CCTN PT III Transplant Study Material
Verified 100% Correct
induction therapy categories
high dose corticosteroids
antibodies directed at T-cell antigens: non-lymphocyte depleting and lymphocyte depleting
methylprednisolone for induction
250-1000mg, start high at transplant then taper
ALL transplants get this for induction
non-lymphocyte depleting agent for induction
basiliximab
basiliximab - Simulect
induce T-cell dysfunction by binding IL-2 receptors on T-lymphocytes
NO lysis or apoptosis of lymphocytes - prevents proliferation
duration 4-6W
well tolerated
good for low immune risk
lymphocyte depleting agents for induction
antithymocyte globulin, rabbit - rATG -
Thymoglobulin antithymocyte globulin, equine -
Atgam alemtuzumab - Campath
antithymocyte globulin, rabbit - rATG - Thymoglobulin
,cytotoxic antibodies against antigens on T lymphocytes, T cell depletion due to complement
lysis/apoptosis with T cell activation, also interferes with B-cells, NKC, and dendritic cells
duration approximately 3-12M
premedicate - APAP, Benadryl, methylpred 30-60min prior
rATG - Thymoglobulin SE
infusion related - anaphylaxis, cytokine release storm
bone marrow suppression - leukopenia,
thrombocytopenia cardiac - tachy, hypo/hypertension
respiratory - tachypnea, dyspnea
INFECTION
myalgia/arthralgia - serum sickness
rATG - Thymoglobulin monitoring
CBC, BP, HR, pulse Ox, temp
cytokine release storm
release of cytokines by activated monocytes and
lymphocytes while medication is infusing
mild systemic symptoms - catastrophic systemic inflammatory response s/s - fever, chills, N,
joint pain, confusion, delirium, headache, hypotension, tachycardia, chest pain, pulmonary
edema, cardiac dysfunction
slow infusion, repeat APAP, Benadryl, glucocorticoid, may have to stop infusion
serum sickness
type III immune-mediated hypersensitivity reaction, antigen-antibody complexes form and
deposit in patient tissue/joints
7-10 days after admin
s/s - fever, rash, polyarthralgias, polyarthritis
STOP med, APAP and antihistamine, possibly steroids ± plasmapheresis
, antithymocyte globulin, equine - Atgam
not used much anymore
high allergy - prick test prior
Alemtuzumab - Campath
monoclonal antibody directed against the cell surface glycoprotein CD52 on both T and
B lymphocytes
duration - B cells return to normal within 3-12M, T cells remain depressed as long as 3Y
obtained directly from mfg
premedicate - APAP, Benadryl, methylpred 30-60min prior
IV or SQ one time dose, SQ better tolerated
alemtuzumab SE
infusion related - anaphylaxis, cytokine release storm
bone marrow suppression
infection
high risk recipient factors
organ: intestine/lung > kidney/pancreas/heart > liver
younger
African-American
higher preformed antibodies - PRA
donor specific antibodies
delayed graft function
high risk donor factors
older donor age
donation after cardiac death
greater number of HLA mismatches
cold ischemic time >24H for kidneys
Verified 100% Correct
induction therapy categories
high dose corticosteroids
antibodies directed at T-cell antigens: non-lymphocyte depleting and lymphocyte depleting
methylprednisolone for induction
250-1000mg, start high at transplant then taper
ALL transplants get this for induction
non-lymphocyte depleting agent for induction
basiliximab
basiliximab - Simulect
induce T-cell dysfunction by binding IL-2 receptors on T-lymphocytes
NO lysis or apoptosis of lymphocytes - prevents proliferation
duration 4-6W
well tolerated
good for low immune risk
lymphocyte depleting agents for induction
antithymocyte globulin, rabbit - rATG -
Thymoglobulin antithymocyte globulin, equine -
Atgam alemtuzumab - Campath
antithymocyte globulin, rabbit - rATG - Thymoglobulin
,cytotoxic antibodies against antigens on T lymphocytes, T cell depletion due to complement
lysis/apoptosis with T cell activation, also interferes with B-cells, NKC, and dendritic cells
duration approximately 3-12M
premedicate - APAP, Benadryl, methylpred 30-60min prior
rATG - Thymoglobulin SE
infusion related - anaphylaxis, cytokine release storm
bone marrow suppression - leukopenia,
thrombocytopenia cardiac - tachy, hypo/hypertension
respiratory - tachypnea, dyspnea
INFECTION
myalgia/arthralgia - serum sickness
rATG - Thymoglobulin monitoring
CBC, BP, HR, pulse Ox, temp
cytokine release storm
release of cytokines by activated monocytes and
lymphocytes while medication is infusing
mild systemic symptoms - catastrophic systemic inflammatory response s/s - fever, chills, N,
joint pain, confusion, delirium, headache, hypotension, tachycardia, chest pain, pulmonary
edema, cardiac dysfunction
slow infusion, repeat APAP, Benadryl, glucocorticoid, may have to stop infusion
serum sickness
type III immune-mediated hypersensitivity reaction, antigen-antibody complexes form and
deposit in patient tissue/joints
7-10 days after admin
s/s - fever, rash, polyarthralgias, polyarthritis
STOP med, APAP and antihistamine, possibly steroids ± plasmapheresis
, antithymocyte globulin, equine - Atgam
not used much anymore
high allergy - prick test prior
Alemtuzumab - Campath
monoclonal antibody directed against the cell surface glycoprotein CD52 on both T and
B lymphocytes
duration - B cells return to normal within 3-12M, T cells remain depressed as long as 3Y
obtained directly from mfg
premedicate - APAP, Benadryl, methylpred 30-60min prior
IV or SQ one time dose, SQ better tolerated
alemtuzumab SE
infusion related - anaphylaxis, cytokine release storm
bone marrow suppression
infection
high risk recipient factors
organ: intestine/lung > kidney/pancreas/heart > liver
younger
African-American
higher preformed antibodies - PRA
donor specific antibodies
delayed graft function
high risk donor factors
older donor age
donation after cardiac death
greater number of HLA mismatches
cold ischemic time >24H for kidneys
