0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

TRANSPLANT REJECTION

Immunosuppressants for transplant recipients:

■ Cyclosporine(Sandimmune, Neoral): Acute toxicity causes reversible
vasoconstriction and renal ischemia. Ca channel blockers and antibiotics
(doxycylcine, erythromycin) can increase cyclosporine levels.
■ Mycophenolate(Cellcept): Side effects include diarrhea, N/V, leukopenia.
■ Tacrolimus (Prograf): Side effects include nephrotoxicity, seizures,
neuropathy.
■ Corticosteroids

TABLE 9.17. Medium Vessel Vasculitis

SYNDROME SIGNS/SYMPTOMS DIAGNOSIS TREATMENT

Polyartertis nodosa Skin ulcers Biopsy (skin, kidney) Prednisone

Nephritis Mesenteric angiogram Cyclophosphamide

Mesenteric ischemia HBV/HCV testing

Wegener Sinusitis c-ANCA Prednisone

granulomatosis Pulmonary infiltrates Lung biopsy Cyclophosphamide

Nephritis

Behçet disease Recurrent painful Biopsy of affected Prednisone

oral and genital tissue

ulcers

Uveitis, iritis, or Immunosuppressants

optic neuritis

Microscopic Pulmonary infiltrates p-ANCA Cyclophosphamide

polyangitis Nephritis Renal biopsy

TABLE 9.18. Small Vessel Vasculitis

SYNDROME SIGNS/SYMPTOMS DIAGNOSIS TREATMENT

Hypersensitivity Palpable purpura Skin biopsy Prednisone

vasculitis

Henoch-Schonlein Palpable purpura Skin biopsy Supportive

purpura (buttocks, lower

extremities)

Abdominal pain, Rectal biopsy Prednisone

N/V/D

Hematuria

Goodpasture’s Cough and dyspnea Renal or lung biopsy Supportive

syndrome Hemoptysis showing basement Prednisone

Glomerulonephritis membrane Cyclophosphamide

antibodies Plasmapheresis

A transplant patient’s failure

to take immunosuppressant

medications should be

considered an emergency.