Side effects of immunosuppressive drugs - my recent challenge

My posts have been a little intermittent recently because of a combination of chronic fatigue and clinic visits for erythropoietin (EPO) injections. After almost 9 years post lung transplant and being on cyclosporine daily ever since I've been diagnosed as anemic due to chronic kidney disease stage lll. The kidney disease is secondary to calcineurin inhibitor (cyclosporine) toxicity.

Many organ transplant recipients on cyclosporine or tacrolimus (Prograf) eventually suffer from kidney disease and require dialysis and go on the waiting list for a kidney transplant. I've had 2 injections of EPO so far and it takes from 4 to 6 weeks for energy levels to improve. I had never given myself a needle before and the clinic staff have been great in training me to do so.

Erythropoietin (EPO) is a hormone produced by the kidney that promotes the formation of red blood cells in the bone marrow. Kidney cells that make EPO detect low oxygen levels in the blood and EPO then stimulates the bone marrow to produce more red cells which increases the oxygen carrying capacity of the blood, thus helping to reduce fatigue and increase energy.

You may have read about the blood doping scandals involving EPO in professional athletics, especially cycling and there's been more news on that front today involving Spanish Rider Garcia.

It goes without saying EPO is banned in professional sports because blood doping boosts the number of red blood cells (RBCs) in the bloodstream in order to enhance athletic performance. Because they carry oxygen from the lungs to the muscles, more RBCs in the blood can improve an athlete’s aerobic capacity (VO2 max) and endurance.

EPO is used for the medical treatment of anemia resulting from chronic kidney disease and myelodysplasia, from the treatment of cancer (chemotherapy and radiation), and from other critical illnesses (heart failure).

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