & Side Effects, Prednisone: 0-50 mg/day round face, diabetes, bone weakening, obesity, increased cholesterol, muscle weakness, cataracts, mood swings

Solid organ transplantation is a quickly evolving field. Many new drugs and strategies are being developed to prevent rejection and minimize side effects from the currently prescribed medications. As a leading transplant center, we participate in many clinical trails to test these new strategies. You may be given a choice to participate in a trial to investigate the efficacy of a new medication or strategy.

Columbia University Medical Center       New York Presbyterian Hospital
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