Getting a new kidney is a second chance at life—but it comes with strings attached. Transplant recipients must take powerful drugs called immunosuppressants to stop their immune system from attacking the new organ. We asked nephrologist Dr Foo Geong Taat to explain why these drugs are vital, what risks they carry, and how patients can live well with them.
WORDS LIM TECK CHOON
 FEATURED EXPERTDR FOO GEONG TAAT Consultant Internal Medicine Physician and Nephrologist Columbia Asia Hospital Bukit Rimau |
A SUCCESSFUL ORGAN TRANSPLANT IS NOT THE END OF THE STORY
An organ transplant is often described as a miracle of modern medicine. However, even the best-matched donor isn’t a perfect match.
- According to Dr Foo Geong Taat, the only perfect match is between genetically identical twins.
- For everyone else, the immune system still sees the donated kidney as an outsider, and without the right medications, it will try to destroy it.
That’s where immunosuppressants — medications that weaken or “dampen” the immune system — come in.
- These medicines block the body’s complex defense mechanisms from launching an attack against the new organ.
- Because the immune system has many different pathways, patients are usually prescribed a combination of drugs that work together to protect the organ.
A Lifelong Commitment
Even decades after surgery, the immune system never forgets that the transplant organ came from someone else.
- Hence, immunosuppressants must be taken for the rest of one’s life.
- “Stopping immunosuppressants can cause irreversible rejection, especially in the early period after a transplant,” warns Dr Foo.
- Even missing doses here and there can increase the risk of graft loss — the medical term for losing the transplanted organ.
- Therefore, staying consistent with immunosuppressants is what allows the transplant organ to keep functioning for the long haul.
COMMON TYPES OF IMMUNOSUPPRESSANTS
Transplant patients in Malaysia typically take a mix of medications, such as:
- Corticosteroids to reduce inflammation and immune activity
- Calcineurin inhibitors to prevent T-cells, a type of immune cell, from being “switched on”
- Anti-proliferative agents to stop immune cells from multiplying
- Mammalian target of rapamycin (mTOR) inhibitors to slow cell growth and immune activity.
- Monoclonal antibodies, which are lab-made antibodies designed to block very specific immune targets
| In Malaysia, these medications are heavily subsidized when obtained from government hospitals, often costing little to nothing, as long as the transplant is performed at the government hospital. |
HOWEVER, IMMUNOSUPPRESSANT USE COMES WITH RISKS
Since immunosuppressants deliberately weaken the body’s defenses, patients become more vulnerable to infections.
- Dr Foo points out they face not just common infections like colds, but also opportunistic infections, caused by rare bugs that only strike when immunity is low.
- Long-term use also raises the risk of certain cancers.
- Some immunosuppressants come with their own side effects, such as kidney and nerve damage, diabetes, or high blood pressure.
HOW TO MINIMIZE RISKS WHILE ON IMMUNOSUPPRESSANTS
So how does a patient stay safe while still living a reasonably active and social life?
Dr Foo emphasizes simple but strict hygiene practices:
- Wash hands regularly, wear gloves when needed, and maintain oral hygiene.
- Avoid close contact with sick people and crowded indoor spaces.
- Stick to well-cooked meals and avoid raw or undercooked food.
- Keep vaccinations up to date.
- Most importantly: never skip or stop medications.
The Supplement Trap
Some patients may think they can “balance things out” by taking immunity-boosting supplements.
Dr Foo is clear about this: don’t do this!
Immunity-boosting supplements can interact with immunosuppressant drugs, change their levels in the blood, or even stimulate the immune system enough to cause sudden organ rejection.
How to Stay Consistent with Medications
Managing life after a transplant is about more than pills. Dr Foo highlights a multi-layered approach:
- Strict medical adherence, taking every dose on schedule.
- Lifestyle adjustments – healthy diet, infection prevention, cancer screening.
- Strong psychosocial support from trained caregivers and family, who can help in emergencies and provide emotional backing as one moves from “sick role” into a full, active life.
| For more information on organ transplant, check out this article where Dr Muhammad Iqbal Abdul Hafidz answers common questions people have on the topic. |
| This article is part of our series on organ transplant. |
