Immunosuppressants complications

Long-term allograft and patient survival is limited by chronic rejection, cardiovascular disease, and long-term immunosuppressive complications, such as malignancy. 

Design an appropriate therapeutic regimen for the management of immunosuppressive drug complications based on patient-specific information. 

PTLDs continue to be a long-term complication of prolonged immunosuppression. Current treatment options are all associated with certain risks. Prevention is the most effective treatment for PTLD. A better understanding in the future of the disease process and the risk factors involved with the development of PTLD will aid in the prophylaxis and treatment of this disorder. 

The long-term goals after organ transplantation are to maximize the functionality of the allograft and to prevent complications of immunosuppression, which lead to improved patient survival. 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

The most commonly used dose for fludarabine is 20 mg/m2 intravenously daily for 5 consecutive days, whereas chlorambucil can be taken daily as an oral tablet with the dose ranging from 4 to 10 mg/day.21 Fludarabine is associated with more toxicities than chlorambucil, including myelosuppression and prolonged immunosuppression.19 Resulting infectious complications may occur during the periods of prolonged immunosuppression. The ease of administration and limited side effects make chlorambucil a practical option for symptomatic elderly patients who require palliative therapy... 

Campath) hypotension prolonged immunosuppression (resulting in infectious complications) during treatment. Premedicate with acetaminophen, diphenhydramine, with or without a steroid to alleviate infusion-related reactions. Subcutaneous dosing may lessen acute toxicity. Initially 3 mg/day as a 2-hour infusion, increase to 1 0 mg/day, then 30 mg/day as tolerated. 

Fludarabine (Fludara) Myelosuppression prolonged immunosuppression resulting in secondary infectious complications edema neurotoxicity Dose 20 mg/m2 IV daily for S days. 

Signs and Symptoms Fever, anorexia, depression, and discharge from the eyes and nose. Pinpoint necrotic lesions appear on the inside of the mouth that rapidly form a cheesy plaque. Further symptoms include severe abdominal pain, thirst, difficulty breathing (dyspnea), and watery diarrhea containing blood, mucus, and mucous membranes. Recovery is prolonged and may be complicated by concurrent infections due to immunosuppression. 

Antibodies have and likely will find additional use in transplantation-related medicine. In general, cell-mediated immunological mechanisms are responsible for mediating rejection of transplanted organs. In many instances, transplant patients must be maintained on immunosuppressive drugs (e.g. some steroids and, often, the fungal metabolite cyclosporine). However, complications may arise if a rejection episode is encountered that proves unresponsive to standard immunosuppressive therapy. Orthoclone OKT-3 was the first monoclonal antibody-based product to find application in this regard. 

In patients infected with HIV, many nonspecific and certain specific cellular immune functions can be shown to be altered or decreased, and a number of seemingly healthy individuals may exhibit marked immunological abnormalities without evidence of clinical illness. As the individual begins to exhibit clinical symptoms associated with AIDS, the abnormalities in the immune system become more extreme. A factor that complicates the study of HIV-induced immunosuppression is that many of the infections patients develop may themselves induce marked changes in the immune system. For this reason, it has been difficult to dissociate the fundamental changes associated with prolonged HIV infection from epiphenomena caused by other infections. One basic defect in the immune system of HIV-infected patients has, however, been elucidated. This is the loss of function and ultimate destruction of a proportion of T lymphocytes. 

Immunosuppression During therapy, do not use live virus vaccines (eg, smallpox). Do not immunize patients who are receiving corticosteroids, especially high doses, because of possible hazards of neurological complications and a lack of antibody response. This does not apply to patients receiving corticosteroids as replacement therapy. 

Carcinogenesis An increased incidence of malignancy is a recognized complication of immunosuppression in recipients of organ transplants. 

Infections Muromonab-CD3 is usually added to immunosuppressive therapeutic regimens, thereby augmenting the degree of immunosuppression. This increase in the total burden of immunosuppression may alter the spectrum of infections observed and increase the risk, the severity and the potential gravity (morbidity) of infectious complications. 

Treatments are broadly the same as for ulcerative colitis being based on appropriate supportive measures, and the use of corticosteroids, the cytokine infliximab or adalimumab for severe and complicated disease and immunosuppressants, typically azathio-prine, for reducing the chances of relapse. Full thickness disease leading to flstulation, free perforation, abscess formation and stricturing usually requires surgery. Aminosalicylates appear ineffective in reducing the chances of relapse. 

E) Eosinophilia this rare complication of ibuprofen therapy is exacerbated by the immunosuppression frequently seen in alcoholics... 

The third edition of the guide, now entitled Transplantation Drug Manual, includes information on agents approved for use in transplant recipients. As in the first and second editions, we compiled practical information on the wide array of pharmaceutical agents currently available—both those used for immunosuppression and those used to minimize posttransplant complications. The agents described here are the most frequently prescribed drugs in the Transplant Service at the University of Wisconsin. We hope you find this information to be useful and practical in managing the transplant patient. 

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