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Transplant

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munsele's version from 2016-06-28 23:56

Section 1

Question Answer
Crossmatching is performed to determine compatibility forhuman leukocyte antigen (HLA) and ABO blood group
Transplant of an organ or tissue from one individual to another of the same species with a different genotypeallograft
Transplanted organ from a genetically identical donorIsograft
Tissue transplanted from one site to another on the same ptAutograft or autologous
Induction immunosuppressant therapyGiven before or at time of transplant to prevent acute rejection - high degree immunosuppression
Most commonly used induction drugBasiliximab
Basiliximab MOAIL-2 receptor antag
Patients at higher risk of rejection will receive what as opposed to BasiliximabAntithymocyte globulin
Maintenance immunosuppressant therapyCalcineurin inhibitor + antiproliferative +/- steroids
If low immunological risk which of the three maintenance classes can be dc'edsteroids
Common sx of rejectionflu-like sx, chills, body aches, nausea, cough, SOB, organ specific sx
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Section 2

Question Answer
Agents with highest level of nephrotoxicityTacrolimus, cyclosporine
Agents most likely to worsen DMtacrolimus, steroids, cyclosporine
Agents most likely to worsen lipidsmTOR inhibitors, steroids, cyclosporine
Agents most likely to cause HTNSteroids, cyclosporine, tacrolimus
Vaccines post transplantNO LIVE VACCINES! inactivated after 3-6mo, PCV13, PPSV23
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Section 3

Question Answer
Antithyrocyte SEinfusion related runs, leukopenia, leukocytosis
Antithyrocyte (ATGAM-equine & thyroglobulin-rabbit) premedwith benadryl, APAP, steroids to reduce infusion rxn
BasiliximabSimulect
Basiliximab premedNot needed, infusion related rxns unlikely
Basiliximab for rejectionCannot be used because it does not deplete immature T-lymphocytes
Systemic steroidPrednisone
AntiproliferativeMycophenolate
Mycophenolate boxed warningshigh risk of infections, lymphoma and skin malignancies, congenital malformation and spontaneous abortions
Cellcept and Myfortic interchangeable?nope! differences in absorption, Myfortic is enteric coated
Cellcept SEdiarrhea, GI upset, nausea, leukopenia
Cellcept stable in which diluentsD5W only!
IF taking mycophenolate PO instructionsTake on empty stomach
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Section 4

Question Answer
Azathioprine warningsHematologic, hepatotoxic, TPMT def are at high risk for myelosuppression
Tacrolimus WarningsIncreased susceptibility to infection
Tacrolimus SEHTN, nephrotoxicity, hyperglycemia, neurotoxicity, hyperkalemia, hypmagnesemia
Tac MonitoringTrough lives, serum electrolytes, renal fun, blood glucose, BP
Cyclosporine WarningsRenal impairment
Cyclosporine SEHTN, nephropathy, hyperkalemia, hypomag, hirsutism, gingival hyperplasia, edema, hyperglycemia, neurotox, QT prolongation
Cyclosporine Monitoring Same as Tac + lipids
CyclosporineNeoral, gegraaf, sandiimune
TacrolimusProgram, astagraf, envarsus
EverolimusFortress, Afinitor
Everolimus SEPeripheral edema, constipation, HTN, hyperglycemia, hyperlipid, hyertriglyc, impaired wound healing, pneumonitis
Sirolimus SEImpaired wound healing, pneumonitis/bronchitis/cough, hyperglycemia, hyperlipidemia
SirolimusRapamune
BelataceptNulojix
Belataxcept warningsUse in EBV pts only, treat latent TB prior to use
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Section 5

Question Answer
Allopurinol metabolized byXanthine oxidase
Daily at home monitoring of temp, wt, blood pressure, and glucose (if DM present)
Taking NSAIDsDo not, can harm kidney
Rejection caused byT cell or B cell mediated mechanisms
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