Table 1.

Immunosuppressive adverse effects scoring system with gastrointestinal and aesthetic adverse effects

Gastrointestinal adverse effects a
Vomiting
0:	None
1+:	Minimal vomiting
2+:	Excessive vomiting requiring symptomatic treatment
Diarrhea
0:	None
1+:	One loose bowel movement per day
2+:	Two to five loose bowel movements per day
Dyspepsia
0:	None
1+:	Episode of indigestion within one hour after taking immunosuppressive medication
2+:	Indigestion for at least half the day
3+:	Indigestion the majority of the day requiring symptomatic treatment
Acid suppressive therapy
0:	None
1+:	Daily use of a histamine-2 receptor antagonist OR a proton pump inhibitor
2+:	Daily use of a histamine-2 receptor antagonist AND a proton pump inhibitor
Aesthetic adverse effects a
Acne
0:	None
1+:	Lesion restricted to face, no specific treatment
2+:	Numerous facial lesions; lesions of upper trunk
3+:	Grade II and topical treatment
4+:	Grade II and systemic treatment
Skin changes
0:	No change
1+:	No gross change but easy bruising
2+:	Obvious thinning multiple or frequent ecchymoses
3+:	Grade II and easy sloughing and/or striae; lacerations
Hirsutism
0:	None
1+:	New hair growth anywhere
2+:	Marked increase in hair growth with noticeable change in appearance
3+:	Grade II and use of depilatories or shaves
Moon facies
0:	No change
1+:	Rounding of jaws barely detected
2+:	Marked rounding with noticeable change in appearance
3+:	Grade II with plethora
Gingival hyperplasia
0:	Absent
1+:	Some hyperplasia
2+:	Severe hyperplasia and bleeding
Buffalo hump
0:	Absent
1+:	Present

^a The scoring system presents a quantitative severity rating of the most common adverse effects of immunosuppressive therapy. Each adverse effect was assessed as a change from pre-transplant status to document that the manifestation was attributed to immunosuppressive therapy or a change related therapy in the post-transplant period.