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Solid organ transplants - Coggle Diagram
Solid organ transplants
Types of rejections
Hyperacute
Actute
Cellular
With Kidney
Scr>30%
biopsy
with heart
do biopsy
Humoral
Chronic
Kidney
Most common
graft loss
Chronic allograft
nephropathy
Heart
Most common cause
graft failure
Cardiac allograft vasculopathy
Monitoring
Routine ultrasound
Prevention
Statins
Glycemic control
Types of immunosuppression
Kidney
Induction
IV Methylprednisone
AND...
High risk
Thymoglobulin
(rATG)
Pre-midicate with
diphenhydramine
acetaminophen
history of previous transplant
blood group incompatability
african decent
delayed graft function
1< HLA mismatches
1%< PRA
Low risk
IL-2RA
Alemtuzumab
Basiliximab
Then
Maintenance
Monitor for rejection
Treatment
of acute rejection
Cellular mediated rejection
Scr>25% from baseline
worseing HTN
proteinurea > 1g/d
dd-cfDNA >1%
Confirmed with biopsy
Inc. tac levels
Methylprednisone
500mg x 3days
Biopsy grade
1
Prednisone
2 or 3
rATG
1 more item...
Antibody mediated
rejection
on Biopsy
CD4 staining
DSA
Plasmaphoresis
or
IVIG
Must get
antimicrobial
antiviral therapy
x 3 months
If
BUN/SCr ⬆️
Then
biopsy
or
empiric
treatment
Normal labs?
Yes
Normal monitoring again
No
Biopsy
1 more item...
+/-
Prednisone
CNIs
Tacrolimus
Dosing
0.1-0.2 mg/kg/day
Prograph
BID
Envarsus
(.7-.8 of
prograph dose)
Neurotox
hyperkal
alopecia
Sub from tac ade’s
Cyclosporine
Dosing
10-14 mg/kg/day
Lowers MMF
levels
Either
Sirolimus
Avoid in liver transplant
Mycophenolate
motetil (MMF)
Pregnancy
Azathioprine
Dosing
180mg myfortic(ER)= 250mg cellcept(IR)
Heart
Induction
Maintenance
Monitor
For rejection
Treatment of
acute rejection
Biopsy
Rejection?
No
Normal monitoring again
CNIs
Tacrolimus
Cyclosporine
Either
Sirolimus
Mycophenolate
motetil (MMF)
Pregnancy
Azathioprine
+/-
Prednisone
IV Methylprednisone
AND...
Thymoglobulin
(rATG)
IL-2RA
Basiliximab
Alemtuzumab
Long term complications
ASVCD
81mg aspirin
Dyslipidemia
Statin
HTN
CCB
preferred
acei
Uv/exposure
Infection risk
CMV
Donor -
recipient -
Acyclovir
D +/R -
or
R +
Ganciclovir
Valaciclovir
BK virus
EBV
donor +
Acyclovir
Hep B,C
Flu
PCP
Trimethoprim/
sulfamethoxazole
Sulfa allergy
dapsone