Special Populations: Transplant Flashcards
Universal donor blood type
Type O
Universal received blood type
Type AB
Allograft
transplant of an organ or tissue from one individual to another
Isograft
transplant from a genetically identical donor = identical twins
Autograph
transplant from same patient, from one site to another
Commonly used induction immunosuppression
Basiliximab (Simulect)
IL-2 receptor antagonist
Patients at high risk of rejection that dont get Simulect could get…..
Atgam
Maintenance of immunosuppression
- Calcineurin inhibitor, CNI (Tacro first line)
- Antiproliferative (Mycophenolate or azathioprine, Myco 1st line)
- with or without steroids, usually prednisone
CNI medicaitons
Cyclosporine
Tacrolimus
Cyclosporine boxed warnings
Nephrotoxicity
inc risk of lymphoma
inc risk of infection
inc BP
Can you use modified and non-modified cyclosporine interchangeably?
no
Cyclosporine Side effects
inc BP
nephropathy
hyperkalemia
hypomagnesemia
hirsutism
gingival hyperplasia
edema
inc BG
neurotoxicity
QT prolongation
Cyclosporine monitoring
trough lvls
serum electrolytes
renal function
BP
BG
lipid profile
Tacrolimus boxed warning
inc susceptibility to infection
possible development of lymphoma
Tacrolimus side effects
inc BP
nephrotoxicity
alopecia
QT prolongation
Hyperlipidemia
hyperkalemia
Tacrolimus monitoring
trough lvls
serum electrolytes
renal function
LFTs
BP
BG
lipid profile
Mycophenolate Mofetil (CellCept) & Mycophenolic Acid (Myfortic) Boxed warning
inc risk of infection
lymphoma and skin malignancies
inc risk of congenital malformations and spontaneous abortions
Mycophenolate side effects
Diarrhea
GI upset
Myfortic is enteric coated = decreased diarrhea
Azathioprine Boxed warning
inc risk of malignancy
hematologic toxicities
mutagenic potential
Everoliumus (Zortress) MOA
mTOR kinase inhibitors = inhibit T-lymphocyte activation/proliferations. can be synergistic with CNIs
Everolimus Boxed warnings
inc risk of infection and cancers
reduced dose when used with cyclosporine
Everolimus warnings
Hyperlipidemia
impaired wound healing
Everolimus side effects
Peripheral edema
inc BP
N/V/D
dont use within 30 days of transplant
Everolimus monitoring
trough lvls
renal functions
LFTs
Sirolimus warnings
impaired wound healing
hyperlipidemia
angioedema
Sirolimus side effects
irreversible pneumonitis/bronchitis/cough = d/c if develops
inc BG
peripheral edema
Prednisone short term side effects
fluid retention
stomach upset
emotional instability
insomnia
inc appetite
weight gain
acute rise in BG and BP w/ high doses
Prednisone long term side effects
adrenal suppression/Cushing’s syndrome
impaired wound healing
inc BP
Diabetes
acne
osteoporosis
impaired growth in children
Belatacept (Nulojix) boxed warnings
inc risk of post-transplant lymphoproliferative disorder (PTLD)
use in EBV seropositive patients only
Belatacept (Nulojix) warnings
treat latent TB prior to use
Azathioprine with Xanthine oxidase inhibitors
CI w/ febuxostat
if using w/ allopurinol, reduce azathioprine dose by 75%
How to treat acute cellular rejection
give high-dose steroids and inc lvls of maintenance immunosuppression
ATGAM givne for steroid resistant or more aggressive ACR.
can use alemtuzumab off-label
Antibody-mediated rejection (AMR) treated with….
plasmapheresis and admin of IVIG and steroids, followed by dose of Rituxmab
