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20 Cards in this Set
- Front
- Back
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Serotyping =
Allograft = Isograft = Autograft = |
Determines most appropriate donor-recipient match
Organ/Tissue transplant between same species/different genotype Donor from identical twin Donor/Recipient is same person |
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Rejection Stages (4) =
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Hyperacute (min - hours)
Accelerated (24 hours - 4 days) Acute (days - months) Chronic (months - years) |
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Reason for induction therapy =
Induction agents = |
To prevent hyperacute, accelerated, acute rejection/permits lower dose of CN - inhibitors
Monoclonal antibody (Muromonab), Polyclonal antibodies (Basiliximab, Daclizumab) High risk of rejection = Anti-thymocyte globulin |
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Primary Immunosuppressive agents =
Adjunct Therapy = Common regimen = |
Calcineurin Inhibitors (Cyclosporine, Tacrolimus - prograf)
Steroids, Azathioprine, Mycophenolate - Cellcept CN-inhibitor, steroids, +/- cellcept |
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Agents used to treat acute rejection/MOA =
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Steroids/Inhibits release of IL-1, synthesis of IL-2
Anti-thymocyte globulin/Binds and lyses T/B-cells (steroid resistant rejection) Muromoab/Inhibits mature T-cells |
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Mechanisms of Action
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Anti-thymocyte globulin - Binds/inhibits T-cell function
Muromonab - Binds/inhibits T-cell function Daclizumab - Inhibit IL-2-T-cell activation Basilixumab - Inhibit IL-2-T-cell activation Steroids - Inhibit IL-1 synthesis, IL-2 release Mycophenolate - Inhibits T-cell proliferation Azathioprine - Inhibits T-cell proliferation Tacrolimus - Inhibits T-cell activation Cyclosporine - Inhibits T-cell activation Sirolimus - Inhibits T-cell activation/proliferation (mTor) Everolimus - Inhibits T-cell activation/proliferation (mTor) Belatacept - Inhibits T-cell activation/proliferation via Mammaliam target of rapamycin (mTor) |
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Name antibodies (4)
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Monoclonal: Anti-thymocyte globulin, Muromunab
Polyclonal: Basilixumab, Daclizumab |
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Black Box Warnings
Anti-thymocyte Globulin Muromonab Daclizumab Basilixamab |
Anti-thymocyte Globulin/Muromonab - Must be administered under supervision of physician with support medical resources available
Daclizumab/Basilixumab - Should only be used by physician experienced in immunosuppressive therapy |
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Black Box Warnings
Mycophenolate Azathioprine Tacrolimus Cyclosporine |
Mycophenolate - Increased risk of infection, lymphoma/skin malignancy, congenital malformations during pregnancy
Azathioprine - Increase risk of neoplasia, infections Tacrolimus - Increased risk of infection, lymphoma Cyclosporine - Renal impairment (high doses), increased risk of infection, lymphoma Gengraf/Sandimmune = increased bioavailability compared to Neoral |
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Black Box Warnings
Sirolimus Everolimus Belatacept |
Sirolimus - Increased risk of infection, lymphoma - not recommended in lung/liver transplant
Everolimus - Increased risk of infection, lymphoma, renal thrombosis - decrease cyclosporine dose when used together Belatacept - Increased risk of post-transplant lympho-proliferative disorder (PTLD) - EBV (-) patients increased risk - Avoid in liver transplant |
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Adverse Effects
Anti-thymocyte Globulin Muromunab |
Anti-thymocyte globulin - Anaphylaxis, fever, chills, pruritis, rash, leukopenia, chest pain, hypertension, edema
Muromunab - Tachycardia, Hyper/hypotension, edema, fever, chills |
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Adverse Effects
Daclizumab Basilixumab |
Hypertension, edema, electrolyte abnormalities, severe hypersensitivity
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Adverse Effects
Steroids (short, long term) |
Short term - Fluid retention, emotional lability, insomnia, increased appetite/weight gain
Long term - Adrenal suppression (cushings), hypertension, decreased wound healing, hypertension, osteoporosis, cataracts |
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Adverse Effects
Mycophenolate Azathioprine |
Mycophenolate - NVD, Hyper/hypotension, edema, tachycardia, hyperglycemia, hyper/hypokalemia, magnesemia, calcemia, hypercholesterolemia, leukopenia
Azathioprine - NVD, Myelosuppression, hepatotoxicity |
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Adverse Effects
Tacrolimus Cyclosporine |
Tacrolimus - Tremor, hyperglycemia, hyperkalemia, hypomagnesemia, hypophosphatemia, hair loss, nephrotoxicity
Cyclosporine - Hypertension, Hirsutism, Gingival hyperplasia, hypertriglyceridemia, nephropathy |
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Adverse Effects
Sirolimus Everolimus Balatacept |
Sirolimus - Delayed wound healing, pneumonitis, thrombocytopenia, anemia, hypertension, peripheral edema
Everolimus - Peripheral edema, constipation, hypertension, hyperlipidemia, delayed wound healing, pneumonitis Belatacept - Anemia, leukopenia, hypertension, insomnia, urinary tract infection, pyrexia hyper/hypokalemia, increased opportunistic infection, tuberculosis, sepsis |
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Patient counseling for all immunosuppressives:
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Do not take any NSAIDs - harm to kidneys
No OTC medications without consulting doctor Protect and cover your skin - increased risk of skin cancer Avoid live vaccines Chronic immunosuppression increases risk of cancer - particularly lymphoma and skin cancer |
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Difference between Myfortic and Cellcept
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Cellcept = mycophenolate mofetil
Myfortic = mycophenolic acid - enteric coated - decreased diarrhea - different absorption rates - not interchangeable |
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Cyclosporine counseling
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No grapefruit juice - increased levels
Neoral oral solution - mix with orange or apple juice Sandimmune - mix with milk, chocolate milk or orange juice Can cause high blood pressure, kidney problems, increase the risk of skin cancer, and cause gingival hyperplasia - brush teeth and floss |
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Tacrolimus counseling
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No grapefruit juice
Can cause high blood pressure, diabetes Can cause QT prolongation Can cause high levels of potassium or magnesium which also increase your risk of QT prolongation |
