Solid Organ Transplant & Med Adherence

induction immunosuppression

glucocorticoid + either…

• lymphocyte depleting agent: antithymocyte globulin or alemtuzumab

  • premed w/ tylenol, benadryl, steroids

  • monitor w/ daily labs

• nonlymphocyte depleting agent: basiliximab

maintenance immunosuppression

1-2 classes ± steroids

• glucocorticoids

• CNIs (tacro, cyclo)

• antimetabolites (mycophen, azathio)

• mTOR inhibitors (siro, evero)

CNIs

• tacrolimus

• cyclosporin (CSA)

CNIs AEs

• nephrotoxic but not renally cleared so no need to dose adjust

• hypertensive

• electorlyte abnormalities

antimetabolites

• mycophenolate (MMF)

• azathioprine

antimetabolites AEs

• MMF → GI distress, teratogenic

• azathioprine → hematologic, hepatotoxic

• azathioprine more severe than MMF

mTOR inhibitors

• sirolimus

• everolimus

mTOR inhibitor AEs

• delayed wound healing

• don’t use immediately after transplant

what bugs should prophylax for?

• pneumocystis jirovecii (PJP)

• cytomegalovirus (CMV)

• herpes simplex (HSV)

• candida

PJP prophylaxis

• bactrim

• 2nd line: pentamidine, atovaquone, dapsone

CMV serostatus risk assessment

• high → donor +/recipient -

• intermediate → recipient +

• low → donor -/recipient -

virus prophylaxis based off risk

• high/intermediate → CMV and HSV prophylax w/ gangiclovir or valganciclovir (3-12 mos)

• low → HSV prophylax only w/ acyclovir (3 mos)

fungal prophylaxis

• nystatin for 1-3 mos

• 2nd line: clotrimazole but DDI w/ CNIs