AI Summary 98% of surveyed liver transplant recipients still take immunosuppressant drugs, and 35% reported kidney problems.
Medically reviewed.
Anti-rejection medicines, also called immunosuppressants, protect your new liver by keeping your immune system from attacking it. You will need them for life. Most recipients take more than one type, such as tacrolimus, a steroid, or mycophenolate mofetil, and each medicine has its own pattern of side effects.
Your transplant team checks for side effects with regular blood tests and visits. Side effects do not mean the transplant has failed, and your team can adjust your plan if one becomes a problem. Take every medicine exactly as prescribed. Do not stop or change a medicine on your own.
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Why Side Effects Happen
Immunosuppressive drugs are necessary for your transplanted liver to survive. They are also linked to significant long-term side effects, including bone disease, high blood pressure, new-onset diabetes, and kidney disease.
Most transplant recipients take more than one medicine. Each one has its own common side effects, and your team watches for them with regular lab tests.
Side effects do not mean the transplant has failed. They mean your team may need to adjust your plan. Some medicines are added to lower the dose of another. For example, everolimus (Zortress) can be used to reduce exposure to tacrolimus or cyclosporine and help protect kidney function.
For a full list of these medicines and how they work, see Immunosuppressive Medications.
Side Effects by Medicine
These are the side effects listed most often for each medicine. You may have some, all, or none. Your team can tell you what to expect from your own plan.
Tacrolimus is a calcineurin inhibitor. Grapefruit and grapefruit juice should be avoided while you take it.
Common Side Effects
Cyclosporine is also a calcineurin inhibitor. Avoid grapefruit products unless your provider approves them.
Common Side Effects
CellCept is often used with a calcineurin inhibitor and may reduce how much steroid you need.
Common Side Effects
Imuran is used less often than newer medicines but remains an option for some recipients.
Common Side Effects
These mTOR inhibitors are sometimes used to lower exposure to tacrolimus or cyclosporine.
Common Side Effects
Many recipients stop steroids within several months after transplant. Others take a low dose long term. Never stop a steroid suddenly without medical guidance.
Common Side Effects
Monitoring
Regular tests help your team catch side effects early. Keep every lab and clinic appointment, even when you feel well.
| Medicine | What Your Team Monitors |
|---|---|
| Tacrolimus | Tacrolimus trough levels, kidney function, liver function, blood pressure, and blood glucose |
| Cyclosporine | Cyclosporine levels, kidney function, liver function, blood pressure, and lipid levels |
| CellCept | Blood cell counts, liver function, and signs of infection |
| Imuran | Complete blood counts, liver function, and signs of infection |
| Prednisolone | Blood glucose, blood pressure, weight, and signs of infection |
Lab schedules vary. Follow the plan your own transplant team gives you.
Long-Term Effects
Side effects can build up over the years. These are the areas to watch.
These problems do not mean you will not do well. They mean your team keeps watching, so it can act early.
Staying Safe
Small daily habits lower the risks that come with immunosuppressants.
Take each medicine exactly as prescribed, without missing doses. Never stop one abruptly, especially a steroid, without medical guidance.
Wash your hands often and avoid close contact with people who are sick. Immunosuppressants raise infection risk, so this matters every day.
Use sunscreen and protective clothing. Several of these medicines raise skin cancer risk, and skin cancer was reported more often in recipients more than 10 years after transplant.
Check with your transplant team before you start any new medicine or supplement. Avoid grapefruit and grapefruit juice with tacrolimus, and with cyclosporine and everolimus unless your provider approves. Avoid live vaccines unless your team approves them. If you take Imuran, avoid alcohol unless your team approves it.
Eat fresh, simple meals low in salt and fat. Move your body every day, drink enough water, and rest well. Staying physically active also supports bone and muscle health, which matters if you take steroids.
Tell Your Team
Do not wait for your next appointment if something feels off. Small signs can be important.
Bring your notes to every visit. You know your body best, and your team can only act on what it hears.
Eating and Recovery
Good habits will not remove every side effect. They do support your health and help you stay on track with your medicines and monitoring. Helpful habits include fresh, simple meals low in salt and fat, daily movement, rest, and taking your medicines even when nothing feels wrong.
Check with your transplant team before you change your diet, add a supplement, or start a new food product. Some foods, such as grapefruit, can affect certain anti-rejection medicines.
Habits That Support You on Anti-Rejection Medicines
Common Questions
No. Side effects are a known part of taking anti-rejection medicines, and they do not mean the transplant has failed. Most recipients take more than one medicine, and each has its own common side effects. Your team watches for them with regular blood tests and visits. If a side effect becomes a problem, your team can adjust your plan, for example by changing a medicine or adding one that lowers the dose of another.
No, not on your own. Stopping a medicine or changing a dose can harm your new liver. Steroids in particular should never be stopped suddenly without medical guidance. If a side effect bothers you, tell your transplant team. They may change your medicine, adjust your plan, or add another medicine so you can take less of the one causing trouble.
Several can. Tacrolimus can cause high blood pressure, elevated blood sugar, and kidney function changes. Cyclosporine can cause kidney function changes and high blood pressure. Steroids such as prednisolone can raise blood sugar, cause weight gain, and lead to fluid retention. Your team checks kidney function, blood pressure, and blood glucose at regular visits for this reason.
Yes. Long-term immunosuppressant use is linked to bone disease, high blood pressure, new-onset diabetes, and kidney disease. In one survey of recipients, 44% reported elevated liver enzymes, 35% reported kidney problems, 19% reported heart problems, and 7% reported new-onset diabetes. Skin cancer was reported by 45% of those more than 10 years after transplant, compared with 11% of those less than 10 years out. Regular follow-up lets your team act early.
Daily habits help. Wash your hands often and avoid close contact with people who are sick, because immunosuppressants raise infection risk. Use sunscreen and protective clothing, because several of these medicines raise skin cancer risk. Avoid live vaccines unless your transplant team approves them. Keep every follow-up visit and lab test, even when you feel well.
Avoid grapefruit and grapefruit juice with tacrolimus. With cyclosporine and everolimus, avoid grapefruit unless your provider approves it. If you take Imuran, avoid alcohol unless your team approves it. Check with your transplant team before you start any new medicine or supplement, including products you can buy without a prescription.
Call when something feels off. Do not wait for your next appointment. Watch for fever, swelling, nausea, or changes in your energy, and call about any new or worsening symptom. Write down your symptoms and questions in a notebook or phone app, and bring them to every visit. Ask whether a side effect could come from a medicine and whether your plan can change.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
