Transplant Therapy Procedures

Question 1

Goals of therapy

Answer 1

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

Question 2

What happens if you give too little of a dose?

Answer 2

Organ rejection

Question 3

What happens if you give too much of a dose?

Answer 3

ADEs, infection

Question 4

3 phases of immunosuppressive pharmacotherapy

Answer 4

Induction, maintenance, rejection

Question 5

Pre-transplant induction therapy

Answer 5

Induction agent
IV bolus of methylprednisone sodium succinate
MPA dose

Question 6

Days 0-7 post-transplant therapy

Answer 6

Few doses of induction agent, then D/C it
IV MEPN changed to PO prednisone with taper
MPA dosing
Low dose CNIs

Question 7

Maintenance dosing therapy

Answer 7

MPA
CNI doses titrated with TDM
Prednisone taper
Monitor allograft function and ADEs

Question 8

Purpose of induction immunosuppression

Answer 8

Prevents organ rejection process from initiating at transplant and immediately on organ placement

Question 9

Induction therapy advantages

Answer 9

May improve early graft function, prevent rejection, and improve survival

Question 10

Induction therapy disadvantages

Answer 10

May increase costs and risk of cytomegalovirus infection and post-transplantation lymphoproliferative disease

Question 11

What does induction therapy do?

Answer 11

Block T-cell activation or other immunologic activation at the time of graft placement

Question 12

Induction therapy drugs

Answer 12

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

Question 13

Thymoglobulin is what kind of immunosuppression therapy?

Answer 13

Depleting induction

Question 14

Thymoglobulin dosing

Answer 14

IV infusion q4-6h for 2-4 daily doses

Question 15

Thymoglobulin MoA

Answer 15

Coat the host’s T-cells in the blood and then they get destroyed by complement system

Question 16

Thymoglobulin ADEs

Answer 16

flu-like syndromes on first dose due to cytokine release syndrome; leukopenia, lymphopenia, thrombocytopenia, pruritus, erythema, serum sickness

Question 17

What can be done to minimize ADEs from thymoglobulin?

Answer 17

Premedicate with APAP and diphenhydramine

Question 18

IL-2 receptor blockers

Answer 18

Basiliximab (Simulect) and daclizumab (Zenapax)

Question 19

Basiliximab brand name

Answer 19

Simulect

Question 20

Daclizumab brand name

Answer 20

Zenapax

Question 21

IL-2 receptor blockers MoA

Answer 21

Against CD25 which will prevent activated T-lymphocyte proliferation

Question 22

IL-2 receptor blockers ADEs

Answer 22

N/V/D

Question 23

What kinds of patients are IL-2 receptor blockers used in?

Answer 23

Low-risk patients

Question 24

What kind of immunosuppression therapy are basiliximab and daclizumab?

Answer 24

NON-depleting induction therapy

Question 25

Alemtuzumab brand name

Answer 25

Campath

Question 26

What kind of immunosuppression therapy is Campath?

Answer 26

Depleting induction therapy

Question 27

Campath MoA

Answer 27

Directly against the CD52 surface antigen expressed on ALL lymphocytes, NK cells, macrophages, eosinophils, male reproductive system

Question 28

Campath clinical uses

Answer 28

B-cell chronic lymphocytic leukemia and MS

Induction agent is an off-label use

Question 29

What kinds of patients is Campath used in?

Answer 29

High-risk patients

Question 30

Campath ADEs

Answer 30

HAMA reactions, fever, rigors, N/V/D, hypotension, profound lymphopenia and neutropenia, thrombocytopenia, increased risk of malignancy, infection, or autoimmune reactions

Question 31

Campath dosing

Answer 31

2 doses or one IV dose over 2-3 hours

Question 32

Purpose of maintenance immunosuppression

Answer 32

Achieve a less intense suppression of the immune system over a longer duration

Question 33

Factors to consider for maintenance therapy

Answer 33

Deceased or living donors, prior transplants, ADEs, HLA mismatch, number of acute rejections, compliance, drug costs

Question 34

Rejection therapy

Answer 34

Management of the immunologic rejection process which can be acute or chronic in order to preserve organ function