immunosupressants and surgery

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Ann - 17 Oct 2006 01:49 GMT

Does anyone know if it's likely that surgery would be carried out
while I'm on mycophenolate? My haematologist says it probably will
but she's only guessing. I'm due to have a dermal fat graft to
replace a coral implant in an enucleated socket. I'm on steroids at
the moment and the surgeon won't do it while I'm on the steroids but I
have yet to tell her that when weaned off the steroids I'll still be
on the mycophenolate for the next six months. Am desperate for this
op .. have been waiting for a long time, had a date all set up and
then due to ITP can't get it done.

I bet nobody here knows but thought I'd try.

Ann

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Dennis R. - 17 Oct 2006 02:53 GMT

> Does anyone know if it's likely that surgery would be carried out
> while I'm on mycophenolate? My haematologist says it probably will
[quoted text clipped - 7 lines]
>
> I bet nobody here knows but thought I'd try.

You MUST tell your doctor about the MMF (CellCept) simply because the
surgeon cannot make an informed decision without knowing. You could also
ask the doctors who put you on the immunosuppressants to inform your
surgeon of your progress, actual dosages, and if they have any
experience with your type of surgery for their other patients. Maybe
they can assure the surgeon that it is okay at this time to operate, or
maybe they will confirm that you should wait.

I take it that your treatment for I.T.P. (immune or idiopathic
thrombocytopenic purpura) will be short term, at least for the CellCept?
No matter how badly you want this operation, withholding crucial
information like this from your surgeon can only cause big problems.

Dennis (Kidney Transplant 1995)

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Ann - 18 Oct 2006 00:20 GMT

>> Does anyone know if it's likely that surgery would be carried out
>> while I'm on mycophenolate? My haematologist says it probably will
[quoted text clipped - 22 lines]
>
>Dennis (Kidney Transplant 1995)

I have been asked to keep in touch but no point telling her anything
just now as I don't have enough to tell. As soon as I know when I
will be off the steroids and can see that the platelet count is
holding up, I will call and explain the situation and see what she
says. Trouble is it can change overnight as it did before when my
platelets crashed so nothing is set in stone.

The idea is that I be on the CellCept for a total of 6 months and then
try to get off it but who knows what will happen. ITP is a weird and
wonderful disorder with a mind of its own. I definitely want off the
CellCept. Having had cancer once already, it's very scary to be on
it.

It's also not quite just a matter of wanting the op but I need it. If
the socket and implant gets infected which is going to become
increasingly likely with the immunosuppressants, then it will end up
being an emergency op.

I guess you have much experience with immunosuppressants being a
transplant patient. What a bother it all is eh? Thanks for replying.

Ann

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Dennis R. - 18 Oct 2006 03:55 GMT

> >I take it that your treatment for I.T.P. (immune or idiopathic
> >thrombocytopenic purpura) will be short term, at least for the CellCept?
[quoted text clipped - 15 lines]
> CellCept. Having had cancer once already, it's very scary to be on
> it.

From what I have briefly read on I.T.P., using immunosuppressants other
than a steroid like prednisone is a new treatment option that seems to
work better than the steroid alone. CellCept only came into common use
in transplantation in the mid to late 1990's. Cycloporine opened the
modern immunosuppressant era for transplantation a decade before.

I would bet that the dosages for I.T.P. and other autoimmune diseases
are much less than used for transplantation, and that the incidence of
cancer and tumours post-transplant is not as scary as some rumours make
it out to be.

> It's also not quite just a matter of wanting the op but I need it. If
> the socket and implant gets infected which is going to become
> increasingly likely with the immunosuppressants, then it will end up

That may not necessairly be the case. It depends on the doses and other
indicators. Within a few years of the transplant, I was down to 7.5 mg
of prednisone daily. There are many with arthritis and asthma patients
who take large doses of steroids for short periods of time without
complications.

Best wishes,
Dennis

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Ann - 19 Oct 2006 00:05 GMT

>> >I take it that your treatment for I.T.P. (immune or idiopathic
>> >thrombocytopenic purpura) will be short term, at least for the CellCept?
[quoted text clipped - 21 lines]
>in transplantation in the mid to late 1990's. Cycloporine opened the
>modern immunosuppressant era for transplantation a decade before.

Steroids on their own work very well with me but they don't want me to
stay on them long term and coming off them only got me a 6 week
remission, so we had to try something else. The CellCept takes
several weeks to have any effect, so back on the steroids in the
meantime. Azathioprine has been used for a long time with ITP but the
side effects are supposed to be more severe than with the CellCept,
although the hospital pharmacy don't like the high cost.. tough luck
to them and thank goodness for the NHS.

>I would bet that the dosages for I.T.P. and other autoimmune diseases
>are much less than used for transplantation, and that the incidence of
>cancer and tumours post-transplant is not as scary as some rumours make
>it out to be.

The dosage is the same I think. 2g per day but obviously for a
shorter time. The idea with ITP is to get to a place where you don't
have to treat. Or you find yourself in the position where the
treatment is worse than the disorder.

>> It's also not quite just a matter of wanting the op but I need it. If
>> the socket and implant gets infected which is going to become
[quoted text clipped - 5 lines]
>who take large doses of steroids for short periods of time without
>complications.

I'm now down to 30mg prednisolone (from initial 60mg) with the 2g
CellCept per day. Cutting prednisolone is a struggle. My knees are
hurting today and I don't sleep at all.. ho hum.

Ann

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