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Transplant Overview, Induction, Maintenance, Complications

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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