Transplant Therapy Procedures Flashcards
I honestly have no idea what else to name this
Goals of therapy
Suppression of the immune response of recipient to donor transplanted organ
Multiple drug regimen approach employed
Use of multiple drugs with different MoAs
Minimize long-term drug-related drug adverse effects
What happens if you give too little of a dose?
Organ rejection
What happens if you give too much of a dose?
ADEs, infection
3 phases of immunosuppressive pharmacotherapy
Induction, maintenance, rejection
Pre-transplant induction therapy
Induction agent
IV bolus of methylprednisone sodium succinate
MPA dose
Days 0-7 post-transplant therapy
Few doses of induction agent, then D/C it
IV MEPN changed to PO prednisone with taper
MPA dosing
Low dose CNIs
Maintenance dosing therapy
MPA
CNI doses titrated with TDM
Prednisone taper
Monitor allograft function and ADEs
Purpose of induction immunosuppression
Prevents organ rejection process from initiating at transplant and immediately on organ placement
Induction therapy advantages
May improve early graft function, prevent rejection, and improve survival
Induction therapy disadvantages
May increase costs and risk of cytomegalovirus infection and post-transplantation lymphoproliferative disease
What does induction therapy do?
Block T-cell activation or other immunologic activation at the time of graft placement
Induction therapy drugs
ATG, ATGAM, IL-2 receptor blocker, alemtuzumab (Campath)
MMF or azathioprine
Glucocorticoids at high doses with rapid taper
Delayed use or low doses of CNIs
Thymoglobulin is what kind of immunosuppression therapy?
Depleting induction
Thymoglobulin dosing
IV infusion q4-6h for 2-4 daily doses
Thymoglobulin MoA
Coat the host’s T-cells in the blood and then they get destroyed by complement system
Thymoglobulin ADEs
flu-like syndromes on first dose due to cytokine release syndrome; leukopenia, lymphopenia, thrombocytopenia, pruritus, erythema, serum sickness
What can be done to minimize ADEs from thymoglobulin?
Premedicate with APAP and diphenhydramine
IL-2 receptor blockers
Basiliximab (Simulect) and daclizumab (Zenapax)
Basiliximab brand name
Simulect
Daclizumab brand name
Zenapax
IL-2 receptor blockers MoA
Against CD25 which will prevent activated T-lymphocyte proliferation
IL-2 receptor blockers ADEs
N/V/D
What kinds of patients are IL-2 receptor blockers used in?
Low-risk patients
What kind of immunosuppression therapy are basiliximab and daclizumab?
NON-depleting induction therapy
Alemtuzumab brand name
Campath
What kind of immunosuppression therapy is Campath?
Depleting induction therapy
Campath MoA
Directly against the CD52 surface antigen expressed on ALL lymphocytes, NK cells, macrophages, eosinophils, male reproductive system
Campath clinical uses
B-cell chronic lymphocytic leukemia and MS
Induction agent is an off-label use
What kinds of patients is Campath used in?
High-risk patients
Campath ADEs
HAMA reactions, fever, rigors, N/V/D, hypotension, profound lymphopenia and neutropenia, thrombocytopenia, increased risk of malignancy, infection, or autoimmune reactions
Campath dosing
2 doses or one IV dose over 2-3 hours
Purpose of maintenance immunosuppression
Achieve a less intense suppression of the immune system over a longer duration
Factors to consider for maintenance therapy
Deceased or living donors, prior transplants, ADEs, HLA mismatch, number of acute rejections, compliance, drug costs
Rejection therapy
Management of the immunologic rejection process which can be acute or chronic in order to preserve organ function
