ICU · Transplant / pharmacology

Post-Transplant Immunosuppression Complications — Toxicity, PTLD & Metabolic

Also known as Post-transplant immunosuppression complications · Calcineurin inhibitor toxicity · Tacrolimus nephrotoxicity · PRES · Posterior reversible encephalopathy · PTLD · Post-transplant lymphoproliferative disorder · Steroid diabetes · EBV lymphoma · Induction therapy · Basiliximab · Antithymocyte globulin · Mycophenolate · Sirolimus · Therapeutic drug monitoring

Post-transplant immunosuppression complications: the immunosuppression principles (induction — ATG/basiliximab/alemtuzumab; maintenance — tacrolimus + mycophenolate ± steroids; rescue for rejection), the drug pharmacology (the tacrolimus — the nephrotoxicity, the neurotoxicity [PRES], the diabetes; the ciclosporin — the nephrotoxicity, the hypertension, the gingival hyperplasia; the mycophenolate — the leucopenia; the azathioprine — the TPMT; the sirolimus — the wound healing, the pneumonitis; the steroids), the calcineurin inhibitor toxicity, the infection (the opportunistic — the CMV, the PCP, the EBV/PTLD), the metabolic (the steroid), the malignancy (the PTLD — the EBV-driven; the skin cancer — the SCC), the TDM (tacrolimus trough levels), and the CYP3A4 drug interactions. The management: the balance the immunosuppression (the rejection vs the toxicity), the reduce/switch the agent, the monitor the levels.