Transplant

Question 1

Sirolimus (rapamycin)

Answer 1

mTOR inhibitor –> arrests T-lymphocytes in the G1 phase –> prevent proliferative response to immune stimuli

Question 2

Rituximab

Answer 2

Monoclonal antibody against CD20 found on B cells

Question 3

Names of Calcineurin inhibitors (2)

Answer 3

Cyclosporine

Tacrolimus (FK 506)

Question 4

MOA of calcineurin inhibitors

Answer 4

Inhibit production of IL 2 –> suppress activation of T-lymphocytes

Question 5

Adverse effects of calcineurin inhibitors

Answer 5

Neuro: Seizures, tremors, vivid dreams
Electrolytes: Hyperkalemia, Hypomagnesemia
Endo: Hyperglycemia and alopecia (tacrolimus)
GI: N/V/D
HTN
HLD

Question 6

Sirolimus (rapamycin) side effects

Answer 6

Edema
Impaired wound healing
hypercholesterolemia
hypertriglyceridemia

Question 7

MOA of Antithymocyte globulin (ATG)

Answer 7

destroy T-lymphocytes via antibody-dependent cellular toxicity. used for induction.

Question 8

ATG side effects

Answer 8

Infusion reaction: Fever, chills, rigors, itching, hypotension –> Consider decreasing rate of infusion
- May be as severe as pulm edema, serum sickness, anaphylaxis

Question 9

Management of antibody-mediate rejection

Answer 9

a. anti-b cell therapy (anti-CD20, anti-CD40)
b. antibody-depletion or reconstitution therapies (e.g., plasmapheresis or IVIG)
c. steroid pulses to suppress T/ B lymphocyte function
d. antiproliferative therapies
e. bone marrow irradiation to suppress lymphopoiesis

Question 10

Criteria for usage of donor cardiac allografts

Answer 10

a. Good biventricular allograft function
b. No significant coronary artery or valve disease

• LV hypertrophy (wall thickness >1.4 cm) adversely affects postimplantation ventricular function.
• Male donor heart implanted into a female recipient is likely to function well