Immunosuppression side effects

Question 1

Prednisolone (6)

Answer 1

• Immune suppression
• Bone
• Weight
• Diabetes
• Skin
• GI

(CVD)

Question 2

CNI (5)

Answer 2

• Tremor
• Mood
• Hypertension
• Nephrotoxic (vasoconstriction of afferent ateriole)
• Neurotoxic

Question 3

Approach to risk of rejection (5)

Answer 3

• r/v baseline renal function - graft function *compare to present
• HLA mismatch
• DSA sensitising events
• Previous renal biopsies - protocol/past rejection episodes
• Adherence/absorption problems

Question 4

Steroids (9)

Answer 4

• Insomnia
• Mood
• Altered fat
• Cataracts
• Oedema
• Diabetogenic
• OP
• HTN
• Hchol

Question 5

mTOR Inhibitor

Answer 5

• Impaired wound healing *if major OT - switch to CNI for OT before changing back to mTOR I
• Hyperlipidaemia
• Oedema
• Proteinuria - d/t podocyte dysfunction
• Pneumonitis - esp sirolimus
• Cytopenia

Question 6

MMF

Answer 6

• Diarrhoea
• Cytopenia
  *Teratogenic

Question 7

Azathioprine

Answer 7

• Cytopenia

Question 8

CNI (10)

Answer 8

• Neurotoxicity
• Tremor
• Diabetogenic
• Cytopenia
• Nephrotoxic
• Increase uric acid
• Hyperlipidaemia
• HTN
• Hyperkalaemia - distal RTA - aldosterone R in distal nephron
• Hypomagnesemia

Question 9

Tacrolimus (1)

Answer 9

• Alopecia

Question 10

Cyclosporin (1)

Answer 10

• Gingival hyperplasia

Question 11

Infection risk - highest in early Tx period when IS is highest

Answer 11

• Any infections - CAP/UTI/Flu
• Viruses: CMV, EBV, HSV, BK, JC, Varicella
• Toxo: parasite
• Candida, PJP, Aspergillus
• Nocardia

Question 12

Dapsone

Answer 12

• PJP
• Toxo

Question 13

Bactrim

Answer 13

• PJP
• Nocardia
• Toxo

Question 14

Pentamidine

Answer 14

• PJP

Question 15

Valganciclovir SE

Answer 15

• Leucopenia

Question 16

Live vaccines

Answer 16

• MMR
• VZV
• BCG
• Yellow fever

Question 17

Malignancy risk increases by 3-5x!

Answer 17

• D/t cellular immunity suppressing cancer cells and viruses

Question 18

Oncogenic viruses (3)

Answer 18

• HPV - Cervical, SCC
• EBV - PTLD - high mortality - RF: ATGAM
• HHV 8 - KS

Question 19

Skin cancer - duration and intensity of IS

Answer 19

• SCC - UV light

Question 20

Cancer screening

Answer 20

• Annual skin check by dermatologist
• Mammogram
• PAP smear
• FOBT (C’scope > FOBT)
• RCC - TS, VHL
• HCC - if HCV, HBV - 6/12 USS + AFP

*Prev history of malignancy

Question 21

Infection approach (5)

Answer 21

1) Vector avoidance
2) Vaccinations
3) Prophylactic antibiotics
4) Appropriate immunosuppression
5) Prompt management of infective episodes - involve GP, early presentation to ED

Question 22

Pregnancy safe IS (4)

Answer 22

• Prednisolone
• Tacrolimus
• Cyclosporin
• Azathioprine

Question 23

Teratogenic (3)

Answer 23

• MMF
• mtor-I
• MTx

Question 24

MTx SE (8)

Answer 24

• Lung fibrosis
• Liver cirrhosis
• Skin Cx
• Teratogenic
• Infection
• Mouth ulcers
• Alopecia
• Pneumonitis