Solid Organ Transplant

  1. What are the 4 tests for transplant?
    • Tissue matching (MHC)
    • Blood type
    • PRA
    • Crossmatching
  2. How many alleles are checked on the MHC antigen for tissue matching?
    6 alleles
  3. What is the term used when all 6 MHC alleles match between donor and recipient?
    zero mismatched
  4. What is a Panel Reactive Antibodies (PRA) test used in transplants?
    • Blood test for pre-formed anti-MHC antibodies against the lymphocytes from a population of donors
    • Higher PRA indicates more chance of rejection
  5. What is crossmatching in transplants?
    • Blood test performed shortly before the transplantation using blood from the donor and recipient to check for antibodies against the donor
    • If donor's blood cells are destroyed, the test is positive and the recipient will almost certainly reject the transplant
  6. What are the types of graft rejection?
    • Hyperacute
    • Acute
    • Chronic
  7. What are the characteristics of a hyperacute graft rejection?
    • Onset minutes to hours
    • Quick loss of graft
    • Prevention is the only treatment
  8. What are the characteristics of an acute graft rejection?
    • Onset days to months
    • Tissue biopsy needed to confirm
    • Usually no loss of graft if managed successfully
    • Therapy includes corticosteroids, polyclonal antibodies or monoclonal antibodies
  9. What are the characteristics of chronic graft rejection?
    • Onset months to years
    • Loss of graft
    • Drug therapy often ineffective; consider re-transplantation
  10. What are the risk factors for acute graft rejection?
    • Black
    • Cadaveric donor
    • Previous implants
  11. What drugs are used for transplantation?
    • Prednisone
    • Methylprednisolone
    • Cyclosporine
    • Tacrolimus
    • Sirolimus
    • Everolimus
    • Azathioprine
    • Mycophenolate mofetil (sodium salt not effective)
    • Antithymocyte globulin (rabbit, horse)
    • Daclizumab
    • Basiliximab
  12. How many drugs are usually used for transplantation?
    3 drugs
  13. Which drugs are used for induction therapy in transplantation?
    • IV Corticosteroids (methylprednisolone, high dose)
    • Calcineurin inhibitor
    • Monoclonal antibody (Basiliximab or Daclizumab) - only for induction!
    • Polyclonal antibody (Antithymocyte - rabbit or horse)
    • Mycophenolate
    • DO NOT use Sirolimus d/t delayed wound healing
  14. Which drugs are used for maintenance therapy in transplantation?
    • Corticosteroid (usually Prednisone)
    • Calcineurin inhibitor
    • Mycophenolate mofetil
    • Mycophenolic acid
    • Azathioprine
    • mTOR inhibitor
    • PICK 1 drug from each of the 4 categories
  15. What are the special considerations for transplantation therapies?
    • Separate Sirolimus and Cyclosporine by 4 hours to decrease potential risk for toxicities
    • Tacrolimus:
    • most commonly used calcineurin inhibitor in renal transplant
    • more effective in decreasing incidence of acute rejections
    • higher incidence of post-transplant DM
    • less cosmetic effects
    • Mycophenolate:
    • used more than azathioprine in renal transplant d/t hepatotoxicity
    • Corticosteroid dose may decrease over time and eventually stopped
  16. Which drugs are used for rejection therapy in transplantation?
    • Acute:
    • increase dose of current therapy
    • Corticosteroid bursts
    • Add a new immunosuppressant (but decrease current doses and start antibiotic prophylaxis - TMP/SMX, gancyclovir, nystatin, H2 blocker/PPI)
    • Chronic:
    • Prevent it through optimization of maintenance therapy
    • re-transplant?
  17. What are the DI of Calcineurin inhibitors and mTOR inhibitors?
    • Azoles
    • Macrolides
    • CCBs
    • Statins
    • Cimetidine
    • TMP/SMX
    • Grapefruit
    • Seizure drugs
    • TB meds
    • St. John's Wort
    • Cholestyramine (p-glycoprotein interaction)
  18. What are the complications of renal transplantation?
    • Bleeding
    • Wound infection
    • Delayed graft function
    • Graft dysfunction
    • Graft rejection
    • Drug-induced nephrotoxicity
    • Cardiovascular/metabolic complications
    • Endocrine dysfunction (bone, anemia, electrolytes)
    • Myelosuppression
    • GI ulceration/perforation
    • Infections (less than other transplants)
    • Post-transplant Lymphoproliferative Disorder (PTLD)
    • Malignancies
  19. What is Post-transplant Lymphoproliferative Disorder (PTLD)?
    • Uncontrolled proliferation of B-cells
    • Potentially fatal
    • Can progress to cancer (non-Hodgkin's)
    • Usually associated with EBV, but not always
    • Treatment:
    • first-line - decrease doses of immunosuppressants
    • alternative - Rituximab?
  20. What are some other considerations involved in the pharmacist's role in transplantation?
    • No live vaccines
    • No herbals (DI)
    • Check with transplant team for OTCs
    • Use high SPF sunblock
    • Screen for DI
    • Educate patient
    • Be careful of water supply
    • Use latex gloves when handling raw meat
    • Wash all fruits and veggies
    • Eat all meat well-done
    • Avoid salad bars and buffet tables
    • Carry meds when traveling, not in checked luggage
    • Pets okay, but use caution
    • Diet and exercise
Card Set
Solid Organ Transplant
Solid Organ Transplant