Post Transplant Complications Flashcards
Preemptive
Least favorable method Do nothing until trigger CMV (PCR over 600) Aspergillus BK (polyoma virus)
Indicators for High Risk of Post-Transplant Infection
Depleting Immunosuppressants High pulse dose steroids Plasmapheresis Early Rejection Graft dysfxn Surgical complications Prolonged use of medical devices
Indicators for Low Risk of Post-Transplant Infection
Good HLA match Good surgery Good graft function Good surgical prophylaxis Effective transplant prophylaxis Appropriate pretransplant vax
Common viral infxns post-transplant
HSV CMV EBV VZV Polyoma Virus (BK,JC, SV40) Flu A/B Adenovirus Parvovirus WNV
Common bacterial/fungal infxns post-transplant
Nocardia MycoTB NonTB Myco Candida Aspergillis Crypto PCP Reactivation Mycosis (histo)
Causes of high risk for immunosuppression
tx of rejection
depleters
3 inducers vs 2
prev tx chemo, broad abx, etc.
Common pathogens in hospital for post-transplant pt
MRSA
VRE
Candida
C.diff
Common pathogens 1-6 mo w/o prophylaxis
Pneumo HSV VZV CMV EBV HBV
Px for bacterial infxns post transplant
SMX/TMP SS daily x 1 yr
- **DAILY for KIDNEY
- **MWF for Liver
Px for fungal infxns post transplant
Clotrimazole/Nystatin TID x 10 days
x3 months for liver
Px for bacterial infxns with sulfa allergy post transplant
atovaquone
dapsone
pentamidine
-ALL 1 YEAR (same as bacterium SS)
High risk pt for CMV will chart
(+/-)
Intermediate risk pt for CMV will chart
(+/+) or
+/-
Px for CMV (+/-)
Valgancyclovir 900 daily x 6 MONTHS
Px for CMV (+/+) or (-/+)
Valgancyclovir 900 daily x 3 MONTHS
Px for CMV (-/-)
Acyclovir 400 BID x 3 months
If CrCl below 25 use half dose
-200 BID x 3 months
Px for CMV with renal impairment
Use Valgancyclovir 450 CrCl 40-60 BID CrCl 25-40 QD CrCl 10-24 q48 hours x3 mo or x6mo for high risk
Valgancyclovir also px against
HSV 1 and 2
EBV
VZV
Drugs causing HTN in post transplant pts
CSA, CCS, mTOR
Use TAC instead of CSA
When do we use CSA?
CSA is pretty much only used when pt is at high risk for NODAT
Goal BP post transplant
140/90
130/80 DM or proteinuria
Drug that causes post transplant dyslipidemia
mTORi
Drug that causes NODAT
TAC
Best maint. regimen for post transplant dyslipidemia
TAC/MMF/Pred
Best maint. regimen for post transplant NODAT
CSA/MMF/Pred (rapid taper)
Avoid TAC if 3+ DM RFs
DM RFs
3 or more = high risk (use CSA) Hep C 40+ yr old AA/Hispanic BMI 30+ Family hx Prior DM hx
Target lipid levels for kidney transplant
TC below 200
LDL below 100
TG below 150
HDL above 40
Tx of post transplant dyslipidemia
Statins (avoid simvistatin if on CSA) DO NOT EXCEED Lova 20 Flvau 40 Rosuva 5 Prava titrate slowly Atorva titrate slowly
Dgx criteria for NODAT
Fasting Glu above 126
Glu or 2 hr fast Glu above 200
Tx of post transplant NODAT
Tx like normal DM
Oral GLIPIZIDE
Lantus/insulin
Tapper CCS w/in 1-2 wks
Drugs that cause diarrhea
MMF
Drugs that decrease GFR
CNIs
TAC is better on kidneys
CSA constricts the AA of the glomerulus
Maint regimen for a 50 y/o AAM with Hep C and a BMI of 31
CSA/MMF/Pred (rapid taper)
NO TAC b/c 3+ DM RFs: Age 40+ BMI 30+ Hep C AA/Hispanic Family/personal DM hx
Maint regimen for pt with TC over 200, LDL over 100, TG over 150, and HDL below 40
CSA/MMF/Pred Same maint regimen. No Simvastatin since taking CSA Can take up to: Lova 20, Fluva 40, Rosuva 5, Atorva/Prava titrate slowly
