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20 Cards in this Set
- Front
- Back
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Induction therapy
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The preop IV administration of mono o polyclonal antibodies to SERIOUSLY immunosuppress the patient
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3 classes of immunosuppressants
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1. Steroids
2. Calcineurin Inhibitors (CNIs) 3. Antiproliferative (Cytotoxic agents) |
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Is rejection a problem with transplantation?
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Not anymore, but immunosuppression is.
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When considering the regimen for induction therapy, what are some risk factors?
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1. Previous transplant
2. African American 3. High panel of reactive antibodies to potential donor 4. Donor health/issues 5. Multiple pregnancies |
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High risk induction therapy regimen
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Thymoglobulin (toxic!) polyclonal
Steroids, Tylenol, Benadryl (anti-serum sickness) CENTRAL line |
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Low risk induction therapy regimen
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Basiliximab monoclonal
No premeds PERIPHERAL line |
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Calcineurin inhibitors of note (review Parham for what a calcineurin inhibitor is)
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1. Tacrolimus
2. Cyclosporine |
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Cytotoxic (antiproliferative) inhibitors of note
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1. Mycophenalate
2. Azathioprine |
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Steroid of choice
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Prednisone. Review: Prednisone is an analog of hydrocortisone, but 4x stronger. It must be converted to Prednolisone in the body before becoming active. (Otherwise we probably couldn't inject it)
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Average life of a living donor kidney
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15 yrs, 2x that of a cadaveric
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Why give a preop transplant patient IVIG?
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Interferes with hyperacute immune response during transplantation, like a competitor. In theory.
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What's so great about a living donor transplant?
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So many things -- viable living organ, no transport time, rapid transfer, shortened hospital times.
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What's the ideal period to avoid acute (first-set) rejection?
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For at least 6 months. If you can do that, the viability of the organ is much better.
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Major side effects to the CNIs?
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Hepatotoxicity, cardio . . . slightly lessened if you use Tacrolimus over Cyclosporin A. Skin cancer. Rampant B cell proliferation.
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Thoughts on dialysis?
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It is ALWAYS better to transplant before a patient starts dialysis.
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Bottom line on those ten million slides regarding toxicity, potentiation, and adjuvant effects?
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The side effects of immunosuppression really really suck.
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What is the asymptomatic indicator of acute rejection
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Elevated creatinine.
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Can antibodies initiate acute rejection?
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Not usually, but it's a problem if they do. Most of these drugs target T cells.
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What's the goal of maintenance immunosuppressive therapy?
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Lower dosing to a fine balance between transplant health and patient health.
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What's the number one responsibility of the physician post-transplant, drug maintenance aside?
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Education and insistence on compliance. It's hard to get people to take complicated and often debilitating medication cocktails, but you have to try.
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