Renal transplantation 2 Flashcards
What is the treatment given to patients following a kidney transplant in general terms ?
Immunosuppressive treatment
What are the 3 classes of immunosuppressive treatment given to patients following a transplant ?
- Calcineurin Inhibitors - Cyclosporin and Tacrolimus
- Azathioprine and Mycophenolate
- Steroids
What is the action of Calcineurin Inhibitors?
Act by inhibiting activation of T helper cells this:
- Reduces NK and cytotoxic T cell activation
- Decrease cytokine release so prevent B cell proliferation and antibody production
What are some of the side effects of calcineurin inhibitors ?
- Renal Dysfunction,
- Hypertension,
- Diabetes,
- Tremors
What is the action of Azathioprine and Mycophenolate?
- Antimetabolites by blocking purine synthesis
- Leads to suppression of proliferation of lymphocytes and B cells (so good for antibody mediated rejection)
What are the side effects of azathioprine and mycophenolate ?
- Leucopaenia (low WBC’s)
- Anaemia
- GI side effects
What drug must azathioprine not be given along side and why?
- Must not be given along side allopurinol
- As it increases the activity of azathioprine by x 30 which then causes aplastic anaemia and very bad leucopaenia which is really bad for someone already at risk of infections
What is the action of steroids in immunosuppresion ?
Act non selectively to suppress activity of T cells and proliferation of B cells.
What are the side effects of steroids ?
- Osteoporosis
- Weight Gain
- Infection
- Diabetes
What is the immunosuppressive treatment of patients following a kidney transplant ?
Induction therapy (so initially) - Steroids, mycophenolate, cyclosporin, tacrolimus, antibodies
Consolidation therapy - Steroids, mycopheonlate, cyclosporin, Tacrolimus
Maintenance therapy - Steroids, myclophenolate, cyclosporin, Tacrolimus
What are some of the reasons a graft can be lost in more long term?
- Chronic rejection
- Recurrent disease
- Cyclosporine/ Tacrolimus toxicity
- Ischaemia
When should a cyclosporin level be checked?
As a trough level at least 8hrs post-dose.
What antibiotics should not be given to someone on tacrolimus and why ?
Do not give macrolides to someone on tacrolimus because they cause increased tacrolimus levels which turn increases K+ and Cr levels which are very toxic to the kidney. This is especially important if this is someone’s transplanted kidney.
