Transplant: Amoxicillin for dental appointment

Posted by hello1234 @hello1234, Nov 17, 2021

Hi all,
I have an 8am morning dentist appointment next week. The dentist would like me to take 2,000mg amoxicillin one hour before the appointment to prevent infection. Normally at 7am I take my Cellcept and Envarsus XR. What do you do in this instance? Has anyone taken amoxicillin with Cellcept and Envarsus XR? Do you take amoxicillin when you visit your dentist or go for a dental cleaning? Thanks everyone!!

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@leahdrose

@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.

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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? ❤

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@hello1234

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? ❤

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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!

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@leahdrose

@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.

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

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@athenalee

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!

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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.

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@cehunt57

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!

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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?

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@hello1234

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.

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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.

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@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.

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@athenalee

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.

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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!! 😊

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@hello1234

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?

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@hello1234 not everyone thought my pancreas transplant was successful. I was not “cured” of my diabetes and I still am dependent on some insulin. BUT the transplant was like my own personal miracle. I can now keep blood sugar under decent control with very little insulin. The best thing was that I had hypoglycemic unawareness. My blood sugar would drop to dangerously low levels and I couldn’t feel it or correct it. This is gone now. Other complications of diabetes have reversed &/or stabilized. I had diabetic retinopathy that has reversed. I had peripheral neuropathy that reversed. I had autonomic neuropathy that has stabilized. I have CKD (chronic kidney disease) associated with diabetes. It was stabilized for a good 11 years. In the last 5 years my kidney function has started declining again. My transplant anniversary is coming up November 30th (16 years)! I am in pretty good shape for the shape I’m in and I thank God for this. Oh, immune suppression. I started out with Cellcept and Prograf. The team thought the Cellcept was causing anemia. It was changed to Rappamune. Awhile back it was dropped and not replaced with anything. The Prograf was changed to the generic Tacrolimus (1.5 mg in the am and 1 mg in the pm). Thank you for your questions. Ask again if you think of anything else. Blessings on your day.

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@cehunt57

@hello1234 not everyone thought my pancreas transplant was successful. I was not “cured” of my diabetes and I still am dependent on some insulin. BUT the transplant was like my own personal miracle. I can now keep blood sugar under decent control with very little insulin. The best thing was that I had hypoglycemic unawareness. My blood sugar would drop to dangerously low levels and I couldn’t feel it or correct it. This is gone now. Other complications of diabetes have reversed &/or stabilized. I had diabetic retinopathy that has reversed. I had peripheral neuropathy that reversed. I had autonomic neuropathy that has stabilized. I have CKD (chronic kidney disease) associated with diabetes. It was stabilized for a good 11 years. In the last 5 years my kidney function has started declining again. My transplant anniversary is coming up November 30th (16 years)! I am in pretty good shape for the shape I’m in and I thank God for this. Oh, immune suppression. I started out with Cellcept and Prograf. The team thought the Cellcept was causing anemia. It was changed to Rappamune. Awhile back it was dropped and not replaced with anything. The Prograf was changed to the generic Tacrolimus (1.5 mg in the am and 1 mg in the pm). Thank you for your questions. Ask again if you think of anything else. Blessings on your day.

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Hi @cehunt57 😊 After reading your note, I would DEFINITELY call your pancreas transplant a huge success! I am so happy to hear that you are celebrating your SIXTEEN YEAR post-transplant anniversary this month…that is awesome beyond words! I was also pleased to hear about the level of immune suppression drugs you are on. (It sounds like you are barely on anything now!). Your doctors obviously feel comfortable that your match is excellent and you need very little suppression to keep things going….and the bonus is you are no longer anemic as a side effect.
I am one year post kidney transplant and my liver enzymes are slightly elevated since the transplant and starting the meds. I have a liver ultrasound and fibroscan scheduled next Friday to check how my liver is doing and then they'll go from there. I will keep you posted.
Thank you so much @cehunt57 for sharing your wonderful pancreas transplant story!
Was your recovery difficult after your surgery and during your first year? I have heard that pancreas transplant recovery can be more difficult than kidney transplant. Is that true or did you have a fairly easy time the first year?

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@hello1234

Hi @cehunt57 😊 After reading your note, I would DEFINITELY call your pancreas transplant a huge success! I am so happy to hear that you are celebrating your SIXTEEN YEAR post-transplant anniversary this month…that is awesome beyond words! I was also pleased to hear about the level of immune suppression drugs you are on. (It sounds like you are barely on anything now!). Your doctors obviously feel comfortable that your match is excellent and you need very little suppression to keep things going….and the bonus is you are no longer anemic as a side effect.
I am one year post kidney transplant and my liver enzymes are slightly elevated since the transplant and starting the meds. I have a liver ultrasound and fibroscan scheduled next Friday to check how my liver is doing and then they'll go from there. I will keep you posted.
Thank you so much @cehunt57 for sharing your wonderful pancreas transplant story!
Was your recovery difficult after your surgery and during your first year? I have heard that pancreas transplant recovery can be more difficult than kidney transplant. Is that true or did you have a fairly easy time the first year?

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@hello1234 after 16 years some things about the pancreas transplant are hard to remember and some not at all. Initially the transplant was connected to my bladder supposedly for a place for pancreatic enzymes to be drained to and monitored to keep an eye on danger of rejection. These enzymes are digestive enzymes (you can find them in drain cleaners!) and they are corrosive. That was one thing that bothered me about the transplant. That part of the transplant didn’t sound like a good idea to me. (I’ve been told that method is no longer used.) Sure enough those enzymes really bothered my bladder. I started passing big clumps of blood in my urine. My transplant was 11/30/2005. In February or March of 2006 I had another surgery called an enteric conversion. The pancreas was taken out, disconnected from the bladder, everything cleaned out and put back in and reconnected to the colon, lower bowel or intestine (can’t remember the exact anatomy name). That was a tougher surgery than the original transplant. The other difficult thing that first year were the numerous labs and changes in immune suppression meds/doses and antibiotic & antiviral medications that are common early on post transplant. It took a lot of trial (and error) to figure out the right combination. Regarding anemia, it wasn’t concluded then that it was due to the pancreas transplant & immune suppression. I still have anemia that is thought to mainly be due to my CKD (chronic kidney disease). My doctors monitor that and treat as they feel necessary.
I am interested in your kidney transplant story. I have been told by my nephrologist that I will at some point need dialysis &/or kidney transplant. The thought of dialysis bothers me. Transplant does not. I have gone through the pre-transplant evaluation and been approved & accepted for kidney transplant. I got listed on UNOS through Mayo in Rochester. I have been looking for a living donor in the hopes of getting a preemptive transplant. My listing was changed to inactive because I am too healthy for transplant at this time! My GFR has bounced from 14 – 42 over the past 5 years and is currently 30. That is more of my story. Please tell me about yours.

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@hello1234

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!! 😊

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Thank you @hello1234. I’ve always been big on research, partially due to curiosity and also I’m a definite control freak, so it’s important to know about things that affect one’s life. Transplantation and autoimmune diseases present new opportunities for exploration! And, it is very interesting all of the similarities and differences between the types of transplants.

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