Transplant: Amoxicillin for dental appointment

I had a pancreas transplant in 2005. Part of the aftercare was an antibiotic prescription to take as a prophylactic before dental appointments. It was explained to me that this was necessary to prevent/treat infections I might encounter with dental procedures since I’m immune suppressed. It wasn’t amoxicillin since I have an amoxicillin allergy but I don’t remember what it was. This went on for several years before routine dental cleanings/exams. At some point I broke a crown, had to find a new dentist (insurance change) to repair it. Antibiotic prophylaxis was no longer a consideration. This past summer I found out I needed a root canal in a different area. The endodontist (another new provider due to insurance change) prescribed an antibiotic for pain I was having not for a prophy. I got the root canal and followed up with a permanent filling. I’ve had 3 new providers this past year and no more antibiotic prophylaxis. Maybe this is because I am so far past the original transplant and I am still here, thank God!

@hello1234, thank you for your reply.
BK virus <34.50, CMV <500, Creatinine 1.12 slightly elevated from last time. My regular nephrologist referred me to another nephrologist in the group plan to further analyze my case. No schedule for biopsy yet. I’m reluctant to have biopsy due to risks involved, and it might further damage the new kidney. But if it’s extremely necessary, then I have no choice. I have an appointment with transplant nephrologist at UCLA tomorrow. Will keep you updated.

Hi @leahdrose 😊 Sounds like good news to me. Your numbers appear to be only a smidgen elevated, so I totally understand why they are not pushing a biopsy.

From my layman point of view, nothing seems urgent. (But it's good that your team of docs are investigating the slight elevation).

How do you feel? Are you feeling calmer after seeing your lab work?

Regarding biopsies - At Mayo, our "protocol" kidney biopsies are performed at 4 months, 1 year, 2 year, 4 year. What protocol does UCLA follow for your biopsy timing?

I hope you are feeling better after all that stress regarding infection and possible signs of rejection. It looks like things are starting to settle nicely for you? ❤

So, you really have to have kidney biopsies? Wow. Is that on your new kidney? Glad us liver transplant folks don’t have protocol biopsies!

Hang in there Leah! We’ll be sending positive healing thoughts your way!

Hi @athenalee 😊 Yes, the protocol kidney biopsies are performed on the new kidney. @leahdrose is correct when she shared her concern about having a biopsy since they are not risk free. The intention of the protocol biopsies is to try to discover any signs of rejection at the cellular level before it shows up in reduced kidney function. And then hopefully with an increase in immune suppression they can calm it down. It really is difficult to know if it's worth the risk of the biopsy if the function tests look good. I assume the data shows that it's currently worth it. I didn't know that the liver transplants do not have protocol biopsies. That's interesting. Maybe it's a more difficult procedure or something like that? So, I assume that liver transplants only monitor the liver enzymes for signs of rejection. I wonder if kidney transplants are the only organ with protocol biopsies.

Hi @cehunt57 😊 Congratulations on your 2005 successful pancreas transplant...that's wonderful! And thank you so much for sharing your dental (antibiotics) experiences with me. It's very helpful to hear other people's experiences.
I am curious, after all of these years after transplant which immune suppression drugs do you currently take? Am I correct in saying that you are cured of diabetes with your new pancreas?

I researched it—heart and lung transplant recipients have to have biopsies too. Heart transplant recipients have the highest rate of rejection, for solid organ transplants. It seems that as long as our liver enzymes are within normal range us liver transplant recipients don’t have protocol biopsies. Pancreas transplant recipients also have labs monitored as it’s apparently difficult to biopsy a donor pancreas.

Stem cell recipients have their chimerism levels monitored, which is the state in which donor cells have durably engrafted in the recipient. Wonder what @loribmt can share about that?

One third of all organ transplants are lost to rejection though, so I’m guessing biopsies are a good thing, especially in more recent transplant recipients.

@hello1234, It’s always nerve wracking checking the lab test results and such a huge relief when it came out good. I’ll ask UCLA what their protocol is on kidney biopsy. I will keep you updated after my appointment with UCLA tomorrow.

Good morning @athenalee 😊 Wow, I can always rely on you to thoroughly research any query or question! You are amazing! I never thought about the intricacies of each organ and whether their recipients had a protocol biopsy schedule like mine. As always, your response was a true learning experience for me! I love it! Thank you for the morning gift and have a wonderful day at work. Happy Friday!! 😊