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Dr. Samra interviews Dr. Lichvar, a Transplant Pharmacist at the University of Irvine, California. She shares excellent analogies as they review Immunosuppression. She describes the body as a garden we need to get ready before we implant the organ. There is induction immunosuppression which is given at the time of transplant this is usually thymoglobulin or Basiliximab.
Then there is Maintenance immunosuppresion. Which is usually a a two drug or three drug regimen which consists of a calcineurin inhibitor usually Tacrolimus or Cyclosporine, a growth inhibitor such a mycophenolate and with or without prednisone are the most common.
Personalization of IMS involves looking at Recipient risk, Immunologic risk, Donor Risk and what is the integration of of other tools in follow up.
Pharmacogenomics - pharmacogenetics testing to review CYP polymorphisms. Tells us about CYP3A5 metabolism especially for Tacrolimus.
HOPE trial - No longer an active trial. Access to transplant patients for HIV positive patients.
BENEFIT trial -Showed better graft survival. Belatacept is a replacement for calcineurin inhibitors mostly Tacrolimus because of its side effects like, high serum creatinine, electrolyte abnormalities, increased risk of Diabetes and hypertension.
BEST trial- Better kidney function and also found higher risk of rejection.
How Belatcept can be used de novo at the time of transplant or later on, Belatacept conversion which is given an infusion every 4-6 weeks. They stay on prednisone because of the elevated rejection risk. Some will convert to Belatacept.
DCD- Donation oafter circulatory death - not brain dead
DBD- Brain dead donor
KDPI is the kidney donor profile index- gives us an idea of the longevity of a kidney. Age,height, weight, diabetes, HTN, DCD, serum creatinine. Its a score from 0-100.
> 85% KDPI donors require a special consent.
In the future, we look forward to advancements in imuunosuppresion, we might have new tools. We really need to focus on policy that affects medication access. As well as AI assisted customization and Xenograft.
Please note this is not medical advice. It is meant for entertainment purposes only.
