Transplant Flashcards
1
Q
Allograft
A
Transplant from one individual to another
2
Q
Isograft
A
Transplant from genetically identical donor
3
Q
Autograft
A
Transplant from same patient (e.g. skin grafting)
4
Q
Induction Immunosuppression
A
- Prevents acute rejection in early-post transplant
- Basiliximab is commonly used for induction but CANNOT be used in tx
- Antithymycyte globulin can be used for patients with higher risk for rejection and can be used as induction or treatment
5
Q
Atgem/Thymoglobulin
A
- Antithymocyte globulin (equine/rabbit respectively)
- Binds to T-cells and interferes with their function (depletes mature and immature T-cells)
- Can be used for induction and tx
6
Q
Antithymocyte Globulin Information
A
- Box Warning: anaphylaxis
- SE: infusion-related rxns (fever, chills, pruritis, decreased BP)
- Premedicate with benadryl, APAP, and steroids to lessen infusion-related rxns
7
Q
Basiliximab
A
- Interleukin-2 antagonist; monoclonal antibody that inhibits IL-2 on T-cells to prevent rejection
- Doesn’t deplete immature T-cells, therefore can’t be used for treatment
8
Q
Maintenance Immunosuppression
A
Combination of:
- Calcineurin inhibitor (Tacrolimus = first-line)
- Antiproliferative agent (Mycophenolate = first line, mostly)
- +/- Steroids (usually prednisone) - not needed in low immunologic risk pts
- *Suppressing mechanisms via different classes helps lower toxicity and reduce risk of rejection**
- Take ideally on empty stomach or be consistent about what you eat with meds
9
Q
Short-term Steroid SE
A
- Fluid Retention
- Upset stomach
- Emotional instability
- Insomnia
- Increased appetite
- Weight gain
- Acute risk in BG and BP
10
Q
Long-term Steroid SE
A
- Adrenal suppression/Cushing’s syndrome
- Impaired wound healing
- Increased BP
- Diabetes
- Acne
- Osteoporosis
- Impaired growth in children
11
Q
CellCept
A
- Mycophenolate Mofetil
- Antiproliferative agent, potential adjuvate to CNI
- Stable in D5W only
- Myfortic = mycophenolate acid (DR capsule, EC to help decrease diarrhea)
12
Q
Mycophenolate Information
A
- Box Warning: Increased risk of infection, lymphomas, skin malignancies, and congenital malformations/spontaneous abortion
- SE: diarrhea, GI upset
- Two formulations are NOT interchangeable
- Decreases efficacy of oral contraceptives
13
Q
Imuran
A
- Azathioprine (also Azasan)
- Antiproliferative agent, potential adjuvate to CNI
- Warning: patients with TPMT deficiency (increases risk for myelosuppression - box warning/SE)
- Avoid use with xanthine oxidase inhibitors (allopurinol, febuxostat)
- SE: GI upset
14
Q
Prograf
A
- Tacrolimus
- Calcineurin inhibitor (inhibits T-cell activation)
- Many formulations available
- Must be given exactly Q12H - draw trough right before next dose
15
Q
Tacrolimus Information
A
- Box warnings: increases susceptibility to infection and lymphomas
- SE: increase BP, nephrotoxicity, increased BG, neurotoxicity, hyperkalemia, hyperlipidemia, QT prolongation
- Monitor: trough level, electrolyte (K/Mg/Phos), renal function, LFTs, BP, BG, and lipids
- Don’t interchange XL and IR formulations
- IV must be non-PVC bag
- CYP3A4 and Pg substrate (MANY DDI)
16
Q
Gengraf/Neoral/Sandimmune
A
- Cyclosporine
- Calcineurin inhibitor
- First 2 brands = modified, last is non-modified (NOT interchangeable)
- Restasis is used for eye drops
17
Q
Cyclosporine Information
A
- Box Warning: renal impairment, increased risk of lymphoma and malignancies, infection, increase BP
- Don’t switch between modified and non-modified, modified has greater bioavailability
- SE: Increase BP, nephropathy, Hyper-K/Hypo-Mg, hirsutism, gingival hyperplasia, edema**, increase BG, neurotoxicity, and QT prolongation
- Monitor: trough, serum electrolytes, renal function, BP/BG, and lipids
- MANY DDI: CYP3A4i and CYP3A4/Pg substrate
- Don’t give in plastic or Styrofoam cup
18
Q
Everolimus
A
- mTOR kinase inhibitor, potential adjuvate to CNI
- Inhibits T-cell activation and proliferation
- Warning: Hyperlipidemia**
- SE: peripheral edema, increased BP, don’t use within 30 days of transplant
- Monitor: trough levels
- Numerous DDI: CYP3A4 substrate (decrease cyclosporine dose)
19
Q
Sirolimus
A
- mTOR kinase inhibitor, potential adjuvate to CNI
- Inhibits T-cell activation and proliferation
- Warning: impaired wound healing and hyperlipidemia**
- SE: Irreversible pneumonitis/bronchitis/cough (D/C if develops), increase BG, peripheral edema
- NOT used in liver/lung transplant
20
Q
Belatacept
A
- Binds to CD80 and CD86 to block T-cell costimulation and inflammatory mediator production
- Potential adjuvate to CNI
- Box warning: increased risk of post-transplant lymphoproliferative disorder (PTLD), use in EBV seropositive patients ONLY
- Warning: treat latent TB before use
21
Q
Caution w/ additive nephrotoxic drugs in…
A
- Tacrolimus
- Cyclosporine
- *CNIs - Monitor renal fxn**
22
Q
Caution w/ additive hyperglycemia drugs in…
A
- Tacrolimus**
- Cyclosporine**
- Steroids**
- mTORi
- *Monitor for new-onset diabetes**
23
Q
Caution w/ additive hyperlipidemia drugs in…
A
- mTORi - worst!
- Steroids
- Cyclosporine
- *Monitor lipid parameters**
24
Q
Caution w/ additive hypertensive drugs in…
A
- Steroids
- Cyclosporine
- Tacrolimus
- *Monitor for HTN**
25
Q
Acute Rejection
A
- Arises from T-cell (cell-mediated) or B-cell related mechanisms (humoral or antibody)
- Biopsy is necessary to determine type of rejection and pick tx
- Initial approach is always high-dose steroids and increased maintenance medications
26
Q
Vaccines
A
- Influenza (inactivated), annually
- PCV13 if never received and 19 yo+, then PPSV23 at least 8 weeks later (potentially PPSV23 Q5y)
- Varicella: administer before transplant and give to all close-contacts, if rash develops quarantine unless you are the transplant patient, then see provider right away
27
Q
Labs for Preventing Graft Rejection
A
Need to crossmatch:
- HLA
- ABO
PRA: panel reactive antibody, how sensitized patient’s body is (likelihood they would attack transplant)
