Transplant medications

Question 2

Tacrolimus

Answer 2

Calcineurin inhibitor
Used to prevent rejection in solid organ transplant

Adverse effects:
Nephrotoicity, can lead to acute renal failure
CVS:HTN, arrythmias
Neurological: tremors, insomnia, bad dreams, headaches
Hepatic: abnormal LFTs
Increased risk infection inc HSV, CMV, EBV, BK virus, bacterial infections, candidiasis
Electrolyte derangement

Tacrolimus is a narrow therapeutic index drug. Therapeutic monitoring of tacrolimus in transplant patients is a valuable tool in adjusting drug levels. Since tacrolimus use is typically in combination with other immunosuppressants, target levels usually decrease as post-transplant time increases to minimize calcineurin inhibitor-mediated nephrotoxicity and adverse effects.[16] Whole blood concentrations should be used, drawn typically within 30 minutes before the next dose.

Also need to monitor:renal function, hepatic function, serum electrolytes (Mg, Phos, K), glucose, and blood pressure. Parameters should initially be measured two to three times a week post-operatively, gradually decreasing as time passes, achieving target levels, and patient stabilization.

Tacrolimus toxicity commonly presents as acute renal failure. Close monitoring of serum creatinine, GFR, and urine output is necessary for patients on tacrolimus.

Toxicity may also present as the development of adverse effects such as tremors, electrolyte disturbances, headaches, and increased SCr.

Question 3

Mycophenolate mofetil (MMF)

Answer 3

Anemia

Question 4

Prednisolone

Question 5

Transplant/long term immunosuppression considerations

Answer 5

• ?rejection/complications
• Medication side effect (eg tacro- HTN, dyslipidemia, nephrotoxicity, neurotoxicity, hypomag)
• avoid NSAIDs and other nephrotoxic drugs
• risk PTLD
• Ensure medication complicance to reduce risk infection
• Effects of frequent hospitalisation
• Growth and development
• More prone to EoE due to immune suppression
• Social situation/locality/finance issues
• ?local health networks /local supports
• Diet/water/sun care - due to nephrotoxic drugs and risk of skin cancers
• Transition in adolescence when age 15+, needs MDT input
• Encourage activity but no contact sports
• Extra vaccines - influenza, pneumococcal and tetanus
• All catch up vaccines and live vaccines given before transplant; live vaccines such as MMR and varicella cannot be given after any solid organ transplant