Solid Organ Transplant

immunosuppression protocol

Calcineurin inhibitor + Antiproliferative + Steroid

Calcineurin inhibitor

Inhibit transcription of cytokines, mainly IL-2, that regulate activity of T-lymphocytes

tacro ade

neurotoxicity, hair loss, HTN, HLD, electrolyte abnormality, nephrotoxicity, new-onset diabetes

cyclosporine ade

neurotoxicity, hirsutism, HTN, HLD, electrolyte abnormalities, nephrotoxicity, new-onset diabetes/hyperglycemia

Increase CNI conc

azole antifungals, calcium channel blockers, macrolide antibiotics, protease inhibitors, grapefruit and Seville oranges

decrease CNI concentrations

rifampin, anti epileptics: carbamazepine, phenobarbital, phenytooin

Cellcept ade

leukopenia

GI disturbance

cellcept BBW

birth defects or 1st trimester pregnancy loss

May reduce concentration of hormonal contraception

superior

mycophenolate mode til is the primary antiproliferative agent used in transplant and has been shown to be superior to azathioprine in prevention of acute rejection

No nephrotoxicity or adverse effects on lipids and glucose levels

azathioprine

first antiproliferative used for SOT but use has declined since introduction of cellcept

Metabolized by xanthine oxidase and thiopurine methyltransferase

may be good option for patients unable to tolerate mycophenolate due to GI side effects or women wanting to become pregnant

mTOR inhibitors

can be used instead of CNI for patients that have ADE or have recurrent skin cancers - sometimes used in combo with low dose CNIs

Bind to regulatory kinases (FKB12) which inhibits mTORC1 and blocks response to IL2 mediated tcell proliferation

everolimus ade

Zortress - delayed wound healing, inc TG, HLD, leukopenia, mouth sores, peripheral edema

sirolimus ade

delayed wound healing, inc TG, HLD, leukopenia, mouth sores,peripheral edema

Co-stimulation blocker and fusion inhibitor

belatacept (Nulojix)

Prevent activation of T cells and promote cell apoptosis - often used instead CNII sparing immunosuppressant regimens

nulojix ade

anemia, leukopenia, peripheral edema, headache, GI disturbance