A patient who received a kidney transplant returns for a follow-up visit to the outpatient clinic and reports a lump in her breast. Transplant recipients are:
A. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral).
B. Consumed with fear after the life-threatening experience of having a transplant.
C. At increased risk for tumors because of the kidney transplant.
D. At decreased risk for cancer, so the lump is most likely benign.
Correct Answer: A. At increased risk for cancer due to immunosuppression caused by cyclosporine (Neoral).
Cyclosporine suppresses the immune response to prevent rejection of the transplanted kidney. The use of cyclosporine places the patient at risk for tumors. Cyclosporine works to suppress cell-mediated immune reactions. Research has detected no effects on phagocytic function in animals, and it does not cause bone marrow suppression in animal or human models.
Option B: Cyclosporine is a widely used immunosuppressive drug, especially in transplant patients. The majority of patients on cyclosporine can be followed as outpatients by the nurse practitioner, primary care provider, an internist, and the specialist. The clinical staff must monitor cyclosporine levels regularly to prevent acute rejection, nephrotoxicity, and predictable dose-dependent adverse reactions.
Option C: Decreases glomerular filtration rate (GFR) due to an increased tone of the glomerular afferent arterioles. Serum creatinine concentration rises and decreases creatinine clearance. The undesirable effects correlate with the duration of treatment and dose.
Option D: Cyclosporine is effective due to specific and reversible inhibition of immunocompetent lymphocytes in the G0 and G1-phase of the cell cycle. The T-helper cell is the primary target, although it may also suppress T-suppressor cells.
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