1 Immunosuppressant Medications Calcineurin Inhibitors CNI Prograf Tacrolimus Hecoria Neoral Cyclosporine Gengraf b mTor Inhibitors Rapamune Sirolimus Zortress Everolimus Prednisone ID: 769883
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1. Immunosuppressant MedicationsCalcineurin Inhibitors (CNI)Prograf/Tacrolimus/HecoriaNeoral/Cyclosporine/Gengrafb. mTor InhibitorsRapamune/SirolimusZortress/EverolimusPrednisoneAnti-proliferative medicationsMyfortic/Mycophenolic acid (enteric coated)Cellcept/Mycophenolate mofetilImuran/AzathioprineInfection Prophylaxis MedicationsPCP ProphylaxisBactrim SS/SMTZ SS QDAfter one year can be changed to TIW ORii. Mepron/Atovaquon (sulfa allergy) – stopped after one yearCMV prophylaxis – Valcyte 450 mg po qd x 6 months (if D-/R-then acyclovir)Anti-fungal—Mycelex troche bid x 3 mosCommon Calcineurin Inhibitor Drug Interactions*Azole anti-fungalsProtease inhibitorsGrapefruitErthromycin/MacrolidesDiltiazem/VerapamilStatins will require lower starting doseCYP450 medications can alter CNI levels* Not an exhaustive list 1. Surgical ComplicationsVascularStenosis –can be managed by interventional radiology or surgical intervention if necessary—should be done at NMH preferablyb. Wound—Dehiscence and infections most common in the first three months—more prevalent in diabetics, obese population.Fluid Collections—require fluid analysisUrinomaLymphoceleSeromaMedical ComplicationsHypertensionHyperlipidemiaChronic kidney diseaseMalignanciesAnemiaLeukopeniaInfectious ComplicationsPneumocystis pneumoniaCytomegalovirusFungalBK virusVaricella zosterUrinary tract infections 1. Visit FrequencyMonths 1, 3, 12, annually and prnLaboratory FrequencySEE CHART on OTHER SIDEProtocol Kidney Biopsy ScheduleMonth 3, 12 and 24 and prnHepatitis B chronic/carrier statesPre-transplant patients must be evaluated and cleared by hepatologist at NMHCarriers will be placed on treatment at the time of transplant pending hepatology recommendationsChronic or carrier HBV patients should remain on treatment after transplant and follow-up with NMH transplant hepatology Health Maintenance ScheduleVaccinationsNo live vaccinesAnnual seasonal influenzaPneumonia vaccine q5 yearsHepatitis A and B if not immuneHepatitis B high-dose (40mg) day 0, 7, 28Colonoscopy –per ACS guidelinesPap Smear/HPV testing –annuallyMammogram—per ACS guidelinesAnnually (with risk assessment)LipidsQ6-12 monthsf. Dermatology screeningi. Annually Common Medications inAbdominal Transplantation Post-TransplantComplications Post-TransplantCare/Management Reference: American Society of Transplantation, Guidelines for Post-Kidney Transplant Management in the Community Setting, 2009
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, mycophenolate mofetil or mycophenolic acid; ^for patients who are HBsAg+ or HBcAb+Kidney, Kidney/Pancreas and Pancreas Alone Transplant Standard of Care (SOC) LabsLaboratory Test0-1 months1-2 months2-3 months 3-12 monthsAfter 1 yearBasic Chem 3x/week2x/week; M, Th1x/week2x/monthMonthly Amylase and Lipase+3x/week2x/week; M, Th1x/week2x/monthMonthlyComp ChemOnce Yearly Hepatic Panel/LFT’s^ Monthly Monthly Monthly Monthly Monthly CBC with diff 3x/week 2x/week; M, Th 1x/week 2x/month Monthly Drug level (FK, Csa, Sirolimus, Everolimus) 3x/week 2x/week; M, Th 1x/week 2x/month Monthly Lipids, iPTH, & UA Once Yearly Urine Dip Every clinic visit Every clinic visit Every clinic visit Every clinic visit Every clinic visit BK screening Blood PCR quant monthly Blood PCR quant monthly Blood PCR quant Q2 months (start mo 4) Blood PCR quant Q 3 months until 2 years then annually/ prn Cpeptide & A1c + Once Every 3 months Every three months Serum pregnancy test* First visit One month 3 months 6months Annually HBV DNA PCR Quant; HBsAg At month 3 Q3months Q6 months
NOSOCOMIALTECHNICALDONOR/RECIPIENTActivation of Latent Infections, Relapsed, Residual, Opportunistic InfectionsCOMMUNITYACQUIREDCommon Infections in Solid Organ Transplantation RecipientsAntimicrobial-resistant speciesMRSAVRECandida species (non-albicans)AspirationsLine InfectionWound InfectionAnastamotic Leaks/IschemiaC. Difficile colitisDonor-Derived (Uncommon):HSV, LCMV, Rabies, West NileRecipient-Derived (colonization):Aspergilus, PseudomonasWith PCP and antiviral (CMV, HBV, Prophylaxis:BK Polyomavirus NephropathyC. difficile colitisHepatitis C virusAdenovirus, InfluenzaCrytococcus neoformansM. tuberculosisAnastamotic complicationsWithout Prophylaxis Add:PenumocystisHerpesviruses (HSV, VZV, CMV, EBV)Hepatitis B virusListeria, Nocardia, ToxoplasmaStrongyloides, Leishmania, T.cruziCommunity Acquired Pneumonia Urinary Tract InfectionAspergillus, Atypical moulds, Mucor speciesNocardia, Rhodococcus species Late Viral:CMV (Colitis/Retinitis)Hepatitis (HBV, HCV)HSV encephalitisCommunity acquired (SARS, West Nile)JC polyomavirus (PML) Skin Cancer, Lymphoma (PTLD)TRANSPLANTATIONDYNAMIC ASSESSMENT OF INFECTIOUS RISK< 4 WEEKS1-6 MONTHS> 6 MONTHSDonor-DerivedRecipient-Derived The Timeline of Post-Transplant InfectionsModified from 1-3