Transplant MoA
Hyperacute, Acute, or Chronic Rejection:
infiltration of T cells into the allograft, which triggers inflammatory and cytotoxic effects on the graft
Acute
Mnemonic: AcuTe
T = T cells
Ball Balls has hyperacute liver organ transplant rejection. You have two medications on hand, ATG and RATG.
ATG = Equine
RATG = Rabbit
Which medication would you use to save Ball Balls? What AE will you expect?
ATG (Antithymocyte Globulin)
AE: Myelosupression
IL-2 Receptor Antagonist
Basiliximab (Simulect®)
Mnemonic: Basiliximab
2 i's, IL-2
Cyclosporine-specific AE!
Hirsutism (HUR-soot-iz-um) is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
Tacrolimus AE: Alopecia (hair loss)
Binds to FKBP (immunophilin FK-binding protein)
Tacrolimus
The Jackson Zoo is a 14 billion dollar estate featuring many exotic animals such as the Capybara, depressed Cougars, and Big Mike (a rhino). A 34 yo women leaves the Jackson Zoo and comes into your clinic. She has recently underwent a liver transplant, and she has found out that is pregnant. She states, "Man, that zoo was total garbage."
Her current medication list:
Prednisone
Cyclosporine
Mycophenolate Mofetil
What adjustments would you make? Can this woman breastfeed after she gives birth?
Stop the MPA. Breastfeeding not recommended.
Yes, Azathioprine should be reduced to 1/4 dose
XO eliminates Azathioprine. Allopurinol inhibits XO.
XO = Xanthine Oxidase
Phenytoin is a drug that is highly protein bound, specifically to albumin. In a liver transplant patient, what should they be concerned about when taking Phenytoin?
Decrease in Albumin, leading to higher concentrations of phenytoin.
Blocks mTOR signaling pathway
Sirolimus (Rapamycin)
Everolimus (Zortress)