Transplant

Question 1

What does Allograft mean?

Answer 1

It is the transplant of an organ or tissue from one individual to another of the same species with different genotype.

Question 2

What dose Isograft mean?

Answer 2

It is the transplant of an organ or tissue made between twins.

Question 3

What dose Autograft mean?

Answer 3

It is the transplant of an organ or tissue between the same person, from one location to another.

Question 4

When is Induction Immunosuppression given?

Answer 4

Given before or at the time of transplant to prevent acute rejection

Question 5

What is the most common Induction Immunosuppression?

What is it’s alternative for patient at high risk of rejection?

Answer 5

Class: Interleukin-2 (IL-2) receptor antagonist
- Basiliximab

Alternative:

Class: Antithymocyte globilins

• Atgam
• Thymogloblin

Question 6

Interleukin-2 (IL-2) receptor antagonist MOA

Answer 6

Chimeric (murine/human) monoclonal antibody that inhibits the IL-2 receptor on the surface of activated T-lymphocytes preventing cell-mediated allograft rejection

Question 7

What are the drug classes used in Maintenance Immunosuppression

Answer 7

• Calcineurin inhibitor (CNI) - always given

Adjuvant agent to CNI:

• Anti-proliferative agents
• mTOR kinase inhibitor
• Belatacept
• Steroids (Prednisone)

Question 8

Agents of Calcineurin inhibitor (CNI)

Answer 8

• Tacrolimus (Prograf); first line
• Cycloporine

Note: Cycloporine is also Restasis for dry eyes and also a DMARD Immunomodulator

Question 9

Agents of Anti-proliferative agents

Answer 9

• Mycophenolate (CellCept); first line

- Azathioprine (Imuran)

Question 10

Anti-proliferative agents BBW

Answer 10

• Increased risk of infection
• Increased risk of lymphoma and skin malignancies
• Increased risk of congenital malformation and spontaneous abortions

Question 11

Anti-proliferative agents ADE

Answer 11

• Diarrhea

- GI upset

Question 12

Calcineurin inhibitor (CNI) BBW

Answer 12

• Increased risk of infection
• Increased risk of lymphoma and skin malignancies
• Renal impairment with high dose of Cycloporine

Question 13

Calcineurin inhibitor (CNI) AED

Answer 13

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

Question 14

Calcineurin inhibitor (CNI) monitoring

Answer 14

• Trough levels
• Electrolytes (K, Phos, Mg)
• Renal function
• LFT
• Blood glucose
• Lipid profile

Question 15

mTOR kinase inhibitor MOA

Answer 15

Inhibit T-Lymphocyte activation and proliferation

May be synergistic with CNIs

Question 16

mTOR kinase inhibitor agents

Answer 16

• Everolimus (Zortress)
• Sirolimus

Note: Everolimus (Afintor) is also used in the treatment of breast, pancreatic, neuroendocrine and renal cancer

Question 17

Belatacept MOA

Answer 17

Binds to CD80 and CD86 to block T-cell co-stimulation and production of inflammatory mediators

Question 18

Sirolimus ADE

Answer 18

Impairs wound healing

Question 19

Which immunosuppression have high risk of Nephrotoxicity?

Answer 19

• Tacrolimus (Prograf)

- Cycloporine

Question 20

Which immunosuppression have high risk of worsening or new onset Diabetes?

Answer 20

• Tacrolimus (Prograf)
• Cycloporine
• Steroid

Question 21

Which immunosuppression have high risk of worsening lipid parameters?

Answer 21

mTOR kinase inhibitor:

• Everolimus (Zortress)
• Sirolimus
• Steroids
• Cycloporine

Question 22

Which immunosuppression have high risk of HTN?

Answer 22

• Tacrolimus (Prograf)
• Cycloporine
• Steroid

Question 23

What is the initial approach in treating acute rejection in transplant patient?

Answer 23

High-dose steroids

Question 24

What are the important vaccines which need to be administered to transplant patients?

Answer 24

• Influenza
• Pneumococcal
• Varicella

Question 25

Tacrolimus (Prograf) clinical pearl

Answer 25

Take on an empty stomach