Solid Organ Transplant

Question 1

What are risk factors for rejection?

Answer 1

1. Sensitization (female gender and pregnant, hx of blood transfusion, hx of prior transplant)
2. younger age
3. donor specific antibody

Question 2

What are the types of induction agents?

Answer 2

cell-depleting
non-depleting

Question 3

When are cell-depleting agents used?

Answer 3

high immunologic risk

Question 4

When are non-depleting agents used?

Answer 4

low-moderate immunologic risk

Question 5

What agent is first line for high immunologic risk?

Answer 5

Anti-thymocyte Globulin THYMO

Question 6

What medications are given with THYMO to reduce infusion related reactions?

Answer 6

acetaminophen
diphenhydramie
+/- steroids

Question 7

What are SEs with THYMO?

Answer 7

infusion related reactions
Pancytopenia
Malignancies

Question 8

What is the alternate therapy to THYMO?

Answer 8

Alemtuzumab CAMPATH

Question 9

What are SEs with Alemutzumab?

Answer 9

infusion related rxns
N/V
Pancytopenia

Question 10

What induction agent is used for low risk?

Answer 10

Basiliximab SIMULET

Question 11

What drug classes are used for maintenence therapy?

Answer 11

1. calcineurin inhibitors
2. antimetabolites
3. mTOR inhibitors
4. Corticosteroids
5. co-stimulation inhibitor

Question 12

What are the calcineurin inhibitors?

Answer 12

Cyclosporine
Tacrolimus

Question 13

What DIs do calcineurin inhibitors have?

Answer 13

CYP3A4 inhibitors/inducers
NSAIDs (nephrotoxicity)

Question 14

What is the first line calcineurin inhibitor?

Answer 14

Tacrolimus

Question 15

What is the goal trough range for Tacrolimus?

Answer 15

8-12

Question 16

What SEs does Tacrolimus have more incidence of vs. Cyclosporine?

Answer 16

Hyperglycemia
Neurotoxicity
Alopecia

Question 17

What SEs does calcineurin inhibitors have?

Answer 17

HTN
hyperglycemia
hyperlipidemia
nephrotoxicity
neurotoxicity
hirsutism
alopecia
gingival hyperplasia

Question 18

What are the antimetabolites?

Answer 18

Mycophenolate
Azathioprine IMURAN

Question 19

What are DIs with Mycophenolate?

Answer 19

Mg/Ca salts decrease absorption

Question 20

What are SEs with antimetabolites?

Answer 20

GI toxicity
Pancytopenia
Alopecia
Rash
Hepatotoxicity
Pancreatitis
Birth defects/miscarrages

Question 21

What are the mTOR inhibitors?

Answer 21

Sirolimus RAPAMUNE
Everolimus ZORTRESS

Question 22

What is the MOA of mTOR inhibitors?

Answer 22

prevent T cell proliferation by inhibiting mammaliam target of rapamycin

Question 23

What DIs do mTOR inhibitors have?

Answer 23

CYP3A4 inhibitors/inducers

Question 24

When are mTOR inhibitors used?

Answer 24

used 6 weeks post transplant due to delayed wound healing

Question 25

What are SEs with mTOR inhibitors?

Answer 25

hyperlipidemia delayed wound healing mouth ulcers lung toxicity pancytopenia

Question 26

What corticosteroids are used for maintenence therapy?

Answer 26

Methylprednisolone IV Prednisone PO

Question 27

What is the role of Belatacept (co-stimulation inhibitor) in therapy?

Answer 27

used for kidney transplants to replace CNI and avoid nephrotoxicity

Question 28

What are the first line agents in the rejection cocktail?

Answer 28

Tacrolimus (CNI) + Mycophenolate (antimetabolites) +/- steroids

Question 29

What agents are used to prevent PJP after transplant?

Answer 29

1. Bactrim 2. Dapsone 3. Atovaquone

Question 30

What agents are given as CMV prophylaxis?

Answer 30

Valganciclovir Ganciclovir

Question 31

What agents are given for HSV prophylaxis when CMV is not being prevented?

Answer 31

Acyclovir Valacyclovir

Question 32

What agents are given for candidiasis prophylaxis?

Answer 32

Nystatin Clotrimazole MYCELEX

Question 33

What is the MOA of antimetabolites?

Answer 33

prevent T cell proliferation by inhibiting purine synthesis

Question 34

What is the MOA of CNIs?

Answer 34

prevent T cell acitivation by inhibiting calcineurin phosphatase