Management of Immunosuppresive therapy and complication

Question 1

Transplant: When examiner ask you about whether she would be a candidate for transplant?
This is how you could potentially answer the question.

Answer 1

I have reservation about her transplant candidancy considering that she is
- socially isolated with only her husband and daughters as local support and she is at risk of losing her husband with his recent diagnosis.
- She also has a history of depression, obesity and diabetes with macrovascular complications which will be difficult to manage with steroids as immunosupression.
-In addition to that, she already has a history of chronic recurrent infections.

Question 2

Medications safe for pregnancy

Answer 2

Steroids
HCQ
Sulphasalazine- in men reduced sperm motility ( stop 3 months prior)

Question 3

Medication Not to be used / Avoided in pregnancy

Answer 3

Methotrexate
Mycophenate
Azathioprine- relatively safer than other if required
Rituximab
Leflunomide
Cyclophosphamide- not good in early pregnancy- result in fetal abnormality.