Over-Simplified Transplant Meds Guide

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bossypants

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I found this somewhat useful for absite preparation so posting this.

Goal of transplant medication is to prevent acute rejection.

Medications given in 2 phases: induction and maintenance. Induction is to knock down the immune system around time of transplant while maintenance is self explanatory.

Induction meds:
1. Thymoglobulin (thymo): used in high risk for rejection patients. Rabbit anti-T cell antibodies. polyclonal. Causes fever, cytokine release syndrome.
2. Basiliximab: used in moderate to low risk kidney patients. monoclonal anti IL2 antibodies. better side effect profile

maintenance meds: goal is to have steroid free regimen due to side effects of corticosteroids. usually has a purine antimetabolite and a calcineurin inhibitor. purine antimetabolite reduces reduces lymphocyte proliferation. Calcineurin inhibitor reduces IL-2 which reduces lymphocyte proliferation.

1. older regimen: purine blocker - azathioprine (leukopenia), calcineurin inhibitor - cyclosporine (nephrotoxicity)
2. newer regimen: purine blocker - mycophenolate trade name cellcept (diarrhea), calcineurin inhibitor - tacrolimus trade name prograf. popular combination for maintenance in kidney transplant.

if patient has excessive diarrhea with mycophenolate they can get switched to azathioprine.
if patient wants to get pregnant, they have to switch from mycophenolate to azathioprine.

sirolimus rapamune - mtor inhibitor - poor wound healing, diabetes like syndrome. useful as it has less nephrotoxicity compared to calcineurin inhibitors. not recommended in postop use due to wound healing issues.

Maintenance meds are metabolized by liver. seizure meds and rifampin increase P450 in liver so require increase in immunosuppression med dose. Emycin, azole antifungals and antidepressants reduce P450 so may require reduction in immunosuppresion med dose.

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