Immunosuppression

Tacolimus/Cyclosporin, Mycophenolate mofetil (MMF), Prednisolone is standard IS protocol

Highly sensitized recipients→ Can Use FK and/or induction agents
Multiparous
Multiple blood transfusion
Prev Transplant
PRA>20%

Steroids
• Hydrocort 200mg IV stat on OT call then 100mg TDS post op
• IV methylprednisolone 500mg at anastomosis
• Replace with Prednisolone 20mg when taking orally
• Taper Prednisolone at 3 months post transplant
o 2.5mg per month till 10mg

Cyclosporin
• LRRT: Neoral 8mg/kg/d 5 days before transplant
• Cad RT: Neoral 10mg/kg/d pre transplant
• C0: <6 mths→250-374ng/ml, 6 mths or more→100-250ng/ml
• C2:<1 month→ 1.7ug/ml, 1-2mth→ 1.5ug/ml, 2-3mth→ 1.3ug/ml, 4-6 mth→1.1ug/ml, 7-12mth→0.9ug/ml, 12mths or more→0.8ug/ml

Tacrolimus
• LRRT: 0.2mg/kg/d in 2 divided doses 5 days before transplant
• Cad RT: 0.3mg/kg/d given when called to OT
• FK level: <6mths→10-15ng/ml, 6 mths or more→5-10ng/ml

MMF
• 1g when OT calls
• Post transplant 1g BD (500mg BD if FK is used)
• Reduce dose if WBC <4

Azathioprine
• 1.5mg/kg/d
• omit in :-
o HepBsAg +ve patients
o Hep C +ve patients
o Post Transplant CAH
o Recipients with Chronic hepatitis and worsening transaminase

Basiliximab
• 20mg on call to OT and D4 post transplant