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Transplant
Transplant Overview, Induction, Maintenance, Complications
| Term | Definition |
|---|---|
| prior to transplant, what are some of the tests to minimize the chance of graft rejection? | - HLA: human leukocyte antigen - ABO blood test - PRA: panel reactive antibody |
| what is required if the PRA is high? | - desensitizing the patient prior to transplant |
| what is the different between the allograft and autograft? | - allograft: different genotype ( one person - to another) ; also called homograft; allogenic - autograft: same genotype ( twin ); also called isofraft - autologous: same genotype ( same person tissue) |
| what are the main type of allograft rejections? | - hyper-acute: 2/2 to mismatch; can't be tx' removal of the organ - acute: within 3 months of the transplant ( use immunosuppressant) - chronic rejection: after prolonged time--leads to organ failure ( no treatment) |
| what are the uses of immunosuppressant therapies in transplant patient? what is the rational? | - Rational: prevent/ stop immune system from attaching the body - induction: prior to transplant - maintenance: chronically after transplant - tx for acute rejection |
| Induction phase: timing? rational? drugs? common drug names? | timing: prior to transplant OR at the time of transplant rational: prevent acute rejection in early post transplant drugs: high immunosuppressant drug + IV steroid ( if needed) common: 1- basiliximab (MOAb) and IL-2 blocker ( only prevention) |
| why basiliximab is ONLY used in PREVENTION setting not for ACUTE rejection treatment? | - it's IL-2 receptor blocker - acts on activated T-lymphocyte cells ( expresses IL-2 receptor which activates t-cell--> attacks the organ) - DOSE NOT act on immature T-lymphocyte ( no IL-2 receptor expressed yet) - CONCLUSION: ONLY PREVENTION |
| What other immunosuppressant alternative in high risk patient? | - use lymphocyte-depleting meds : Thymoglobulin - depletes both mature and immature lymphocytes - can USE for PREVENTION ( higher doses) and maintenance |
| PREVENTION drugs: | 1- basiliximab IL-2 receptor blocker 2- Thymoglobulin: lymphocyte-depleting 2- off-lable: alemtuzumab |
| what is the MOA of thymoglobulin? | - Acts on both mature and immature T-lymphocyte; binds to antigens on T-lymphocyte --> interfere with it's functions |
| Common side effects seen with thymoglobulin? | - INFUSION related reaction --> pre-med with ( steroid, Tylenol, and diphenhydramine ) - hematological disorder: leukopenia and thrombocytopenia |
| Common monitoring parameters for thymoglobulin? | - CBC - WBC: T-lymphocytes ( T-cell count) |
| What is the dosing? duration of thymoglobulin? | - dose: dose varies based on source ( rabbit vs human) - duration: 5-14 days |
| What is the MOA of basiliximab? | - IL-2 receptor blocker - acts on the activated mature T-Lymphocyte - binds to IL-2 receptor on T-lymphocyte --> inhibits the T-cell mediated Allograft rejection |
| common side effects seen with basiliximab? | - GI: n/v/cramp/ GI upset/ - HTN, weakness, fatigue - infection: URTI, cough |
| common monitoring parameters of basiliximab? | - infection - s/sx of hypersensitivity |
| What is the dosing? duration of basiliximab? | - dose: 20mg IV - duration: 5 days |
| What are the most common maintenance combination therapy in transplant patient? | - Calcineurin inhibitor ( Tacrolimus OR cyclosporine) - Anti-proliferative agent (mycophonolate, OR everolimus, sirolimus, belatacept or azathioprine) - +/- steroid |
| Common Calcineurin inhibitors? | Tacrolimus Cyclosporine: modified and non modified |
| Common Anti proliferative agents? | - Mycophonolate - azathioprine |
| Common mTOR inhibitor? | everolimus - sirolimus |
| Common CD80 AND CD 86 INHIBITOR? | - belatacept |
| Common steroid used? | - Prednisone |
| Common side effect with the short-term use of prednisone? | 1- fluid retention 2- GI upset 3- emotional instability+ insomnia 4-increases appetite + wt gain 5- rise in blood pressure + sugar |
| Common side effects with the long-term use of prednisone? | 1- adrenal suppression--> Cushing syndrom 2- HTN/ DM 3- impaired wound healing 4- impaired growth 5- acne 6- osteoporosis |
| What is the MOA of mycophenolate? | - it's anti-proliferative agent - inhibits T-cell proliferative via altering Purine synthesis |
| what is the BBW associated with the use of mycophenolate? | - since it inhibits the proliferation of T-cell: 1- increases the risk of infection 2- lymphoma and skin cancer 3- congictale abnormalities |
Created by:
Smoham38
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