Immunosuppressants After Solid Organ Transplant Carry Nutritional Implications

After a patient receives a solid organ transplant, long-term nutrition management is key to navigate potential adverse events from immunosuppressive therapies needed to prevent rejection, according to an invited review article published in Nutrition in Clinical Practice.

“Each immunosuppressive agent has differing adverse effects, which include nutrition-related concerns such as hyperglycemia, hyperlipidemia, and electrolyte disturbances” wrote authors Nicole K. Wilson, PharmD, MS, and Ann D. Kataria, PharmD, of Baylor University Medical Center, Dallas, Texas. “An interdisciplinary team approach is essential to minimize adverse drug reactions.”

The article covers immunosuppressive agents commonly used after transplant and potential concerns associated with nutrition.

According to the review, a patient’s fed or fasting state can affect the absorption of calcineurin inhibitors. Fasting increases the absorption of immediate release-tacrolimus, for example, but a high-fat meal increases absorption of cyclosporine and sirolimus. While the efficacy of calcineurin inhibitors is proven, potential adverse effects are numerous and, depending on the agent, can include hyperlipidemia, hypertension, hyperkalemia, hyperglycemia, and gastrointestinal upset.

Mycophenolate products, meanwhile, cause gastrointestinal issues in 40% to 85% of users, the authors noted. The review also covers mammalian target of rapamycin (mTOR) inhibitors and mentions associations with delayed wound healing, hyperlipidemia, proteinuria, mouth ulcers, pneumonitis, and bone marrow suppression. With long-term mTOR inhibitor use, significant drops in lean body mass and skeletal muscle mass area can occur. Corticosteroid use is common in transplant recipients, the authors wrote, but the medications are associated with a slate of adverse effects, which can include osteoporosis, hyperlipidemia, hypertension, hyperglycemia, psychiatric symptoms, and compromised wound healing.

The costimulation blocker belatacept, used in kidney transplant, appears to avoid the metabolic complications possible with calcineurin inhibitors and mTORs, the authors reported. However, belatacept poses an increased risk of rejection.

Reference

Wilson NK, Kataria AD. Immunosuppression in solid organ-transplant recipients and impact on nutrition support. Nutr Clin Pract. 2024;39(1):109-116. doi:10.1002/ncp.11099