Transplant

• Allograft (allergenic transplant/homograft): Transplant of an organ from one individual to another of the same species with a different genotype
• Autograft (autologous transplant): Transplant of tissue from one site to another on the same patient
• Chronic immunosuppression may lead to neoplasia (esp. lymphoma)

Immunosuppressant

Monoclonal Antibodies

• Reverse rejection by binding to antigens of T-lymphocytes (killer cell) and interfering w/ their function
• General BBW: anaphylaxis
• Antithymocyte glubulin (ATG, Atgam)
  • SE: anaphylaxis (skin testing recommended), fever, chills
  • Monitor: T- lymphocyte , CBC, PLT, vital signs
• Muromonab-CD3 (Orthoclone OKT3)
  • CI: SZ, HF, uncontrolled HTN, fluid overload, pregnancy
  • May need to pre-medicate

 

Interleukin 2 (IL-2) receptor antagonist

• Drugs: Daclizumab (Zenapax), basiliximab (Simulect)
• MOA: Chimeric(murine/human) monoclonal antibody that inhibit IL-2 receptor on surface of activated T-lymphocytes preventing cell-mediated allograft rejection
• BBW: only use by immunosuppressive experienced Dr.

 

Antiproliferative

• Inhibits T-lymphocyte proliferation by altering purine synthesis, increases risk of malignancy in humans
• Mycophenolate (CellCept, Myfortic, Mofetil)
  • BBW: increase risk of infection, lymphoma, skin malignancy
  • SE: diarrhea/vomiting, leukopenia, sepsis
  • CellCept and Myfortic are not interchangeable due to difference in absorption
  • Take on empty stomach to avoid diff in absorption
  • Can decrease level of OC. Its level can be decreased by antacid, cyclosporin, metronidazole, PPI, quinolones, sevelamer, bile acid resins, rifamycin
• AZA - azathioprine (Azasan, Imuran)
  • BBW: immunosuppression, increase risk of neoplasia and infection
  • SE: myelosuppression, hepatotoxicity
  • Allopurinol, ASA, ACEI, bactrim may increase its level

 

Calcineurin antagonist

• Drugs: Tacrolimus (Prograf), Cyclosporin (Neoral, Gengraf,Sandimmune)
• MOA: Suppress cellular immunity by inhibiting T-lymph activation
• SE: tremor, nephropathy, HTN
• BBW: increase risk of infection
• Tacrolimus (Prograf): Take on empty stomach, hyperglycemia, hyper/hypo-K, 3A4 substrate
• Cyclosporin: Modified Gengraf/Neoral has better bioavailability than non-modified Sandimmune and are not interchangeable.

• SE: gingival hyperplasia,  hirsutism
• 3A4 substrate and inhibitor

 

mTOR kinase inhibitor - mammalian target of rapamycin

• MOA: Inhibit T-cell activation and proliferation
• Drug: Sirolimus (Rapamune, Rapamycin)
• SE: hyperlipidemia, TCP, anemia, HTN
• BBW: increased risk of infection, lymphoma, not recommended in lung/ liver transplant

Corticosteroid

• For example: prednisone if taking long term, can suppress immune system.

 

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