Special Populations: Transplant

Question 1

Universal donor blood type

Answer 1

Type O

Question 2

Universal received blood type

Answer 2

Type AB

Question 3

Allograft

Answer 3

transplant of an organ or tissue from one individual to another

Question 4

Isograft

Answer 4

transplant from a genetically identical donor = identical twins

Question 5

Autograph

Answer 5

transplant from same patient, from one site to another

Question 6

Commonly used induction immunosuppression

Answer 6

Basiliximab (Simulect)

IL-2 receptor antagonist

Question 7

Patients at high risk of rejection that dont get Simulect could get…..

Answer 7

Atgam

Question 8

Maintenance of immunosuppression

Answer 8

1. Calcineurin inhibitor, CNI (Tacro first line)
   2nd. Antiproliferative (Mycophenolate or azathioprine, Myco 1st line)
   3rd. with or without steroids, usually prednisone

Question 9

CNI medicaitons

Answer 9

Cyclosporine
Tacrolimus

Question 10

Cyclosporine boxed warnings

Answer 10

Nephrotoxicity
inc risk of lymphoma
inc risk of infection
inc BP

Question 11

Can you use modified and non-modified cyclosporine interchangeably?

Answer 11

no

Question 12

Cyclosporine Side effects

Answer 12

inc BP
nephropathy
hyperkalemia
hypomagnesemia
hirsutism
gingival hyperplasia
edema
inc BG
neurotoxicity
QT prolongation

Question 13

Cyclosporine monitoring

Answer 13

trough lvls
serum electrolytes
renal function
BP
BG
lipid profile

Question 14

Tacrolimus boxed warning

Answer 14

inc susceptibility to infection
possible development of lymphoma

Question 15

Tacrolimus side effects

Answer 15

inc BP
nephrotoxicity
alopecia
QT prolongation
Hyperlipidemia
hyperkalemia

Question 16

Tacrolimus monitoring

Answer 16

trough lvls
serum electrolytes
renal function
LFTs
BP
BG
lipid profile

Question 17

Mycophenolate Mofetil (CellCept) & Mycophenolic Acid (Myfortic) Boxed warning

Answer 17

inc risk of infection
lymphoma and skin malignancies
inc risk of congenital malformations and spontaneous abortions

Question 18

Mycophenolate side effects

Answer 18

Diarrhea
GI upset

Myfortic is enteric coated = decreased diarrhea

Question 19

Azathioprine Boxed warning

Answer 19

inc risk of malignancy
hematologic toxicities
mutagenic potential

Question 20

Everoliumus (Zortress) MOA

Answer 20

mTOR kinase inhibitors = inhibit T-lymphocyte activation/proliferations. can be synergistic with CNIs

Question 21

Everolimus Boxed warnings

Answer 21

inc risk of infection and cancers
reduced dose when used with cyclosporine

Question 22

Everolimus warnings

Answer 22

Hyperlipidemia
impaired wound healing

Question 23

Everolimus side effects

Answer 23

Peripheral edema
inc BP
N/V/D
dont use within 30 days of transplant

Question 24

Everolimus monitoring

Answer 24

trough lvls
renal functions
LFTs

Question 25

Sirolimus warnings

Answer 25

impaired wound healing
hyperlipidemia
angioedema

Question 26

Sirolimus side effects

Answer 26

irreversible pneumonitis/bronchitis/cough = d/c if develops
inc BG
peripheral edema

Question 27

Prednisone short term side effects

Answer 27

fluid retention
stomach upset
emotional instability
insomnia
inc appetite
weight gain
acute rise in BG and BP w/ high doses

Question 28

Prednisone long term side effects

Answer 28

adrenal suppression/Cushing’s syndrome
impaired wound healing
inc BP
Diabetes
acne
osteoporosis
impaired growth in children

Question 29

Belatacept (Nulojix) boxed warnings

Answer 29

inc risk of post-transplant lymphoproliferative disorder (PTLD)
use in EBV seropositive patients only

Question 30

Belatacept (Nulojix) warnings

Answer 30

trat latent TB prior to use

Question 31

Azathioprine with Xanthine oxidase inhibitors

Answer 31

CI w/ febuxostat

if using w/ allopurinol, reduce azathioprine dose by 75%

Question 32

How to treat acute cellular rejection

Answer 32

give high-dose steroids and inc lvls of maintenance immunosuppression

ATGAM givne for steroid resistant or more aggressive ACR.
can use alemtuzumab off-label

Question 33

Antibody-mediated rejection (AMR) treated with….

Answer 33

plasmapheresis and admin of IVIG and steroids, followed by dose of Rituxmab