Term
| Too much immunosuppression |
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Definition
| CV disease, metabolic abnormalities, bone disease, opportunistic infection, malignancy, nephrotoxicity |
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|
Term
| not enough immunosuppression |
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Definition
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Term
| Calcineurin Inhibitors (CNI) |
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Definition
| Tacrolimus (Prograf), Cyclosporine |
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Term
|
Definition
| Mycophenolate mofetil (Cellcept), Mycophenolate sodium (Myfortic); Azthioprine |
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Term
|
Definition
|
|
Term
| Maintenance Immunosuppression |
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Definition
| Calcineurin Inhibitors; Antiprolieratives; mTOR inhibitors; Corticosteroids |
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|
Term
| Pre-transplant risk factors |
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Definition
| pre-existing HTN; renal artery stenosis; kidney dysfunction; non-compliance (diet, medications); race (African American, Hispanic) |
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|
Term
| Post-transplant Risk Factors |
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Definition
| immunosuppressnats (corticosteroids, CNI), delayed graft function, persistent kidney dysfunction, CAN (chronic allograph nephropathy) |
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Term
|
Definition
| <130/80; CCBs, ACEIs, ARBs, BBs, Alpha-1 Antagonists, Diuretics |
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|
Term
| counteract afferent arteriolar vasoconstriction caused by CNIs; increased risk of ischemic heart disease |
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Definition
|
|
Term
| inhibit CYP3A4, increase CNI levels |
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Definition
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|
Term
| effective in reducing proteinuria in KTRs; reduces expression of profibrotic transforming growth factor-beta1 in patients with CAN; cardiovascular benefits; monitor renal fxn |
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Definition
|
|
Term
| First line therapy for patients with established cardiovascular disease |
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Definition
|
|
Term
| beneficial in men with BPH |
|
Definition
|
|
Term
| useful in patients with fluid overload; loops preferred over thiazides |
|
Definition
|
|
Term
| one of the strongest risk factors for CV disease in kidney transplant recipient |
|
Definition
|
|
Term
|
Definition
| risk is greatest in 1st 3 months after transplant; incidence by the end of the 1st year is 10-30% in pts on CNI plus corticosteroid |
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|
Term
|
Definition
| COrticosteroids (insulin resistance, gluconeogenesis); calcineurin inhibitors (decrease insulin synthesis, release, sensitivity; islet cell toxicity) |
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|
Term
|
Definition
| sulfonylureas- glipizide preferred (short acting, reduced risk of hypoglycemia) |
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|
Term
| watch for renal function (kidney txt pts)-- lactic acidosis |
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Definition
|
|
Term
|
Definition
| HMG CoA Reductase Inhibitors; Ezetimibe; bile acid sequestrants, gemfibrozil, niacin |
|
|
Term
| HMG CoA Reductase Inhibitor: least drug interactions |
|
Definition
|
|
Term
| Shown to lower TC< LDL, and TG in renal transplant patients; Increased levels when taken w/ CNI |
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Definition
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|
Term
| only used if TG < 400 mg/dL; interferes w/ enterohepatic cycling of mycophenolate and absorption of CIs |
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Definition
|
|
Term
| Pre-existing renal osteodystrophy; tertiary hyperparathyroidism; electrolyte abnormalities; drug induced |
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Definition
|
|
Term
| Drug induced osteoporosis |
|
Definition
| corticosteroids (decreased absorption of Ca and phosphate, increased urinary excretion of Ca, inhibiton of osteoblasts; calcineurin inhibitors- high turnover osteopathy |
|
|
Term
|
Definition
| DEXA (Basline, 1-2 years post transplant); Labs: electrolytes, PTH |
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|
Term
| common in chronic kidney disease: ~28% kidney transplant recipients |
|
Definition
|
|
Term
|
Definition
| obesity/weight gain; HTN; diuretics; cyclosporine (may impair excretion of uric acid) |
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|
Term
|
Definition
| NSAIDs- avoided due to potential to reduce kidney function; Colchicine- use cautiously (renal fxn), Corticosteroids; Allopurinol |
|
|
Term
| Risk is greatest in first 6 months and after treating an episode of acute rejections |
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Definition
|
|
Term
| most common within the first month post-transplant |
|
Definition
| bacterial infections (pneumonias, wound/surgical site, UTI, catheters) |
|
|
Term
| Bacterial infections prophylaxis |
|
Definition
| septra SS 1 tab daily x 6 months, alternative for sulfa allergy --> ciprofloxacin |
|
|
Term
| most common within 2-6 months after transplant |
|
Definition
|
|
Term
| most important virus in transplant population- chronic rejection, allograph vasculopathy |
|
Definition
|
|
Term
|
Definition
| valcye 450-900 mg daily x 6 months; Acyclovir 800 mg BID x 6 months (only in lowest risk) |
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|
Term
|
Definition
| high dose Valganciclovir, 900 BID; IV ganciclovir; Cytomegalovirus IV Immune GLobulin (Cytogam) |
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|
Term
|
Definition
|
|
Term
| Major cause of transplant dysfunction and graft loss; decrease immunosuppression; Leflunomide, cidofovir, IVIF, quinolones |
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Definition
|
|
Term
| 60-80% seropositivity in adults in the US; Progressive Multifocal Leukoencephalopathy-- demyelinating neurologic illness |
|
Definition
|
|
Term
| post transplant lymphoprolierative disease (PTLD) |
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Definition
|
|
Term
| typically due to reactivation of latent virus; treatment : localized: oral acyclovir, valacyclovir; systemic: IV acyclovir, transition to oral |
|
Definition
| Herpes Simplex, Herpes Zoster |
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Term
|
Definition
| oral thrush; Pneumocystis Jiroveci Pneumonia (PCP) |
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|
Term
|
Definition
| after induction therapy; porphylaxis: Clotrimazole troche after meals and before bedtime x 1-3 months, DDI: Azole antifungals inhibit CYP3A4 |
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|
Term
| Pneumocystis Jiroveci Pneumonia (PCP) |
|
Definition
| occurs within 2-6 months of transplant; Prophylaxis: TMP/SMX SS daily x 6 months |
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|
Term
| Vaccines and Immunizations |
|
Definition
| important for pts and household contacts to stay up to date with routine immunizations; NO live vaccines after transplant |
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|
Term
|
Definition
| squamous cell carcinoma, basal cell carcinoma, Kaposi's sarcoma |
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|
Term
| post transplant lymphoproliferative disease (PTLD) |
|
Definition
| reduce immunosuppression, Rituxan, chemo |
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|
Term
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
| azole antifungals; macroldies; diltiazam/verapamil, metronidazole, amiodarone, grapefruit juice |
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|
Term
|
Definition
| phenytoin, carbamazepine, valproic acid, rifampin, st. john's wort, antacids, cholestyramine, orlistat |
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