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Oncology / Organ Transplant > Post Transplant Complications > Flashcards

Post Transplant Complications Flashcards

1
Q

Preemptive

A 
Least favorable method
Do nothing until trigger
CMV (PCR over 600)
Aspergillus
BK (polyoma virus)
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2
Q

Indicators for High Risk of Post-Transplant Infection

A 
Depleting Immunosuppressants
High pulse dose steroids
Plasmapheresis
Early Rejection
Graft dysfxn
Surgical complications
Prolonged use of medical devices
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3
Q

Indicators for Low Risk of Post-Transplant Infection

A 
Good HLA match
Good surgery
Good graft function
Good surgical prophylaxis
Effective transplant prophylaxis
Appropriate pretransplant vax
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4
Q

Common viral infxns post-transplant

A 
HSV
CMV
EBV
VZV
Polyoma Virus (BK,JC, SV40)
Flu A/B
Adenovirus
Parvovirus
WNV
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5
Q

Common bacterial/fungal infxns post-transplant

A 
Nocardia
MycoTB
NonTB Myco
Candida
Aspergillis
Crypto
PCP
Reactivation Mycosis (histo)
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6
Q

Causes of high risk for immunosuppression

A

tx of rejection
depleters
3 inducers vs 2
prev tx chemo, broad abx, etc.

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7
Q

Common pathogens in hospital for post-transplant pt

A

MRSA
VRE
Candida
C.diff

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8
Q

Common pathogens 1-6 mo w/o prophylaxis

A 
Pneumo
HSV
VZV
CMV
EBV
HBV
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9
Q

Px for bacterial infxns post transplant

A

SMX/TMP SS daily x 1 yr

  • **DAILY for KIDNEY
  • **MWF for Liver
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10
Q

Px for fungal infxns post transplant

A

Clotrimazole/Nystatin TID x 10 days

x3 months for liver

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11
Q

Px for bacterial infxns with sulfa allergy post transplant

A

atovaquone
dapsone
pentamidine
-ALL 1 YEAR (same as bacterium SS)

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12
Q

High risk pt for CMV will chart

A

(+/-)

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13
Q

Intermediate risk pt for CMV will chart

A

(+/+) or

+/-

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14
Q

Px for CMV (+/-)

A

Valgancyclovir 900 daily x 6 MONTHS

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15
Q

Px for CMV (+/+) or (-/+)

A

Valgancyclovir 900 daily x 3 MONTHS

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16
Q

Px for CMV (-/-)

A

Acyclovir 400 BID x 3 months
If CrCl below 25 use half dose
-200 BID x 3 months

17
Q

Px for CMV with renal impairment

A 
Use Valgancyclovir 450
CrCl 40-60 BID
CrCl 25-40 QD
CrCl 10-24  q48 hours
x3 mo or x6mo for high risk
18
Q

Valgancyclovir also px against

A

HSV 1 and 2
EBV
VZV

19
Q

Drugs causing HTN in post transplant pts

A

CSA, CCS, mTOR

Use TAC instead of CSA

20
Q

When do we use CSA?

A

CSA is pretty much only used when pt is at high risk for NODAT

21
Q

Goal BP post transplant

A

140/90

130/80 DM or proteinuria

22
Q

Drug that causes post transplant dyslipidemia

A

mTORi

23
Q

Drug that causes NODAT

A

TAC

24
Q

Best maint. regimen for post transplant dyslipidemia

A

TAC/MMF/Pred

25
Q

Best maint. regimen for post transplant NODAT

A

CSA/MMF/Pred (rapid taper)

Avoid TAC if 3+ DM RFs

26
Q

DM RFs

A 
3 or more =  high risk (use CSA)
Hep C
40+ yr old
AA/Hispanic
BMI 30+
Family hx
Prior DM hx
27
Q

Target lipid levels for kidney transplant

A

TC below 200
LDL below 100
TG below 150
HDL above 40

28
Q

Tx of post transplant dyslipidemia

A 
Statins (avoid simvistatin if on CSA)
DO NOT EXCEED
Lova 20
Flvau 40
Rosuva 5
Prava titrate slowly
Atorva titrate slowly
29
Q

Dgx criteria for NODAT

A

Fasting Glu above 126

Glu or 2 hr fast Glu above 200

30
Q

Tx of post transplant NODAT

A

Tx like normal DM
Oral GLIPIZIDE
Lantus/insulin
Tapper CCS w/in 1-2 wks

31
Q

Drugs that cause diarrhea

A

MMF

32
Q

Drugs that decrease GFR

A

CNIs
TAC is better on kidneys
CSA constricts the AA of the glomerulus

33
Q

Maint regimen for a 50 y/o AAM with Hep C and a BMI of 31

A

CSA/MMF/Pred (rapid taper)

NO TAC b/c 3+ DM RFs:
Age 40+
BMI 30+
Hep C
AA/Hispanic
Family/personal DM hx
34
Q

Maint regimen for pt with TC over 200, LDL over 100, TG over 150, and HDL below 40

A 
CSA/MMF/Pred
Same maint regimen.
No Simvastatin since taking CSA
Can take up to:
Lova 20, Fluva 40, Rosuva 5, Atorva/Prava titrate slowly

Oncology / Organ Transplant (12 decks)

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