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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
A kidney from a living or deceased donor can be transplanted into the pelvis of the recipient by attaching the kidney's blood vessels to the iliac vessels and implanting the ureter in the bladder. To reduce the chances of rejection of the kidney, the donor and the recipient are matched whenever possible for their blood group and HLA types and the recipient is given immunosuppressive drugs. The drugs commonly include steroids, tacrolimus or ciclosporin and mycophenolate or azathioprine. Biological therapies such as the monoclonal antibody basiliximab are also used. If transplant rejection occurs, immunosuppression is increased.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Basiliximab is a chimeric human/mouse monoclonal antibody against the α chain of the IL-2 receptor CD25. It was demonstrated to reduce acute rejection in adult renal transplanted patients under dual or triple immunotherapy, without increasing the incidence of adverse events (including infection and malignancy) [42]. Although involving a limited number of children, immunoprophylaxis with basiliximab given intravenously at day 0 (pre-operatively) and 4, associated with dual therapy, reduced acute rejection in the first six months and maintained graft survival and function [43–44]. Adverse drug reactions were similar in baxiliximab and placebo treated adult renal transplant recipients receiving immunosuppressants. Tolerability data are however limited in paediatric patients. Anaphylactic shock is a very rare event, reported after a second course of basiliximaab [45].
Liver transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Caroline Lemoine, Riccardo A. Superina
A detailed discussion of immunomodulatory regimens is beyond the scope of this chapter, but the overall strategy remains fairly simple: Minimizing adverse effects of immune suppressants, namely bacterial, viral, or fungal infection and malignancy while optimizing graft survival by preventing rejection. There is no universally accepted standard regimen immunomodulation following pediatric LT. At the authors’ center, a single preoperative dose of 10 mg/kg of methylprednisolone is administered. About 12 hours postoperatively, both mycophenolate (10 mg/kg/dose) and tacrolimus (0.1 mg/kg/dose) are given twice daily with a tacrolimus level desired range of 10–12 ng/mL. Methylprednisolone is tapered over the following month from 2.0–0.3 mg/kg per day and converted to an oral equivalent after return of bowel function. Mycophenolate is started immediately after surgery in order to reduce dependence on calcineurin inhibitors. Rapamycin can be added later. Anti-interleukin-2 receptor monoclonal antibodies, such as basiliximab, are sometimes used. Steroid-sparing regimens are becoming increasingly popular, but are not appropriate for patients with a history of autoimmune hepatitis.
Role of thrombocytopenia in risk stratification for acute kidney injury after living donor liver transplantation
Published in Platelets, 2021
Jaesik Park, Jangsu Jeong, Ho Joong Choi, Jung-Woo Shim, Hyung Mook Lee, Sang Hyun Hong, Chul Soo Park, Jong Ho Choi, Min Suk Chae
The surgical technique and anesthetic care protocol for LDLT were previously described in detail [14,15]. Briefly, the piggyback surgical technique was performed on the right lobe with reconstruction of the middle hepatic vein. After anastomosis of the portal vein, hepatic artery, and biliary duct, hepatic circulation was assessed using Doppler ultrasonography. Anesthetics and hemodynamic management were applied and blood products were transfused according to laboratory guidelines or thromboelastography results. A triple immunosuppressive regimen (i.e., a calcineurin inhibitor, mycophenolate mofetil, and prednisolone) was administered according to the LDLT protocol of our hospital. Basiliximab was administered before surgery and on postoperative day (POD) 4. These immunosuppressive drugs were progressively tapered after surgery.
Risk factors and outcomes of prolonged recovery from delayed graft function after deceased kidney transplantation
Published in Renal Failure, 2020
Huanxi Zhang, Qian Fu, Jinqi Liu, Jun Li, Ronghai Deng, Chenglin Wu, Weijian Nie, Xutao Chen, Longshan Liu, Changxi Wang
For immunosuppression induction, patients received either anti-thymocyte globulin (ATG) or basiliximab. ATG was given at a dose of 50 mg during the transplant operation, and then daily for the next 2 days. For basiliximab, 20 mg was given on the day of surgery, and then again on postoperative day 4. For maintenance immunosuppression, patients received either tacrolimus (TAC) or cyclosporine (CsA). The starting dose of TAC was 0.15 mg/kg/d, and that of CsA was 5 mg/kg/d. Dosages were adjusted based on therapeutic drug monitoring results. Before the serum creatinine level started to decline, the target trough level of TAC was 4–6 ng/ml, and the target trough level of CsA was 100–150 ng/ml. As allograft function gradually recovered, the trough levels of TAC and CsA were adjusted based on our routine protocol. The target trough level of TAC was 6-8 ng/ml during weeks 1–4, and 5–7 ng/ml thereafter. The target trough level of CsA was 150–200 ng/ml during weeks 1–4, 120–180 ng/ml during month 1–3, and 100–150 ng/ml thereafter.
Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date
Published in Expert Opinion on Pharmacotherapy, 2022
Goce Spasovski, Lada Trajceska, Irena Rambabova-Bushljetik
Acute rejections most frequently occur in the first post-transplant year and strongly affect the long-term renal graft survival [16]. Thus, a need for more selective induction therapy including interleukin 2 receptor antagonists (IL-2RA), basiliximab, and daclizumab was considered. Basiliximab is a monoclonal antibody specifically binding the α-subunit of the IL-2R known as CD25 surface antigen that interrupts the critical pathway of the allograft rejection through inhibition of IL-2-mediated lymphocyte activation. Basiliximab delivers a safer and expectable therapeutic action compared with polyclonal antibodies as well-tolerated drug, with minimal side effects [17]. The IL-2R inhibition lasts for 4 weeks when administered intravenously 2 times 20 mg (days 0 and 4) [18].