Standard medications

Liver allograft recipients usually take cyclosporine orally twice daily at daily dosages ranging from 3 mg/kg to 10 mg/kg. The evening dose is taken near 9 p.m. so that consistent trough levels can be obtained when needed on the following morning in the our clinic office. Recipients usually take prednisone 20 to 10 mg PO q a.m.

Cyclosporine comes in two forms: liquid and gel caps. Both forms have approximately the same bioavailability. The liquid form requires careful measurement for administration. The liquid requires a vehicle to ease the swallowing of this unpleasant tasting medication (i.e. chocolate milk, or orange juice). The gel caps do not require this measurement nor the need for a vehicle to ease swallowing. Furthermore, the gel caps appear to reduce wastage of the medication. The capsules come in 100 mg and 25 mg amounts such that minute changes in dosage are still possible.

Patients intolerant to cyclosporine are converted to azathioprine 0.5 to 1.5 mg/kg PO q AM (Imuran) or changed to a "ultra-low dose" cyclosporine dosage regime supplemented with azathioprine. Azathioprine is not used very often in our patients because of its less specific action and its recognized risks of producing wound healing problems, infectious complications and drug related hepatitis. Some transplantation groups use azathioprine routinely within the first two weeks following transplantation to avoid the nephrotoxicity of cyclosporine. Many centers also routinely employ "triple drug" therapy (i.e., cyclosporine, azathioprine, and prednisone). Because acute rejection is such an limited problem in patients on an intravenous cyclosporine dose of four to six mg/kg daily, and because renal function seems to be well maintained at these level of drug dosage, we do consider the risks of excessive immunosuppression to be justified. These risks include lymphoma, squamous cell carcinoma of the skin, and viral and fungal sepsis.

Because of the ulcerogenic effect of steroids (i.e. prednisone) these recipients are maintained on antacids, either Mylanta, Maalox, Alternagel or Phosphogel depending on serum electrolytes tests and renal function following discharge. In general, these patients are maintained on these antacids permanently.

For the first six months following transplantation these recipients seem to be prone to oral candidiasis (thrush). Therefore, recipients are routinely placed on high dose oral Nystatin (i.e. Mycostatin 1 million units swish and swallow q six hours)

Although some liver transplantation programs routinely place their patients on prophylactic oral Bactrim and Acyclovir, we have not found this to be a necessity. With the use of low dose and biopsy directed immunosuppression, we have had a very low incidence of such life threatening infectious complications such as Pneumocystis pneumonia, systemic Herpes Simplex or Cytomegalovirus in the late postoperative period.

Prior to discharge patients must demonstrate the independent ability to take their prescribed medications. We instruct them to avoid "over the counter" medications without consulting their physician.  Tylenol, stool softeners, cough medications and decongestants are acceptable as needed. Patients should also contact our office as new medications are prescribed to assure there are no contraindications of untoward drug interactions.