transplant

allograft/allogenic tranplant

tranplant of organ/tissue from one individual to another

isograft

tranplant from genetically identical twin/donor

autograft/autologous transplant

transplant to/from the same patient (stem cell, skin graft)

induction options

basiliximab/rabbit/alemtuzumab + high dose steroids

use of basiliximab

induction only

use of antithymocyte globulin

induction and treatment of rejection

use of alemtuzumab

induction only; off label

basiliximab generic

simulect

basiliximab dosing

20mg IV on day 0 then repeat on d4

basiliximab moa

IL2 receptor antagonsitc; chimeric monoclonal antibody tha tinhibits the IL2 receptor on the surface of activate T cells

antithymocite globulin moa

binds to antigens on t cells to interfere with their function

antithymocytie globulin premeds

diphenhydramine, acetaminophen, steroids

antithymocyte globulin infusion time

at least 4 hours; 6 hours for first dose

general maintenance regimen

CNI (belatacept as an alternative) ± antiproliferative agent (mTORi as an alternative) ± steroids

calcineurin inhibitors moa

suppresses cellular immunity by inhibiting T cell activation

calcineurin inhibitors

cyclosporine and tacrolimus

cyclosporine generic

gengraf, neoral, sandimmune (iv)

cyclosproine eye drops

cequa, verkazia

tacrlolimus generic

prograf

tacrolimus er capsule

astagraf xl

tacrolimus er tablet

evarsus xr

goal trough for tacrolimus

3-15ng/ml

bw cyclosporine

increased risk of malignancy and infection; nephrotoxicity; increased BP

goal trough cyclosporine

100-400ng/ml

side effects cyclosproine

increase bg, hyperlipidemia, hyperkalemia, hypomagnesemia, hirsutism, gingibal hyperplasia, neurtox, hyperuricemia

Calcineurin inhibitors monitoring

tough, k and mg, renal funciton, LFT, bp, BG, lipid profile

iv administration sandimmune

non-pvc needed

iv admin tacrolimus

non-pvc needed; continous infusion

tacrolimus bw

incresed riks of malignany and infection; astagraf xl associated wtih increased mortality with female liver transplant recipients

tacrolimus side effects

increased; BG, BP, lipids, LFTs. Decreased mag. Hypo/hyper kalemia or phosphatemia; qt prolongation, neurotoxicity

tacrolimus counseling

food decreasese abosrption; avoid alcoholic beverages wtih xl/xr, increase rate of release and side effects

antiproliferative agents moa

inhibit t and b cell proliferation by altering purine nucleotide synthesis

antiproliferative agents

azathioprine, mycophenolate mofetil/acid

azathioprine generic

azasan, imuran

azathiprine dose

1-3mg/kg po daily, decrease if crcl<50

azathioprine warnings

myelosuppresion, esp due to genetic deficiency of TPMT, increase risk of infection

azathiprne se

GI (sever n/v/d), acute pancreatitis, rash, hepatotoxicity

mycophenolate mofetil generic

cellcept

mycophenolate mofetil forms

tablet, capsuel, suspension, injection

cellcept doseing

1-1.5g po/iv q12

cellcept admin notes

stable only in d5w; BUD 4hrs. do not use if allergic to polysorbate 80

mycophenolic acid generic

myfortic

myfortic dose forms

ec DR tab

mycophenolate bw

increase risk of malignancy, infection, and congenital malformations and spontaeous abortions (REMS)

mycophenolate se

diarrhea, abdominal pain, n, v, leukopenia anemia, changes to bp, edema, tachycardia, pain, increase bp, electrolyte imbalances

mycophenolate monitroing

cbc, intolerable diarreha, pregnancy test, renal function, lfts, signs of infection

mycophenolate tablets storage

protect from light in original container

mammalian target of rapamycin (mTOR) kinase inhibitors moa

inhibit t cell activation/prolieration. May be synergistic wtih CNIs

mTOR inhibitors

everolimus, sirolimus

everlimus generic

zortress

sirolimus generic

rapamune

myfortic dosing

360-720mg po q12h

everolimus trough level

3-8ng/ml

everolimus dosing

0.5-1.5mg po q12h

sirolimus trough level

4-12ng/ml

sirolimus dose

1-5mg po daily

essentially, all transplant drugs carry an increased risk of what

malignancy and infection

everolimus bw

if used with cyclosproine, reduce doses of cyclosproine; increased risk of renal artery thrombosis can result in graft loss; not recommended in ehart tranplant. do not use within 30 days of tranplant

sirolimus bw

not recommnded for use in liver (hepatic artery thrombosis) or lung transplant

sirolimus warnings (additional)

decline in renal function when used long term with cyclosporine, latent viral infection, and increased risk of hemolytic uremic syndrome when used with a CNI

mtor warnigns

hyperliipidemia, impaired wound healing, penumonitis, angioedema, male infertility, proteinuria

mtor knase inhibitors se

peripheral edeam increased BP/BGG, constipation, n/b/d, abodminal pain, headache, fatigue, fever, rash/prurirtis, acne, anemai, leukopenia, thrombocytopenia, stomatitis

mTOR kinase inhibitiors monitoring

tough levels, renal function, lfts, lipids, BG, BP, CBC, urine protein, sign infection.

everolimus storage

protect from light and moisture

mycophenolate decreases levels of WHAT DRUGS

hormonal contraceptives

belatacept moa

inhibit t cell activation and procution of inalmmatory mediators by binding to CD80 and CD86 on antigen presenting cells, blocking costimulation with CD28 on t cells

belatacept generic

nulojix

belatecept is dosed with what weight

tbw, rounded to nearest 12.5mg

prednisone dosing

2.5-20mg po daily or on alternating dosing

belatacept dosing

initially 10mg/kg on d1,5,and then at ends of weeks2, 4, 8 and 12 after transplant

maintenance; 5mg/kg at the end of wek16 and then monthly

belatacept bw

increased risk of PTLD with those without immunity to EBV- only use for those with a EBV seropositivie paitnets only

avoid in liver tranplant patients

belatacept warnings

increased risk for oppurtunistic infections, tb. needs test for latent TB prioir to intiation. TB should be treated prior to use

belatacept se

headache, anemai, leukopenia, constipation, d, n, peripheral edema, changes in BP, cough, photosensitivity, insomnia, UTI, pyrexia, changes in potassium, hypophos

belatacept monitoring

monitor for PML, PTLD, CNS infection, TB test prior to start, EBV seropositivie prior to start

types of organ rejection

t cell (cell) and b cell (humoral or antibody)

acute cellular rejection (ACR) treatment

high dose steroids; increasing maintenance meds; rabbit if resistent

antibody mediated rejection (amr) treatment

plasmapheresis, IVIG, steroid, f/b rituximab

when is infection prophylaxis ESSENTIAL

first 6 months after transplant and after acute rejection treatment