Transplant
Disclaimer: the clinical information on this site is only meant to serve as a reference. Please consult with your team for individual diagnostic and treatment decisions.
- For transplant pyelonephritis, reminder that the transplanted kidney is placed in the lower anterior abdomen so the patient may not have CVA tenderness with pyelonephritis and may have lower abdominal pain and may not have dysuria if bladder sensation is affected by the surgery
- For fevers consider CMV viremia and BK virus
- For diarrhea consider CMV colitis (serum level and possibly colonoscopic biopsy)
- For AKI consider transplant rejection or BK virus
- Common transplant medications: tacrolimus aka Prograf (can be replaced by sirolimus aka Rapamycin or cyclosporine aka Gengraf), prednisone, and mycophenolate mofetil aka Cellcept
- Tacrolimus aka Prograf: calcineurin inhibitor, make sure blood level is drawn first and then dose is given, timed to 6am/6pm in EPIC to coincide with blood draws, goal level 4-8 depending on organ transplanted and time since transplant, often still needs immunosuppression if transplant has failed but organ remains within the body, can cause magnesium wasting, squamous cell carcinoma of the skin, AKI, hyperkalemia, posterior reversible encephalopathy syndrome (PRES) presenting as headache and hypertension, and post-transplant lymphoproliferative disorder (type of B-cell lymphoma)
- Prednisone: carries risk of hyperglycemia, osteoporosis, fungal infections including PCP and Aspergillus, adrenal insufficiency
- Mycophenolate mofetil aka Cellcept: side effects (nausea, diarrhea, leukopenia), often the first transplant drug to be held while actively infected or having GI symptoms