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
