Transplant Flashcards
Induction immunosuppression
antithymocyte globulin (Atgam- Equine)
(Thymoglobulin-Rabbit) - can be used for induction and treatment
Basiiximab (simulect) - inhibits IL-2 receptor on T lymphocytes
high dose IV steroids
Maintenance immunosuppression
calcineurin inhibitor (or Belatacept) + antiproliferative agent +/- steroids
systemic steroids
prednisone
antiproliferative agents
-inhibit T- and B- lymphocyte proliferation by altering purine nucleotide synthesis
-Mycophenolate Mofetil (CellCept)
-Mycophenolic Acid (Myfortic)
-Azathioprine (TPMT deficiency - Increase risk of myelosuppression)
-increased risk of infection, lymphoma, skin malignancies
*cell cept and myfortic ARE NOT INTERCHANGEABLE
*Myfortic is EC to reduce diarrhea
*Cell cept IV is compatible in D5
*decreases efficacy of oral contraceptives
calcineurin inhibitors: Tacrolimus (Prograf)
-increase susceptibility to infection
-increased BP, nephrotoxicity, increased BG, neurotoxicity, hyperkalemia, HLD
-specific trough levels (3-15)
*IV must be in non-PVC bag
*do not interchage XL and IR
Calcineurin inhibitors: cyclosporine
-modified: Gengraf, Neoral
-non-modified: Sandimmune
mTOR
everolimus, sirolimus
nephrotoxicity
tacrolimus and cyclosporine
worsening or new onset diabetes
tacrolimus, steroids, and cyclosporine
worsening lipid parameters
mTOR inhibitors, steroids, and cyclosporine
HTN
steroids, cyclosporine, and tacrolimus
Vaccines
-required vaccines are given pre-transplant if not up-to-date
-inactivated vaccines can be given 3-6 months post-transplant (once the immune system recovers from the induction immunosuppression) except for the influenza vaccine which can be administered 1 month post transplant
important vaccines for transplant patients
-flu annually
-pneumococcal
-varicella
