Chapter 337 Transplantation Flashcards
Most common used maintenance immunosuppressive therapies combination:
prednisone
a calcineurin inhibitor
and an antimetabolite
inhibitors can replace one of the last two agents as maintenance immunosuppressive therapy
mammalian TOR (mTOR)
an analogue of mercaptopurine, was for two decades the keystone to immunosuppressive therapy in humans
Azathioprine
Azathioprine is administered in doses of
1.5–2 mg/kg per day
now used in place of aza- thioprine in most centers due to Its advantage in its increased potency in preventing or reversing rejection and less bone marrow suppression
Mycophenolate mofetil or mycophenolate sodium,
Dose of prednisone is given immediately before or at the time of transplantation, and the dose is reduced to 30 mg within a week.
200–300 mg
For treatment of acute rejection, is administered immediately upon diagnosis of beginning rejection and continued once daily for 3 days.
methylprednisolone, 0.5–1 g IV
prednisone; maintenance doses of
5–10 mg/d are the rule.
major effect of steroids is preventing the release of
IL-6 and IL-1 by monocytes-macrophages.
is a fungal peptide with potent immunosuppressive activity and a calcineurin inhibitor
Cyclosporine
Cyclosporine acts on the calcineurin pathway to block transcription of mRNA for IL-2 and other proinflammatory cytokines, thereby inhibiting
T cell proliferation
(previously called FK506) is a fungal macrolide and an alternative in renal patients whose rejec- tions are poorly controlled by cyclosporine.
Tacrolimus
is a fusion protein that binds costimulatory ligands (CD80 and CD86) present on antigen-presenting cells, inter-rupting their binding to CD28 on T cells.
Belatacept
This inhibition leads to T cell anergy and apoptosis and is FDA approved for kidney transplant recipients and is given monthly as an intravenous infusion
Belatacept
Amelioration of hypertension to the range of ____ mmHg should be the goal in all patients.
120–130/70–80
