Transplant

Question 1

Testing

Answer 1

1) HLA

2) ABO Blood Type

Question 2

Induction Immunosuppression Tx

Answer 2

Given BEFORE transplant

1) Basiliximab (Simulect)

2) Antithymocyte Globulin (Atgam / Thymoglobulin)
- premedicate for infusion reactions

Question 3

Maintenance Immunosuppression Tx

Answer 3

1) Calcineurin Inhibitors (CNI): Tacrolimus, cyclosporine
2) Adjunct to CNI = Antiproliferative: Mycophenolate

3) +/- Steroids: Prednisone

Question 4

Tacrolimus Brand / ADRs

Answer 4

Calcineurin Inhibitor (CNI)

Prograf / Astagraf XL / Envarsus XR

Take on EMPTY STOMACH!

Dose: Q12H

ADRs:

• Nephrotoxicity*
• Hyperglycemia*
• HTN*
• Neurotoxicity
• Hyperkalemia
• QT prolongation

DDI:

• CYP3A4 & Pgp SUBSTRATE
• Avoid Alcohol

Question 5

Mycophenolate Brands / ADRs

Answer 5

CellCept (mofetil)
Myfortic (acid) = enteric coated; less diarrhea

Take on EMPTY STOMACH!

ADRs:

• Cancer Risk = Lymphoma & Skin malignancies
• Decreases Oral Contraceptives
• Pregnancy X

Question 6

Azathioprine

Answer 6

Imuran

CI: TPMT Deficiency, allopurinol / febuxostat

Question 7

Cyclosporine

Answer 7

Calcineurin Inhibitors (CNI)

Gengraf & Neoral (Modified)
Sandimmune (Non-modified)

Do NOT use plastic or styrofoam with liquids:

1) Neoral = OK juice (NOT milk)
2) Sandimmune = OK juice or milk

ADRs:

• same as Tacrolimus
• gingival hyperplasia
• hirsutism

DDI:
- CYP3A4 & Pgp

Question 8

mTOR Inhibitors

Answer 8

Everolimus (Zortress) = decrease dose of Cyclosporine
Sirolimus (Rapamune)

ADR:
- HYPERLIPIDEMIA!