Drugs

When should steroids be withdrawn following kidney transplantation? The long-term use of steroids is associated with numerous adverse effects, including osteoporosis, new-onset diabetes after transplant, poor wound healing, hypertension, obesity, and dyslipidemia. Patients at lower immunologic risk do well with early steroid withdrawal 3 to 21 days post-transplantation. However, the benefits of early steroid withdrawal …

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Are there generic versions of transplant medications? There are generic versions of Tacrolimus, Cyclosporine, and MMF that are commonly used today. If the patient is switched from a brand name to a generic version, the transplant center should be notified so they can follow closely along. Cyclosporine has different brand names, including Sandimmune and Gengraf. …

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What is the purpose of CNI minimization or avoidance strategies? These strategies are meant to avoid the long-term toxicities associated with CNI use—in particular, nephrotoxicity. This must be individualized to the patient and their immune risk for rejection. Various strategies include switching to a lower drug level target for tacrolimus in combination with an mTOR …

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What are the common drug interactions of concern with immunosuppressants? The major drug interactions involve the CNIs (cyclosporine, tacrolimus) and drugs that are metabolized through the cytochrome p450-3A4 system  Classes of Immunosuppressive Drugs Used in Kidney Transplantation A. Glucocorticoids B. Small molecule drugs 1. Immunophilin-binding drugs a a. Calcineurin inhibitors (cyclosporine, tacrolimus) b. Mammalian target of rapamycin inhibitors (sirolimus, everolimus) 2. Inhibitors …

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What is belatacept? A biological agent that blocks the co-stimulation necessary for activation of the T-cell (signal 2), Belatacept is associated with less metabolic side effects and nephrotoxicity compared to CNIs and mTOR inhibitors. Drug levels do not need to be checked, allowing for less lab draws. Another advantage is that once loaded, it is …

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What are mtor inhibitors? mTOR inhibitors block the mTOR and thus prevent cytokine signals from activating the T-cell cycle (signal 3). Two examples of these medications are sirolimus and everolimus. The principal adverse drug reactions include hyperlipidemia, impaired wound healing, and thrombocytopenia. Additionally, mTOR inhibitors have been linked to mouth ulcers and pneumonitis. The half-life …

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What are the anti metabolites used for immunosuppression? Inosine monophosphate dehydrogenase inhibitors (IMPDH inhibitors) inhibit purine synthesis. Two important drugs in this class are MPA and MMF. MPA directly inhibits IMPDH (a key enzyme in purine synthesis), whereas MMF is a prodrug that releases MPA. The principal side effects of these medications are gastrointestinal (nausea, …

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