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1. Immunosuppressant Medications Calcineurin Inhibitors (CNI) Prograf / Tacrolimus / Hecoria PowerPoint Presentation
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1. Immunosuppressant Medications Calcineurin Inhibitors (CNI) Prograf / Tacrolimus / Hecoria - PowerPoint PPT Presentation


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Common Medications in Abdominal Transplantation. Post-Transplant Complications. Post-Transplant Care/Management. 1. Visit Frequency Months 1 , 3 , 12, annually and prn Laboratory Frequency SEE CHART on OTHER SIDE Protocol Kidney Biopsy Schedule Month 3, 12 and 24 and prn

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slide1

Common Medications in

Abdominal Transplantation

Post-Transplant

Complications

Post-Transplant

Care/Management

    • 1. Visit Frequency
      • Months 1, 3, 12, annually and prn
    • Laboratory Frequency
      • SEE CHART on OTHER SIDE
    • Protocol Kidney Biopsy Schedule
      • Month 3, 12 and 24 and prn
    • Hepatitis B chronic/carrier states
        • Pre-transplant patients must be evaluated and cleared by hepatologist at NMH
        • Carriers will be placed on treatment at the time of transplant pending hepatology recommendations
        • Chronic or carrier HBV patients should remain on treatment after transplant and follow-up with NMH transplant hepatology
    • Health Maintenance Schedule
      • Vaccinations
        • No live vaccines
        • Annual seasonal influenza
        • Pneumonia vaccine q5 years
        • Hepatitis A and B if not immune
          • Hepatitis B high-dose (40mg) day 0, 7, 28
      • Colonoscopy –per ACS guidelines
      • Pap Smear/HPV testing –annually
      • Mammogram—per ACS guidelines
        • Annually (with risk assessment)
      • Lipids
  • Q6-12 months
      • f. Dermatology screening
  • i. Annually
  • 1. Immunosuppressant Medications
    • Calcineurin Inhibitors (CNI)
    • Prograf/Tacrolimus/Hecoria
    • Neoral/Cyclosporine/Gengraf
    • b. mTor Inhibitors
    • Rapamune/Sirolimus
    • Zortress/Everolimus
    • Prednisone
    • Anti-proliferative medications
    • Myfortic/Mycophenolic acid (enteric coated)
    • Cellcept/Mycophenolatemofetil
    • Imuran/Azathioprine
  • Infection Prophylaxis Medications
    • PCP Prophylaxis
    • Bactrim SS/SMTZ SS QD
      • After one year can be changed to TIW
    • OR
    • ii. Mepron/Atovaquon (sulfa allergy) – stopped after one year
    • CMV prophylaxis – Valcyte 450 mg poqd x 6 months (if D-/R-then acyclovir)
    • Anti-fungal—Mycelex troche bid x 3 mos
  • Common Calcineurin Inhibitor Drug Interactions*
    • Azole anti-fungals
    • Protease inhibitors
    • Grapefruit
    • Erthromycin/Macrolides
    • Diltiazem/Verapamil
    • Statins will require lower starting dose
    • CYP450 medications can alter CNI levels
    • * Not an exhaustive list
  • 1. Surgical Complications
    • Vascular
    • Stenosis –can be managed by interventional radiology or surgical intervention if necessary—should be done at NMH preferably
    • b. Wound—Dehiscence and infections most common in the first three months—more prevalent in diabetics, obese population.
    • Fluid Collections—require fluid analysis
    • Urinoma
    • Lymphocele
    • Seroma
  • Medical Complications
    • Hypertension
    • Hyperlipidemia
    • Chronic kidney disease
    • Malignancies
    • Anemia
    • Leukopenia
  • Infectious Complications
    • Pneumocystis pneumonia
    • Cytomegalovirus
    • Fungal
    • BK virus
    • Varicella zoster
    • Urinary tract infections

Reference: American Society of Transplantation, Guidelines for Post-Kidney Transplant Management in the Community Setting, 2009

slide2

Kidney, Kidney/Pancreas and Pancreas Alone Transplant Standard of Care (SOC) Labs

Urine Dip to include: Protein, leukocytes, nitrites, protein, blood, glucose, blood; Reflex testing for Protein trace or >: order random urine protein and creatinine; Reflex testing for Leukocyte and/or nitrate positive: Order urine C&S

+pancreas patients only; *only those child-bearing females (ages up to 60) on Myfortic, Cellcept, mycophenolatemofetil or mycophenolic acid; ^for patients who are HBsAg+ or HBcAb+

slide3

The Timeline of Post-Transplant Infections

Modified from 1-3

Donor-

Derived

NOSOCOMIAL

TECHNICAL

DONOR/RECIPIENT

Activation of Latent Infections, Relapsed, Residual, Opportunistic Infections

COMMUNITY

ACQUIRED

TRANSPLANTATION

DYNAMIC ASSESSMENT OF INFECTIOUS RISK

Recipient-

Derived

< 4 WEEKS

1-6 MONTHS

> 6 MONTHS

Common Infections in Solid Organ Transplantation Recipients